Editors Note: Rob Relyea is an engineer and an advocate for the immunocompromised. He created a digital tracker to locate available doses of Evusheld and other Covid-19 therapies. He is currently on personal leave from Microsoft. The views expressed here are his own. Read more opinion on CNN.
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My wifes lymphoma diagnosis and 50th birthday came on the same day in March 2021. Rebecca had been aggressively chasing the cause of the small lump she found in her abdomen. With access to a world-class cancer center and support of family and friends, her chemoimmunotherapy regime was deemed a success after a six-month fight. Remission!
This was right around the time that Covid-19 vaccines became widely available. Rebeccas oncologist encouraged her to get her shot ASAP. She participated in a Leukemia & Lymphoma Society study which found that many blood cancer patients immune systems had a markedly worse antibody response to the vaccine, compared to healthy individuals.
Another recent study published in the journal Nature Cancer found that a third shot of vaccine improves immune responses, unless the recipient of that shot is on a specific drug which happened to be a key part of my wifes treatment regime. We were left feeling hopeless; Rebeccas test results showed that her condition and her treatment had conspired to prevent her body from mounting a full immune system response to the vaccine.
Rebecca had won the first round against lymphoma, but our fear of her heightened danger from Covid-19 only grew. We lived with two anxieties: Would her cancer return, and could she stay safe from Covid-19?
Throughout this time, family and friends did all we could do to protect her. I followed developments and grew my understanding of how to keep her and myself healthy. Vaccines and boosters were required for anybody with whom she would spend time.
We were early adopters of N95 and KN94 masks. I did all the shopping. Carryout meals were OK, but no indoor dining in public. Non-household members visited us outside in the backyard. Paid medical leave (thanks to my employer and the state of Washington) allowed me to support her fully. Eventually, we added rapid testing of close family visiting her at home as a key part of her protection.
Then, on December 8, the US Food and Drug Administration announced emergency use authorization for Evusheld, a two-dose cocktail of two different monoclonal antibodies, for moderately to severely immunocompromised people. A randomized clinical trial had shown that the drug could provide 77% reduced risk of Covid-19 for recipients compared to those who received a placebo.
Protection can last six months in the body, to fill the void of antibodies against Covid-19 in immunocompromised people. Evusheld seemed like the pandemic gamechanger that immunocompromised people had been waiting for.
But almost four months in, our health system has failed to execute its campaign to protect the vulnerable. The supply of Evusheld is short, patient outreach is poor and goals to protect the immunocompromised are not being set, measured or reached. On top of that, we are not effectively using the supply already in the pipeline, with thousands of boxes sitting around unused. (In a statement to CNN, a spokesperson for the Department of Health and Human Services said that the government is committed to helping protect immunocompromised Americans and other vulnerable populations from COVID-19, noting that while the national supply of Evusheld is great enough to meet the requests of every state, finding and accessing doses has been challenging for some.)
The government initially ordered 700,000 doses of Evusheld, and 1 million more between January and February. But, as Matthew Cortland, a senior fellow at progressive think tank Data For Progress, pointed out, this presents a major math problem: 1.7 million doses would only provide one year of protection for 850,000 of the at least 7 million Americans who are immunocompromised. How can we think that is good enough?
On February 24, the FDA announced the recommended dose needed doubling due to continued analysis of Evushelds effectiveness against certain Omicron subvariants. This move effectively meant that we had half the supply we thought we had a day earlier now only enough for one year protection for 425,000 of the 7 million people. And now, due to shifting variant prevalence, the FDA can no longer recommend a timing for repeat dosing.
We dont know what the new dosing guidelines will be, or when the FDA feels confident issuing them. But we know there wont be enough doses to go around.
Based on my conversations with other immunocompromised people, most are not learning about this drug from their doctors. And equity is hard to maintain when word of mouth is how news about key health initiatives is spread.
The brand new covid.gov website needs to provide information on Evusheld for the immunocompromised in addition to vaccines, masking and testing.
Beyond that, health organizations need to fix this lack of information. Use patient medical records as a starting point in the effort to find people who would benefit from Evusheld. Contact them. Help them get in line. Provide transparency. People lacking great health care access must be identified and routed to available doses.
Despite capturing data from Evusheld providers, the US Department of Health and Human Services doesnt share the quantity of the drug that has been administered to patients. It also hasnt publicly shared goals for getting doses to patients.
Without goals and measurements, how can we rally our health system to protect the immunocompromised?
After my advocacy for several months, my wife has secured her dose of Evusheld, but there are so many more who need protection. Im working closely with other advocates to call for needed improvements to the Evusheld campaign.
As a software engineer, Ive been able to understand governmental data about Evusheld inventory, and Im sharing it in useful ways with a mapping tool that is easy to use and shows the inventory history of Evusheld at hospitals across the nation.
It has enabled many eligible people to help their doctors locate doses for them. This information can fill existing gaps in distribution, enabling people to advocate for themselves or loved ones. But people shouldnt be forced into what Ive previously called a Hunger Games hunt.
Nearly half of Pettis County residents have received at least one dose of COVID-19 vaccine.
According to Pettis County Health Center officials, 49.2 percent of the county has received one dose; 42.6 percent have been fully vaccinated; and 39.6 percent have been fully vaccinated plus a booster.
There is one individual hospitalized at Bothwell Regional Health Center, as compared to four last week. One additional death was reported last week for a total of 160 since the beginning of the pandemic.
Vaccine is available for everyone five years of age and older. The first booster dose is given five months after the last dose for Pfizer or Moderna vaccines or two months after the J & J vaccine are available for those 12 years and older through the Pettis County Health Center, Katy Trail Community Health and Bothwell Regional Health Center.All vaccines are free.
The Pettis County Health Center provides vaccine for individuals at home.You need to Call (660) 827-1130 to make arrangements.The Pettis County Health Center will be the only regular source for Moderna vaccine.
