Media Advisory
Thursday, March 31, 2022
Achieving classical herd immunity against SARS-CoV-2, the virus that causes COVID-19, may not be attainable, according to a new perspective published in The Journal of Infectious Diseases. However, widespread use of currently available public health interventions to prevent and control COVID-19 will enable resumption of most activities of daily life with minimal disruption, the authors note. Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, David M. Morens, M.D., senior scientific advisor to the NIAID director, and Gregory K. Folkers, chief of staff to the NIAID director, authored the perspective.
The general concept of herd immunity implies that transmission of an infectious agent can be blunted, except for sporadic outbreaks, because a certain proportion of the population is already protected through vaccination or prior infection. The authors explain how the scientific understanding of herd immunity and its applications to various diseases have evolved over time. High levels of herd immunity have enabled the United States to largely control polio and measlestwo diseases caused by viruses that have not undergone significant evolution. However, the authors note, the benefits of achieving herd immunity thresholds have been less successful with respiratory viruses such as influenza, which continually mutate.
Dr. Fauci and his colleagues write that achieving classical herd immunity against SARS-CoV-2 is unlikely, due to a combination of factors that include features of the virus as well as current societal dynamics. These include the virus ability to continually mutate to new variants; asymptomatic virus transmission, which complicates public health control strategies; the inability of prior infection or vaccination to provide durable protection against reinfection; suboptimal vaccination coverage; and adherence to non-pharmacologic interventions.
However, the authors note, controlling COVID-19 without major disruptions to society is now achievable because of widespread background immunity via prior infection or vaccination, booster shots, antiviral drugs, monoclonal antibody therapies and widely available diagnostic tests. Research to develop pan-coronavirus vaccines, which could protect against multiple coronaviruses or at least multiple SARS-CoV-2 variants, remains crucial.
Living with COVID is best considered not as reaching a numerical threshold of immunity, but as optimizing population protection without prohibitive restrictions on our daily lives, the authors conclude.
DM Morens et al. The Concept of Classical Herd Immunity May Not Apply to COVID-19. The Journal of Infectious Diseases DOI: 10.1093/infdis/jiac109 (2022).
Dr. Fauci and Dr. Morens are available for comment.
NIAID conducts and supports researchat NIH, throughout the United States, and worldwideto study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.
About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIHTurning Discovery Into Health
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Millions of people could lose health insurance coverage when the COVID-19 emergency ends USA TODAY
Four women who have combined their emergency management education and experience to serve
Emergency management is transforming. Growing populations, a global pandemic, and intensified natural and human-made disasters are key reasons the field has an evolving scope.
Pictured in above image (from L to R): Katja Miller, Clarissa Grant, Julia Watson, and Torii Sutherland
In Hillsborough County, there is another noteworthy shift. As a mighty team of 17, the County's Office of Emergency Management (OEM) is dominated by women. Torii Sutherland, Katja Miller, Julia Watson, and Clarissa Grant are four of the women changing the face of emergency management.
The tides of change
They are in good company. For the first time in history, the nation's emergency management departments - the Federal Emergency Management Agency (FEMA) and the U.S. Fire Administration -both have women at the helm.
When emergency management was in its infancy, the field naturally attracted individuals working in law enforcement, fire rescue, and the military. Traditionally, those roles were male-driven, therefore, emergency management was as well.
Miller, who focuses on human services and mass care for the County, looks forward to the continued evolution of emergency management with women holding top positions. Grant, an operations coordinator, agrees. She hopes for an increased number of women in the field and more diverse leadership.
Miller and Grant's wishes are coming true on a national scale.
In the early days of emergency management, when staff mostly hailed from law enforcement, fire rescue, and the military, responding to emergencies was the primary focus. Now, response is one pillar of emergency management, and the field has grown to embrace preparedness and recovery in impactful ways.
What once was a field entered into by progression is now entered into as a profession. Academia is driving people into emergency management, driving diversity, and - as proven by Miller, Grant, Sutherland and Watson - when education meets experience, capabilities soar.
