What Happened This Week In COVID-19 Vaccination

Pace of vaccinations is slowing way down in the U.S., Sanofi, GSK report positive phase 2 results, the behavioral economics behind the vaccine lotteries, and going beyond the current crop of "spikecentric" vaccines.

Pace of vaccination has fallen off sharply

As of Thursday (May 20), 279,397,250 doses of COVID-19 vaccine had been delivered in the U.S. and 126,605,166 people, or roughly 38% of the population, had been fully vaccinated, according to data collected by the CDC. But the agency’s data also shows that the pace of vaccination has fallen way off.The daily number of vaccinations peaked on April 1 at 4,295,348, according to the CDC’s tally. On Monday (May 17), 1,307, 438 doses were administered which is less than one-third of the April 1 peak. There is some lag in reporting so the number for Monday may go up some, but the overall trend is clear.

Vaccinate first, then worry about what you are going to do with other doses in the vial, says CDC

With vaccine supply now often exceeding demand, the CDC issued new COVID-19 vaccine waste guidelines on Tuesday (May 18) that say providers should start using vials even if they don’t have people willing to be vaccinated scheduled or identified.

“Providers should not miss any opportunities to vaccinate every eligible person who presents at a vaccination site, even if it means puncturing a multidose vial to administer vaccine without having enough people available to receive each dose,” say the guidelines. Pfizer vials hold about six doses, the Moderna, about 10 (although Moderna was given the go-ahead recently to start to start distributing 15-dose vials) and the J&J vials, five.

“If you have someone in front of you who needs a vaccine, go ahead and use what you’ve got and try to use it as best you can and as efficiently as you can. But we know that we’re at a point where there will be some wastage that is unavoidable. We’ve got to get people vaccinated now,” Thomas Dobbs, state health officer for Mississippi, told The Wall Street Journal.

FDA warns against antibody tests

The FDA issued a warning on Wednesday (May 19) against using antibody tests to measure immunity or protection from COVID-19, especially for someone who has received a COVID-19 vaccination. “The authorized vaccines for prevention of COVID-19 induce antibodies to specific viral protein targets; post-vaccination antibody test results will be negative in individuals without a history of previous natural infection if the test used does not detect the type of antibodies induced by the vaccine,” read the warning.

CDC continues to take heat for its unmasking guidance

Many people celebrated, but CDC continues to take heat for announcing last Thursday (May 13) that it was advising that fully vaccinated people no longer needed to wear masks in many circumstances. “It’s a Public Health 101 failure,” David Michaels, an epidemiologist who led Occupational Safety and Health Administration during the Obama administration, was quoted as saying in a Politico story posted early on Wednesday (May 19). Although the CDC is hoping the maskless vaccinees will encourage the unvaccinated to get the jab, Michaels is among those who see CDC as muddying the masking waters. “By giving advice to vaccinated people but ignoring the fact that many or most people in many settings will not be vaccinated, the CDC is causing confusion and setting back our efforts to stop this pandemic,” he told Politico.

Sanofi, GSK report positive results for the vaccine they are developing together

Sanofi and GlaxoSmithKline issued a press release on Monday (May 17) to announced positive interim results from a phase 2 of the vaccine they’re jointly developed. A phase 3 trial is expected to start in the next few weeks, the companies said. Although a full year behind the RNA vaccines developed by Pfizer and Moderna, the Sanofi-GSK vaccine might have some advantages because is made using the same system that Sanofi uses to make a flu vaccine and can be stored a fridge rather than freezer temperatures

The positive results reported by the two companies were not direct protection against infection but, rather, a rise in antibody levels in response to the virus (seroconversion). The results, according to the press release, showed 95% to 100% seroconversion following a second injection in all age groups (18 to 95 years old) among the 722 volunteer in the trial, across all dose “with acceptable tolerability and with no safety concerns.” Depending on how it fares in a phase 3 trial, the vaccine might be available at the end of this year.

Why the vaccine lotteries might work

The governors of New York and Maryland announced on Thursday (May 20) that they are following Ohio’s example and dangling the chance of winning lottery jackpot to people who get vaccinated. New York vaccinees will be given a lotto ticket that gives them a chance to win $5 million, and Marylanders who get the jab will have the incentive of a chance of a daily prize of $40,000.

Kevin Volpp, an behavioral economics as it applies to healthcare, explained some of the psychology of lotteries as behavior changers in the Washington Post on Monday (May 17). Although the chances of winning are vanishingly small, lotteries tap into “anticipated regret,” Volpp explained: People want to avoid the fomo when winners are announced.

Related: Using Behavioral Economics to Influence Healthcare Decisions

One downside of the vaccine lotteries might be some messaging that vaccination is undesirable because people apparently need a chance at a monetary reward to get the shots.

Reasons the vaccination debacle in India

Jon Cohen, the top COVID-19 journalist for Science, reports from India that although India has success with mass vaccination in the past, those campaigns have focused on children.

“Adults, even the wealthiest, do not routinely get immunized against influenza, shingles, pneumococcal disease, or anything else,” Cohen wrote in a story posted on Wednesday with a Mumbai, Vellore and New Delhi dateline. False and bad information on social media has also been a factor, according to Cohen’s reporting. 

India experienced very few COVID-19 cases in the early months of the pandemic, and many have criticized the government for letting its guard down and not ramping up vaccination out of false sense of confidence that the country had kept the disease at bay.

Going beyond the current crop of “spikecentric” vaccines

The race to develop vaccines (develop as opposed to rolling out, which is very much a mission not-yet accomplished) was won partly because developers focused on the now-familiar spike proteins of the SARS-CoV-2 as the antigens that could train people’s immune systems to find off the virus.

But Katherine J. Wu reported in Atlantic magazine on Friday (May 21) that vaccine developers are now working on vaccines that would contain additional pieces of the coronavirus “ushering in an end to our monogamous affair with spike.” Wu writes that “potential perks of this tactic run the gamut: More vaccine ingredients could help the body identify more targets to attack, and loop in untapped reservoirs of immune cells that have no interest in spike.” William Matchett of the University of Minnesota told her that “it’s like diversifying a portfolio.”