A second booster dose is available for anyone 50 years of age or older or those with compromised immune systems four months after the first booster.
The Pettis County Health Center has regular walk-in clinics from 9 a.m. to 5:15 p.m. on Tuesdays. It also is available to provide vaccine to individuals at home and at places of employment.If there is an increased demand for the vaccine, health center personnel will provide additional opportunities.
Ambassadors met to review implementation of two resolutions: one on the Secretary-Generals appeal for a global ceasefire during the crisis, and the other on cooperation to facilitate vaccine access.
Ted Chaiban, Global Lead Coordinator for COVID-19 Vaccine Country-Readiness and Delivery, highlighted the need for urgent action this year.
The window of opportunity is gradually closing. We risk losing the momentum and failing on vaccine equity, he said, speaking from the Democratic Republic of the Congo.
We must therefore use every opportunity to bundle or integrate COVID-19 vaccination with other health and humanitarian interventions and leverage these investments for the longer-term strengthening of health systems.
Although widespread vaccination is critical to ending the pandemic, it is not happening in conflict areas, Dr. Esperanza Martinez of the International Committee of the Red Cross (ICRC) told the Council.
The good news is that, as the supply of vaccine doses grows, the potential to get jabs in arms grows too, she said.
The ICRC has called for international humanitarian law to be respected during conflict. Medical facilities and their personnel, as well as humanitarian workers, must be protected from attacks.
COVID-19 vaccination must also be integrated into a broader health strategy that includes greater investment in health systems.
For Dr. Martinez, this is an opportune moment to see how COVID-19 vaccinations can be routinized and integrated with other health services that are prioritized during times of conflict.
Finally, local communities must also be involved in vaccination activities, something which also enhances the safety of frontline workers, she said.
Dr. Martinez warned how lack of engagement can undermine public trust in vaccinations, as happened in West Africa with Ebola and now in many countries during the pandemic.
Even if communities can be reached, people will not accept being vaccinated if they dont trust those administering the vaccine, and they do not see other pressing priorities being addressed, she said.
MINUSCA
A peacekeeper from the UN Multidimensional Integrated Stabilization MIssion in the Central African Republic (MINUSCA) pours hand sanitizer into a childs hand.
Misinformation around vaccines, including that they cause infertility in men and women, has contributed to vaccine hesitancy in South Sudan, said Dr. Emmanuel Ojwang, Health and Nutrition Coordinator with the international agency CARE in the country.
However, in the face of huge challenges including food insecurity, flare-ups of intercommunal violence, flooding and a fragile health system the Government and partners were able to rollout COVID-19 vaccines.
Strategic investments in community education and mobilization of religious leaders were keys to busting myths and misinformation, he said.
Delivering vaccines to the last mile in remote and underserved communities, will require a scale-up in healthcare workers, training and infrastructure.
Furthermore, with women less likely to have access to health information and services, gender must be at the centre of the rollout if it is to be equitable and effective.
Dr. Ojwang urged the Council to ensure safe and unhindered humanitarian access to all people in need, and for COVID-19 vaccine costing models and budgets to reflect real-world costs of rolling them out to last-mile communities.
Ensure NGOs, women-led organizations and frontline health workers have meaningful roles in COVID vaccine roll-out, not just in delivering services to the last mile - but in decision making about the response, he recommended.
As the United Kingdom holds the rotating Security Council presidency this month, the meeting was chaired by Lord Tariq Ahmad of Wimbledon, the UK Minister of State whose portfolio includes the UN.
He said Resolution 2565, on global cooperation on vaccine access, must remain a top priority.
What is clear is full, safe and unhindered humanitarian access, and the protection of health workers in line with International Humanitarian Law, remain vitally important, but sadly elusive, he remarked.
Lord Ahmad said the Security Council can help ensure COVID-19 vaccination is prioritized by Governments in countries in conflict, in addition to supporting efforts to boost international cooperation.
This year also represents perhaps the best opportunity so far to improve vaccination in countries on the Councils agenda, according to Sarah bint Yousif Al Amiri of the United Arab Emirates (UAE), Minister of State for Advanced Technology.
The fair and equitable distribution of vaccines is both a strategic investment and a moral obligation. It is also achievable, she said.
Therefore, it is important that the Council continues to underscore what she called the security benefits of vaccination.
Echoing previous speakers, Ms. Al Amiri also highlighted how improved humanitarian access enhances vaccination efforts, making conditions safer for health workers and the people they serve.
The Councils support for these tools from ceasefires to days of tranquility to humanitarian notification systems as appropriate in specific contexts, can make a difference in the rapid delivery and distribution of vaccines, she said.
Sure, it is fun to see an avatar simulate your body movements in real time, but the interactive augmented reality art installation making its way around campus has a serious aim: educating participants about how COVID-19 impacts health and encouraging vaccination.
The Covid Reflections installation isone of seven projects funded by the Arts for UF Vaccine Confidence Program, an initiative sponsored by UFs College of Arts Center for Arts in Medicine. Thecenter has previously partnered with the Centers for Disease Control and Prevention to increase COVID-19 vaccine confidence.
On Monday, the installation was set up outside the Reitz Union near a UF Health van offering free COVID-19 vaccines. As hoped, the avatar attracted groups of students who were giving it a workout. As of noon, about 30 people had tried it out.
The art installation consists of a large display connected to an iPhone that uses body tracking software to display a 3-D virtual avatar of a person standing in front of the screen. The avatar tracks the users movements and employs computer augmentation to present the impact of COVID-19 on the heart and lungs.
The installation also shows what happens to the avatar if vaccinated and ends with an FAQ section about COVID-19 vaccinations.
It was created by Ines Said, Austin Stansbury and Erica Del Hagen. Said is a software engineer who teaches in the Digital Worlds Institute; Stansbury and Hagen are graduate students in the institutes Masters in Digital ARts and Sciences (MiDAS) program.