Education meets experience
A strong drive to use her skills to help people during times of crisis led Sutherland from satellite communications to the military, and it eventually guided her to Hillsborough County. In her current role as Planning Section Chief, Sutherland is able to expand her knowledge base and use her talents to help Hillsborough residents during critical moments. Sutherland holds a master's degree in biochemistry, and says she is constantly learning in her position.
Similarly, Miller knew that she wanted to serve. Beginning her career as a firefighter at age 18, Miller was hooked. While obtaining her bachelor's degree at USF, a course titled "Planning for Emergencies" opened her eyes to emergency management, and in the midst of COVID-19 and 18-hour workdays, Miller pushed through, earning her master's degree in crisis and emergency management.
Having her mom as a director for BayCare, Watson always knew that she was destined for something in the medical field. She started out as an EMT for Pinellas County but wanted more. Helping people in emergencies was her passion, but Watson sought to help people on a large scale. While working full time, Watson obtained her undergraduate degree in emergency management and homeland security. Like Miller, while on the front lines of COVID-19, Watson completed her master's degree in disaster medicine and management.
Grant chooses this line of work because of the great need. Grant says that she has always had an interest in public health and science. And she has carried that interest through her adult life. Grant has her nursing degree, an undergraduate degree in biology and chemistry, and her master's degree in public health. Emergency management is a big component of public health, and Grant wanted to be able to help communities prepare for and recover from disasters at any moment.
Women play an important role
As Women's History Month closed out, questions specific to the role of women in emergency management were posed to the group.
What do women bring to this line of work? Sutherland, Watson, Miller, and Grant agree that compassion and resiliency are just two of many qualities. And, in emergency situations, these abilities are crucial.
How can the profession increase the number of women in the field? Through education and mentorship.
Finally, why should women be in emergency management? Their resounding answer, "Why not?"
Read Part One
Travel to Mexico during Covid-19: What you need to know before you go The Mercury News
Shunda Williams was recovering from COVID-19 pneumonia at Texas Health Presbyterian Hospital Dallas last year, still requiring oxygen, when she realized she couldnt manage her fork.
My hand kept doing this, said Williams, 46, sitting recently in her Dallas apartment, holding up her right hand, then abruptly letting it drop. I had no control over it. It was just dangling, falling.
After several tests, including magnetic resonance imaging (MRI), a physician told Williams that she had experienced 10 mini-strokes, she recalled. While theres no way to know for sure, the physician believed the virus had contributed along with possibly her other medical conditions, including diabetes, Williams said.
More than two years after the emergence of SARS-CoV-2, researchers and physicians are still trying to sort out to what extent the infection boosts the risk of stroke, and for how long that risk lasts.
The likelihood of having a stroke around the time of infection is still relatively low 1.4% according to a meta-analysis of 61 studies but may require weeks to months of recovery. Williams finally returned home to her 12-year-old daughter, Zaniya, after six weeks of hospitalization, first to treat the virus and later for stroke-related rehabilitation.
Now a study, published online Feb. 7 in Nature Medicine, indicates that higher stroke vulnerability might extend through the first year after a bout with COVID-19.
The analysis, which compared 153,760 patients treated through the Veterans Affairs system to those who didnt contract the virus, found that the likelihood of a stroke within the first year was 52% higher, resulting in four additional strokes per 1,000 patients.
Although strokes were more likely in patients who were most severely ill, they also occurred in those who had mild symptoms and didnt need to be hospitalized, said Dr. Ziyad Al-Aly, the studys senior author and chief of research and development at the Veterans Affairs St. Louis Health Care System in Missouri.
Thats really important because thats really the majority of people with COVID-19, he said. One of the implications of the findings of this study is that now we need to start thinking about COVID-19 as a cardiovascular risk factor.
While the Nature Medicine findings are intriguing, they dont show whether the strokes occurred shortly after the infection or throughout the first year, said Dr. James de Lemos, a professor of cardiology at the University of Texas Southwestern Medical Center in Dallas, who studies cardiovascular risk and the virus.