The team wanted to explore how augmented reality could be used in a public health setting, Stansbury said. They used the Unity programming language, primarily designed for game development, to create an app that works on an iPhone, which Said describes as both innovative and really hard.
We thought it would be a novel way to provide information about COVID19 and connect with students in a way the media hasnt, Stansbury said.
The installation will be set up at the Plaza of the Americas from 9 a.m. to 3 p.m. on April 12 and April 18. The trio also will present the project at this months AI Symposium on April 14 and the Convergence Student Showcase set for April 18. They also plan to author a paper on using artificial reality in public displays to promote public health.
This event is in partnership with UF health officials to ensure that the information is accurate and up-to-date.
Natalie Rella, the Center for Arts in Medicine communications and marketing specialist, believes this project as well as the six others on arts and COVID-19 will result in more vaccinations in the community.
This is a cross-sector integration of arts and medicine and hearts and minds, she said. Maybe through this avenue, we can make an impact.
Doomed from the start. That phrase neatly describes the Apollo 13 mission, which launched this day in 1970, and the ongoing Covid-19 vaccination effort in the U.S. Yet both can be seen as successful failures.
When astronauts James Lovell, John Jack Swigert, and Fred Haise blasted off from the Kennedy Space Center, they were anticipating mankinds third trip to the surface of the moon. Two days into the mission, a defective oxygen tank exploded when they were some 200,000 miles away from Earth, imperiling their lives and making it impossible to complete their mission. Around-the-clock efforts by teams on the ground, imbued with NASA ingenuity, helped the astronauts return safely to Earth in what was nothing short of a miracle. Our mission was a failure, Lovell wrote later, but I like to think it was a successful failure.
We see parallels with Covid-19: a mission doomed from the start that has managed to eke out some successes.
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More than two years into the pandemic, its clear that the country has failed its primary mission of saving lives. The U.S. is now approaching a devastating 1 million deaths from Covid-19, an incomprehensible loss of life. But within this massive failure there has been a public health success: The tireless work, ingenuity, and collective action of scientists, public health practitioners, and clinicians in both the public and private spheres reminiscent of what NASA scientists and engineers did, but on a much larger scale has led to what is arguably the single most successful vaccination program in U.S. history.
Months before Covid-19 emerged in December 2019, the Global Health Security Index indicated that no country was really prepared for a pandemic. Although the U.S. was deemed most prepared, its capabilities could not compensate for the many shortcomings of its health care and public health systems. These are the same shortcomings that have consistently led the countrys health care system to rank last among high-income countries: incomplete access to care, glaring inequities, insufficient public health resources and infrastructure, and mistrust in both government and industry, to name a few. There was no reason to think the pandemic would solve these problems. Indeed, it made many of them worse and also created new ones.
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But the vaccines their development, manufacture, and widespread uptake have been a massive success. As we write this, the Centers for Disease Control and Prevention estimates that 88% of American adults have received at least one dose of a Covid-19 vaccine and 75% have been fully vaccinated, a higher Covid-19 vaccination rate than other non-mandatory vaccines have reached after being around for decades.
This means that in the span of about 18 months, some 227 million adults voluntarily got vaccinated despite the time it took to arrange an appointment, the discomfort, the likelihood of minor side effects like a sore arm or flu-like symptoms, and the uncertain likelihood of more serious side effects from the most rapidly developed vaccine of all time.
We know it might be hard to view any part of the Covid-19 pandemic response as a success. At times it feels impossible to think weve done anything right when Americans continue to spread SARS-CoV-2 and die from Covid-19 every day. The work is by no means done, and there are substantial gaps in vaccination coverage among adults, particularly when it comes to booster doses and younger populations.
Yet when rates of adult Covid-19 vaccination are compared to rates of vaccination against other vaccine-preventable illnesses, the U.S. has done remarkably well in a short amount of time: More American adults have received a two-dose Covid series since it became available than are current on their once-every-10-years tetanus boosters (about 70.5% of the adult population is up to date). Many more adults have been vaccinated against Covid than get vaccinated against influenza, where were lucky to see even half of the adult population vaccinated in a given year.
Eighty-eight percent is a simple statistic, but simple figures can reveal a lot about broader trends. For points of reference, a higher percentage of U.S. adults have had at least one dose of the Covid-19 vaccine than, according to Gallup, drink alcohol (60%); use Google (74%) in a typical week; find polygamy unacceptable (78%); or send their kids to public schools (83%). And despite the saying as American as apple pie, only 19% of Americans actually rate apple pie as their favorite, making Covid vaccination more American than apple pie at least by the numbers.
There are few things Americans appear to agree on more than Covid vaccination, though two key issues have clearly been settled: The Wizard of Oz was a classic (89%) and Gigli probably should never have been made (94%).
It was by no means certain that Covid-19 vaccination would become a widely accepted part of American life in less than a year and a half. This should be viewed as an important public health accomplishment a success within the countrys broader failure. Why? Surveys indicate that self-preservation and self-interest seem to be the major drivers as people make decisions to get vaccinated meaning public health messaging has helped many Americans see through widespread disinformation, fearmongering, and conspiracy theories to understand their own risks and take the appropriate action to lower them.
But the sense of duty that serves as a primary motivator for some and a secondary motivator for many more cant be discounted. Concerns about externalities an economic term that refers to the effects an individuals decisions has on others are at the core of this sense of duty and are what make getting vaccinated not just a privately beneficial decision but a patriotic one, even when promoting the public good isnt the primary motivator and even when people dont necessarily view it this way. Indeed, one study has shown that a sense of purpose can be a motivator of vaccination decisions.
If we were to ask the NASA workers whose tireless efforts brought Lovell, Swigert, and Haise back home, we imagine that self-interest wanting to keep their job would have been one motivator. But other motivations that kept them working through sleepless nights would surely have included a sense of duty, purpose, and even patriotism.
Patriotism in America is about coming together under common threads and common values. More than 40 million people watched television to see if the Apollo 13 astronauts would make it back to Earth safely. When they did, a New York Times reporter wrote that the events in all probability united the world in mutual concern more fully than another successful landing on the moon would have.
If there is any indication of Americans mutual concern for our national health and well-being, it could very well be the 88% of us who have received Covid-19 vaccinations.
To be sure, uptake of Covid-19 vaccines in the U.S. has not been as high as in other countries, including countries like Brazil or Vietnam that have far fewer resources than the U.S. And its certainly worth making comparisons between the U.S. and countries that have outperformed it to learn whatever public health lessons this pandemic has to offer. But it is also important to consider what might have happened had the U.S. not achieved the high levels of vaccination it did.
Its also tempting to point to divisiveness within the country as a sign of failure and, in particular, for the vaccinated to view the unvaccinated as paying no price for their decisions and being inconsiderate of their duty to their community and their country. Lies and misinformation have fueled very loud critics of scientifically undisputed infection-control measures, while assumptions about the character of the unvaccinated have led to vitriolic, misplaced accusations about entire groups of people.
While we personally think that our unvaccinated and undervaccinated neighbors could be doing more, extreme views are pervasive and ignore an important reality: We have all made sacrifices or done something other than getting vaccinated that supports our communities during the pandemic, whether its working an essential job with higher risk of infection, managing family life disruptions from social distancing and infection control measures, or helping neighbors that have been hit hard financially by economic disruptions. While most Americans now have some degree of biological immunity against Covid-19, none of us has been immune to the social and economic tolls of the pandemic. And, sadly, many more unvaccinated Americans have paid the ultimate price death from Covid-19 than vaccinated Americans since vaccines became widely available
Public health wont be taking days off for the foreseeable future, nor will doctors and nurses and caregivers. Many of them are running on fumes, though some want to stop. Lets not lose sight of the success buried within this larger failure and take a moment to recognize a truly remarkable achievement: 255 million (and counting!) people children, adults, our neighbors and friends have bettered their country by getting Covid-19 vaccinations.
Christopher M. Worsham is a pulmonologist and critical care physician at Massachusetts General Hospital in Boston and an instructor in medicine at Harvard Medical School. Anupam B. Jena is an internal medicine physician at Massachusetts General Hospital, an associate professor of health care policy at Harvard Medical School, a faculty research fellow at the National Bureau of Economic Research, and host of the Freakonomics, MD podcast.
President Joe Biden signed an executive order mandating vaccines for around 3.5 million federal staff and government contractors in September. White House photo by Adam Schultz
When COVID-19 vaccines started to become available in late 2020, the world breathed a collective sigh of relief. After nearly a year of the public health crisis, widespread lockdowns and associated disruption to peoples lives and national economies, there was a glimpse of light at the end of the tunnel. But it was both a great achievement and something of a headache for governments.
The vaccine would dramatically reduce the number of people becoming seriously ill with coronavirus and take the pressure off hospitals that had for months been operating at breaking point. And it would enable governments to begin slowly lifting restrictions and, in turn, restart economies. But all this relied on one thing peoples willingness to have the vaccine.
In an age of rising populism, and with conspiracy theories and fake news spreading like wildfire on social media, governments and scientists had to work hard to cut through the clamour and disseminate the facts, with varying success. At the same time, many ministers, whose civil servants had been working either wholly or partially remotely for months, had designs on getting the workforce back into offices.
To get things moving, some governments introduced COVID-19 vaccine mandates either for the entire civil or public service or sections of it. This enabled governments to get staff back together in workplaces safely and to act as a role model for wider society, signalling that the vaccine was safe and that it would enable citizens to get back to some semblance of what their lives had been like pre-pandemic.
But how effective have those public sector vaccine mandates been? What are civil servants perceptions of mandates both in countries where they have been introduced and those where they havent? And could they have a negative impact on civil service recruitment and retention?
To find out, Global Government Forum ran a survey. Open between 26 January and 19 February, it gathered nearly 4,000 responses from civil and public servants in 10 countries Canada, the US, UK, New Zealand, Italy, Mexico, Australia, the Dominican Republic, Brazil and Colombia.
The survey found that a slim majority of officials agree with vaccine mandates, with 48.8% in favour of the measure, and 45.7% against. The close result shows just how divisive the issue is. Drill down into the results by country, though, and there is some variation. Of the five countries with the most survey respondents (100 or more each) Canada, the US, the UK, New Zealand, and Italy New Zealand is the most supportive, with 58.9% agreeing with vaccine mandates for government employees.
While respondents in the US are most against the intervention 49.7% disagree with it those in the UK are least supportive. There, 44.3% of respondents agree with vaccine mandates for civil servants. But it is also the case that fewer people from the UK disagree with mandates than any of the other four countries bar New Zealand. This apparent discrepancy is explained by a higher number of people than in the other countries saying they neither agree nor disagree with vaccine mandates.
Respondents in Canada and Italy are split down the middle in terms of whether they agree or disagree with vaccine mandates, at around 47% and 48% respectively in both countries.
Of the five countries, only the UK has no vaccine mandate in place. There were plans to make vaccination mandatory for all health and social care workers in England from 1 April this year but the government formally revoked these last month after 90% of those responding to a public consultation disagreed with the plans.
Italy has the most wide-reaching mandate. One of the worst affected countries early in the pandemic, its government initially introduced a vaccine mandate for teachers and healthcare workers and in September last year became the first European country to extend that to its 1.2 million government and local authority employees and all private sector workers. In January this year, it expanded that further still, making it mandatory for all individuals over 50 to get the vaccine whether in employment or not.
Canada and the US have introduced mandates for their federal employees. And in New Zealand, vaccination is mandatory for workers in health, education, corrections, fire and emergency, and border control, while some other government departments and agencies require staff working in frontline roles or who want to work from offices to be vaccinated.
While these countries have declared the mandates successful, they have not been without controversy, even in New Zealand where public trust in government is considered high.
Read the full results of Global Government Forums vaccine mandate survey, including perceptions in Australia, Brazil, Mexico, the Dominican Republic, and Colombia.
Prime minister Jacinda Ardern was initially reluctant to introduce mandates but decided they were necessary to reach the vaccination levels needed to safely reopen following lockdowns put in place to curb the Delta outbreak. The mandates are undoubtedly one of the reasons 95% of the countrys eligible population is fully vaccinated, she has said.
New Zealand news website Newshub revealed in Februarythat more than 2,600 government workers had been stood down for failing to comply with the mandate. More than half of that number were in the health sector, with 814 having had their employment terminated, 226 having been stood down from their duties, and 140 staff having chosen to resign, according to government data. A spokesperson reportedly told Newshub that around 7% of the 13,500 frontline workers covered by the mandate were no longer attending incidents.
That same month, inspired by the truckers protests in Canada, thousands of people blocked streets around parliament in the capital, Wellington, to protest against COVID-19 vaccine mandates and restrictions, culminating in violence and 120 arrests. Three days later, on 25 February, the mandate for police and the defence force which required staff to have two doses of the vaccine by 1 March or face being fired wasbranded unlawful and quashed by the High Court.
Ardern later announced that from 4 April vaccine mandates would be dropped for workers in some sectors, including education, but would continue to apply for those in health, corrections, aged care and at the border.
Like New Zealand, the US government has also come up against the courts on the issue of whether vaccine mandates are lawful.
Having announced in July last year that he was considering mandatory vaccination for federal employees, president Joe Biden signed an executive order mandating vaccines for around 3.5 million federal staff and government contractors in September. Employees were told they must be fully vaccinated or face the possibility of disciplinary action up to and including removal from service.
White House press secretary Jen Psaki said the overarching objective of the discipline process for feds who flout vaccine mandate rules was to reduce the number of unvaccinated Americans, which stood in October 2021 at around 80 million. We want to reduce that number, decrease hospitalisations and deaths and allow our children to go to school safely Obviously the federal workforce is one of the largest in the country and we would like to be a model of what we think other businesses and organisations should do around the country, she said.
In November, the US Office of Management and Budget announced there had been 96.5% compliance with the mandate across federal government. It defined those in compliance as having had at least one dose of the vaccine or with a pending or approved exception or extension. Government has shown these requirements work: they increase vaccination rates leading to a safer, more productive, and efficient workforce. Theyre good for workers, good for businesses, and good for the country, the White House said in a statement.
Read more: Commerce and transportation departments top US federal vaccine mandate table
However, in late January a court issued an injunction against the mandate, ruling that the Biden administration exceeded its authority by issuing it. Judge Jeffrey Brown of a district court in Texas said the case brought by Feds For Medical Freedom was not about whether people should be vaccinated but instead about whether the president can, with the stroke of a pen and without the input of Congress, require millions of federal employees to undergo a medical procedure as a condition of their employment, Brown wrote. That under the current state of the law [] is a bridge too far.
That decision was overturned by an appeals court last week, though the ruling wasnt based on the presidents legal authority in the matter but on a technicality the mandate was reinstated by an appeals court after a panel of judges ruled that the plaintiffs hadnt followed the complaints procedure set out in the Civil Service Reform Act.
Canada, meanwhile, announced in August 2021 that all federal government workers must be vaccinated against COVID-19 by the end of the following month by law or face unpaid leave though this was later extended to the end of October. The government said in a statement that, as the countrys largest employer, it must show leadership in protecting public servants and the communities in which they live and work.
We know vaccinations are the best way to help protect our fellow Canadians from COVID-19 variants of concern, Dominic LeBlanc, president of the Privy Council for Canada and minister of intergovernmental affairs, said at the time. We are encouraged by the many federal employees who have already been vaccinated, and hope that vaccination rates will continue to climb as the Government of Canada moves ahead on its vaccination strategy.
As for civil and public servants perceptions of vaccine mandates, the surveys free text box, which allowed respondents to explain the reasons behind their answers anonymously, and comments posted on the Global Government Forum website, offer a snapshot of the arguments seen in wider society. Those who agree with vaccine mandates believe that the vaccines are safe, feel a moral responsibility to get the jab to protect themselves and others, and often feel that government staff should lead the way in the hope that citizens will follow suit.
This may be the land of the free but we are in the middle of a pandemic that knowns no boundaries and theres no stopping it unless we vaccinate [] Be an American and do your part vaccinate the life you save may be your own, one person wrote.
Another feels that vaccine mandates, while not ideal, are necessary. While Im not generally in favour of the government forcing citizens to do pretty much anything against their will COVID-19 is a serious virus that obviously kills people, they wrote. The vaccinations have proven to be safe and very effective in reducing the risk of serious COVID illness, and almost completely eliminating COVID death. I begrudgingly support the COVID vaccination mandate, and really why would anyone wish to make this a political issue and the last hill they fight on?!
On the other hand, many believe they should have the right to choose whether or not they get the vaccine and see government intervention of this kind as an infringement of civil liberties. Those on this side of the fence typically voice stronger opinions, describing governments decisions to mandate vaccines as, for example, disgusting, tyranny, and coercion and control.
Freedom, liberty and individual rights. My body, my choice, one Canadian survey respondent wrote.
And then there are those who appear to be in favour of vaccines but have concerns over the impact of governments introducing mandates for their employees with threat of discipline for non-compliance.
For example, one person wrote: [An] ineffective and damaging way to drive up vaccination rates damages peoples livelihoods, causes more animosity and alienates those who are hesitant, pushing them further to more extremist views. [It also] damages the strategy needed to properly protect against COVID testing, face masks, distancing and vaccines by making people assume vaccinations will completely halt transmissions.
Read more: Aye of the needle: overcoming vaccine hesitancy
Respondents in the UK also had strong feelings that vaccine mandates risk undermining public health programmes generally and help give rise to anti-vax rhetoric. Vaccine mandates completely undermine years of carefully built-up trust in public health, one respondent wrote. Coercing people into health interventions is just bad policy. All this will do is create mistrust and mean that uptake of vaccines in general is lower. It also serves to mainstream anti-vaccine movements which were until now on the margins of society.
This chimes with the stance taken by the World Health Organization from a public health perspective. In April 2021, WHO said it does not presently support the direction of mandates for COVID-19 vaccination, having argued that it is better to work on information campaigns and making vaccines accessible.
As for whether the survey respondents think vaccine mandates will be effective in driving up vaccination rates, 59.4% agree and 26.5% disagree. This shows that many of those who do not agree with vaccine mandates nevertheless believe that they are or will be effective.
However, there are problems with measuring mandates success and effectiveness, not least that it is impossible to know how many people would have got vaccinated had it not been required by law. And then there are those in the US, for example who have been granted or are seeking exemption from the mandate on medical or religious grounds to take into account. What proportion of those are genuine and what proportion of those seeking exemption have no grounds to do so but are trying their luck in the hope of avoiding the jab?
Denis McDonough, secretary of the US Department of Veterans Affairs which issued its own vaccine mandate ahead of Bidens government-wide one said in October that the number of departments employees seeking exemptions for the COVID-19 vaccine far exceeded those sought when the department mandated inoculations for flu.
Compare the proportion of federal workers who have been vaccinated with that of the general population, though, and it appears the mandate has been successful. The White Houses Psaki said at the end of January that more than 93% of the 3.5 million federal employees covered by the mandate had received at least one jab while the US Centers for Disease Control and Prevention reported that 77.0% of the total US population of 332 million had received their first dose as of 5 April. Though the comparison between the general population and those working for government is not an easy one and largely ignores factors such as socio-economic background, this suggests loosely that the vaccine mandate has been successful in driving up vaccination rates if not among citizens, as a knock-on effect, then certainly among civil and public servants.
In Canada, by the end of March, 98% of federal public servants were fully vaccinated. The countrys chief public health officer, Dr Theresa Tam, said during a press conference in February that theres now obvious evidence that [vaccine mandates] work. We saw a plateau in the uptake of vaccines after a really tremendous effort by Canadians, and then after the introduction of vaccine mandates by the various provinces and territories and jurisdictions, we did see an uptick.
Health minister Jean-Yves Duclos added that in the six months to mid-February as many as three million Canadians chose to get vaccinated sooner because of the mandate.
Now, the Canadian government is considering whether to narrow its mandate requirements, like New Zealand has done, or abolish it completely.
Read more: Trust and teamwork: Hannah Cameron on how New Zealand dodged the COVID bullet
Among the consideration for governments reviewing their vaccine mandates is what impact it could have on civil servants return-to-office. Some argue that scrapping mandates could derail plans, particularly as many public servants are keen to continue to work from home and could resist returning to the workplace without a vaccination policy in place.
According to Global Government Forums survey, 46.8% of respondents said they feel safe (or would feel safe) working on-site without a vaccine mandate in place, while 44.3% said they do not or would not feel safe.
Countries that have introduced vaccine mandates, particularly those with strong enforcement policies that include firing non-compliant staff, have had to decide whether the effectiveness of the mandate in boosting vaccination rates outweighs the possible fallout. As well as the risk of losing staff, potential negative effects include creating a divide among colleagues that damages workforce morale, and putting off potential talent from applying for government jobs.
In the survey, 57.9% of respondents agree that vaccine mandates for government employees will affect retention, with staff either choosing to quit rather than get the vaccine or being fired for non-compliance. Nearly a quarter disagree.
I suppose that means I am fired, one GGF reader commented on a web story about the introduction of the mandate for US federal employees. What an injustice for employees. I dont work with the public and will be fired for non-compliance. I am sure others will leave and work establishments will lose great employees.
As for recruitment, 43.3% of survey respondents believe vaccine mandates for public servants will put people off applying for government jobs, while 38.7% believe there will be no impact.
In a context of labour shortage, coercive measures like mandatory vaccination may pose more risks than benefits, one person wrote.
Another said: Our workplace does not have a vaccine mandate per se, but without vaccination one cannot come into the office or interact with the public. I believe that this will force people from their jobs. Mandates must be considered in the context of the overall support for vaccination. They are a clumsy, heavy-handed tool if not supported by good public health communications and community support. They will increase vaccination rates and show that the public sector is leading but at what cost?
Read more: Exclusive: vast majority of public servants still working remotely, GGF survey finds
Opinions such as these leavegovernments under no misapprehension that vaccine mandates are problematic. Some national administrations felt it their duty to enforce them in a bid to protect their workforce and the communities it serves and to stand up as an example to the wider public. Others, concerned about harming public trust and future public health programmes, chose communication campaigns aimed both at staff and the general public as their weapon of choice in the fight against coronavirus.
The evidence suggests that countries that have introduced mandates for public servants have been successful in increasing vaccination uptake. But with hesitant and anti-vax employees given little choice but to comply, at what cost to morale and retention?
One day, we may have the data that provides an unequivocal answer as to whether or not vaccine mandates were the right choice in the case of COVID-19 and crucially, whether governments will turn to such interventions again when faced with future pandemics and health emergencies. But as the GGF survey indicates, one thing we can say for certain is that the issue has divided public servants like few before it.
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When germs infiltrate our bodies, such as the virus that causes COVID-19, they assault and grow. The invasion causes an illness, which is known as an infection. To combat infection, our immune system employs a variety of strategies. Red blood cells provide oxygen to tissues and organs whereas white blood cells, often known as immune cells, combat illness.
When a person is infected with the virus that causes COVID-19 for the first time, it might take several days or weeks for their body to develop and employ all of the germ-fighting mechanisms needed to recover. The person's immune system recalls what it learned about how to defend the body against COVID-19 after the infection.
The body normally produces T-lymphocytes and B-lymphocytes types of white blood cells a few weeks following immunization. As a result, a person might become infected with the virus that causes COVID-19 either before or shortly after immunization and become ill as a result of the vaccine failing to give adequate protection.
The process of establishing immunity following vaccination can sometimes induce symptoms such as fever. These symptoms are typical and indicate that the body is strengthening its defenses.
Pfizer-BioNTech and Moderna are both mRNA vaccines and include material from the virus that causes COVID-19, which instructs human cells on how to manufacture a harmless protein that is unique to the virus. This material is not harmful. After making copies of the protein, our cells destroy the vaccine's genetic material. Our cells understand that the protein shouldn't be there and produce T- and B-lymphocytes that will remember how to fight the COVID-19 virus if we become infected again.
Vector vaccines such as the Johnson & Johnson vaccine include a modified form of a virus other than the one that causes COVID-19. A viral vector is material from the virus that causes COVID-19 inside the modified virus's casing.. Once the viral vector has entered our cells, the genetic material instructs the cells to produce a protein that is specific to the COVID-19 virus. Our cells create copies of the protein using these instructions. This causes our systems to produce T-lymphocytes and B-lymphocytes that remember how to fight the virus if we become infected again.
Booster doses improve or restore COVID-19 protection that has deteriorated over time. Everyone over the age of 12 who has completed the primary series of the COVID-19 vaccination should obtain a booster.
In our latest interview, News Medical speaks to Dr. Rachel Ruderman, a fourth-year resident at Northwestern University Feinberg School of Medicine, about her current research, which reveals no detectable link on ultrasound scans between COVID-19 vaccination and birth defects.
My name is Rachel Ruderman. I am a 4thyear resident in obstetrics and gynecology at Northwestern University in Chicago. I love obstetrics -the changing physiology of pregnancy and how it impacts women and their children not only during pregnancy but after. Pregnancy can also expose significant future health risks and issues with social and economic support that really impact health.
Through the last two years of the pandemic, I have seen an amazing emergence of high-quality data and science on COVID in pregnancy and the development of lifesaving vaccines. Despite excellent evidence that COVID vaccines are safe and effective, many pregnant women have been hesitant to be vaccinated. Much of this stems back to pregnant people's initial exclusion from vaccine trials.
However, we now have a fund of research that supports the idea that the vaccine is safe and effective in pregnancy, while COVID during pregnancy can lead to worse maternal and fetal outcomes. Still - I noticed that a lot of my patients were hesitant to be vaccinated, and often cited their baby as the reason why. Thus, I wanted to look at whether getting the vaccine earlier in the pregnancy, during a key developmental time, as opposed to later in pregnancy or not at all, could be associated with an increased risk of birth defects.
Image Credit: Prostock-studio/Shutterstock
Birth defects are a large group of congenital abnormalities which include external structural defects (i.e. cleft lip) and internal structural defects(i.e. cardiac abnormalities). Major defects are extremely taxing to the neonate, the parents, and the healthcare system. For example, certain congenital cardiac anomalies require several surgeries, prolonged inpatient admissions, and high costs to the parents as well as the healthcare system.
Tons of research focuses on what we can tell our patients are safe and unsafe during pregnancy, especially during the critical period of organ development (the "Teratogenic Window") so we can prevent the physical, mental, social, and economic impacts of birth defects.
The study involved looking at patients who had a routine mid-pregnancy anatomy scan and documentation about vaccination status. If a vaccine was administered in pregnancy, we recorded at what point in pregnancy it was given. In Illinois, this is more easily done because of a state-wide database that records vaccinations and shares them with providers across different hospital systems (I-CARE [illinois.gov]). From there, we looked at the patient's demographics (age, number of pregnancies, self-reported race, and ethnicity), as well as other health issues like high blood pressure and diabetes.
With all this information, we were able to see if the timing of vaccination impacted anomalies discovered on these mid-trimester ultrasounds. We also looked at whether pre-existing conditions (like diabetes) or age impacted the presence of anomalies. We found no difference in the rate of anomalies between those vaccinated during the "Teratogenic Window" and those either vaccinated later in pregnancy or those not vaccinated at all. There was no increased risk after adjusting for those pre-existing conditions.
Image Credit: Keron art/Shutterstock
TheCDC has a database called the V-safe registry, which looks at outcomes from pregnant women who have received the vaccines. They found no difference in outcomes in those who got the vaccine compared to controls. However, people that got the COVID vaccine early on are different from those who declined vaccination, and our study gives more information on these different patients. We looked at patients who not only declined vaccination but also got vaccinated later in pregnancy and discovered the same outcomes.
We know that pregnant patients with COVID have an increased risk forICU admission and intubation, as well as anincreased risk for high blood pressure disorders of pregnancy, preterm birth, and needing a c-section. What we know now in addition is that the vaccines developed for the general population are safe and effective for pregnant patients and help dramatically decrease these risks. We also know that antibodies from the vaccine werehigher than the antibodies people received from a COVID infection.
I have seen firsthand the misinformation online and how it has made my patients skeptical of getting the vaccine during pregnancy. The more we can counter this dangerous messaging with real, high-quality data, the better and safer our patients and their babies will be. It's so important to break down this information so the general public can really understand for themselves what the evidence is and make decisions that can benefit them in the long run.
I have noticed that having conversations with my patients that are honest and open is the most helpful. I always ask people why they are hesitant or concerned, and then try to explain my recommendations using the significant amount of evidence we have on the Covid vaccine during pregnancy.I always check if my pregnant and postpartum patients are vaccinated and boosted. Talking with patients one on one and validating their concerns can go a long way.
Image Credit: eggeegg/Shutterstock
Next year I will be a Maternal Fetal Medicine fellow at the University of Chicago taking care of high-risk pregnancies (sick moms and babies). I plan to do research on the postpartum period and would love to look at the postpartum experiences of women who were vaccinated against COVID or infected with COVID during pregnancy.
I would always recommend checking out reputable sites like the CDC and WHO. There's a lot of great COVID information for patients on ACOG's website (the American College of Obstetricians and Gynecologists). There's a lot of misinformation online so it's important to make sure the sources you're accessing are legitimate!
Readers can find the full study at: https://news.northwestern.edu/stories/2022/03/covid-19-vaccine-not-associated-with-birth-defects/?fj=1
Rachel Ruderman is a native of Chicago. She attended the University of Michigan where she studied Global Health and received a Master of Public Health. She returned to Chicago for medical school and stayed for residency at Northwestern. During her tenure at Northwestern, she has published on issues of accessing quality postpartum care.
Rachel also developed awomen's health advocacy curriculum and established an infertility education program at Chicago's John H. Stroger Jr Hospital, a safety net hospital in the city. Next year she will be a Maternal Fetal Medicine fellow at the University of Chicago where she plans to do research on the postpartum period.
New Zealand's third death considered by safety monitoring officials to be linked to the Pfizer Covid-19 vaccine was a teenager.
On Monday evening, the Ministry of Health advised it had been notified of the tragic circumstance by the Covid-19 Vaccine Independent Safety Monitoring Board.
The teenager had myocarditis at the time of their death in December. However, there was not enough information at the time to determine the potential role of the vaccine.
Matt Rourke/AP
A third death considered to be linked to the Pfizer Covid-19 vaccine was a teenager, officials said.
Myocarditis inflammation of the heart muscle is a known, very rare side effect of the Pfizer vaccine. It can result from viral infections such as flu and puts about 100 Kiwis in hospital each year.
READ MORE:* Covid-19: Coroner investigating after autopsy links Dunedin man's death to 'very rare' side effect of Pfizer vaccine* Covid-19: Woman with medical issues dies from myocarditis, rare side-effect of Pfizer vaccine
Myocarditis has been estimated to affect about 30 per 1,000,000 vaccine recipients in New Zealand. It has largely been seen in males between 12-30 years of age after the second dose.
During Tuesday's press conference, the Director-General of Health Ashley Bloomfield advised that the young person, who had a dose of vaccine in the weeks prior to their death, was not experiencing any symptoms of myocarditis at the time of their quite sudden and very sad death.
The board considered the myocarditis was possibly due to vaccination. Its important to note the case is with the coroner, who is still investigating the cause of death.
ALDEN WILLIAMS/Stuff
To date, 4,005,406 Kiwis over the age of 12 have had two doses of Covid-19 vaccine.
Covid-19 is more likely to cause myocarditis than the vaccine almost four-times higher risk and the risk of Covid-19 far outweighs the risk of the vaccine.
More than eight of 10 reported cases have recovered quickly with rest and common medications, such as ibuprofen. Most reported cases have required hospital care for assessment and monitoring, because sudden death is a rare complication, the Immunisation Advisory Centre said, which is run out of the University of Auckland.
Bloomfield added the family were very clear" they didn't want the death to put people off from being vaccinated, or to be used by groups to undermine vaccine efforts in New Zealand.
More than four million Kiwis over the age of 12 have had two doses of Covid-19 vaccine.
Two previous deaths have been linked to the vaccine to date: a woman in her 50s and 26-year-old Rory Nairn, of Dunedin.
A new analysis of more than 11 studies, covering 395 million Covid-19 vaccine doses, published in the Lancet Respiratory Medicine on Monday found the very low risk of myopericarditis was comparable to or lower than the risk following non-Covid vaccinations.
Myocarditis is inflammation of the heart muscle, while pericarditis is inflammation of the tissue forming a sac around the heart. Myopericarditis means that both the heart muscle and the sac are inflamed.
It found the overall incidence of myopericarditis following Covid-19 vaccination was 18 cases per million, compared to 56 cases per million for non-Covid vaccines, such as influenza.
Symptoms of myocarditis or pericarditis linked to the vaccine generally appear within a few days, mostly within the first few weeks after vaccination, the Ministry of Health says.
If you get any of these new symptoms after vaccination, you should seek medical help, especially if they dont go away:
BERLIN
Germanys health ministry said Monday that the country may have to discard 3 million doses of expired COVID-19 vaccine by the end of June.
Ministry spokesman Hanno Kautz told reporters in Berlin that not many doses have been destroyed so far, though he couldnt give an exact figure.
But Kautz said that we have more vaccine available at the moment than is being used and than we can donate. He added that COVAX, the U.N.-backed program to distribute shots to poorer countries, isnt currently accepting donations.
There is certainly a danger of vaccine being discarded, Kautz said. However, he added that it recently emerged that the BioNTech-Pfizer vaccine can be stored for longer than previously thought, so German officials now believe that 3 million doses may have to be discarded or destroyed by the end of June down from a previous estimate of 10 million.
Germanys vaccination program has slowed considerably, with an average of only 33,000 shots administered per day over the past week compared with over 1 million at times when the countrys booster campaign was in full swing in December.
Some 76% of the population has been fully vaccinated and 59% also have received a booster. Officials arent satisfied with the vaccination rate, particularly among older people, but the German parliament last week rejected a proposal to require all people 60 and over to get inoculated.