.This study raises the possibility that there could be effects that last longer than most of us would have predicted, de Lemos said. But much more study is needed before we can determine if this is true. And even if it is true, it looks like the risks for any one individual are very small.
Understanding infection and stroke
A short-term risk of stroke also has been identified in patients with other serious infections, including influenza and sepsis, said Dr. Mitchell Elkind, professor of neurology and epidemiology at New York Citys Columbia University, who studies stroke and infectious disease.
For instance, research has shown that stroke is more likely during the first several months after sepsis, he said. I think thats consistent with whats being seen here with regard to COVID.
The causes of stroke and other cardiovascular conditions are still being examined but appear in part to be related to the inflammatory impact of SARS-CoV-2 throughout the body, including the lining of the blood vessels, de Lemos said. By irritating the protective lining of those vessels, that inflammation might encourage the formation of clots, he said.
Another recent analysis, which looked at strokes in 37,379 adults ages 65 and older with COVID-19, found that the greatest likelihood was during the first three days after diagnosis when it was 10 times higher.
That risk quickly declined and was just 9% higher 15 to 28 days after diagnosis compared to the control period, according to the findings, published online Feb. 3 in the journal Neurology. Both the Neurology and the Nature Medicine studies stopped enrolling patients in early 2021, before the vaccine became widely available.
Dr. Gabriel de Erausquin, a neurologist who studies long-COVID and the brain at the University of Texas Health Science Center at San Antonio, said hes not surprised by the Nature Medicine findings, as hes seen unexpected strokes in relatively young or healthier individuals.
These adults are typically middle-aged and dont have obvious risk factors, such as diabetes or obesity, he said. De Erausquin, who doesnt treat patients hospitalized with the virus, said the strokes hes seen are usually during recovery, and by that, I mean in the months following the acute infection.
Clinicians also have recounted unusual stroke cases to Brian Abraham, a regional chief executive officer for the Albuquerque, N.M.-based rehabilitation chain ClearSky Health. His administrative oversight includes two Dallas-Fort Worth area hospitals..
At one of them, ClearSky Rehabilitation Hospital of Flower Mound, clinicians have treated at least three patients in the past nine months with similar stories, he said. They had mild cases of the viral infection and were quarantined at home when they collapsed with what turned out to be a stroke, he said. None of those patients were over the age of 47.
Stroke rehabilitation can take longer with these patients, if theyre still recovering from the virus, as they often require numerous rest breaks, Abraham said. Something as simple as sitting up on the edge of the bed can drop their oxygen saturation rates to the 50s and 60s percentiles, he said.
A tougher recovery
Following her mini-strokes, Shunda Williams completed three weeks of inpatient rehabilitation followed by two months of outpatient rehabilitation once she returned home.
During inpatient rehabilitation, Williams worked on improving the weakness in her right arm and leg, along with her balance, so she could shower and dress herself safely, said Jason Mathew, a Texas Health Dallas occupational therapist.
Mathew remembers Williams for her big smile and fierce determination to get better. She was concerned about just getting home to her daughter and being able to take care of her, he said.
Anyone who has had COVID-19 should alert their physician so they can be more proactive about other risk factors, such as controlling blood pressure, said Al-Aly, who authored the Nature Medicine study.
But Elkind disagreed that the virus at this point should be considered a long-term risk factor, as any heightened vulnerability is likely to be short-term, he said. Plus, Elkind said, for any one individual, its still a very unlikely event to occur.
People should focus instead on healthy eating habits, exercise and regular checkups, including blood pressure, said Elkind, also the immediate past president of the American Heart Association.
UT Southwestern researchers led a study, published earlier this year in the American Heart Journal, which found that the percentage of patients with uncontrolled high blood pressure increased from 15% to 19%, compared with pre-pandemic.
Williams road hasnt been the easiest, even after she went home last April.
She learned in late 2021 that she had suffered a silent heart attack at some point, and physicians implanted two stents to open clogged blood vessels. But Williams, who also has an adult son, doesnt report any lingering stroke effects, other than occasional memory lapses. She makes more lists these days.
She didnt return to her warehouse job and works a customer service position from home, relishing the time with her daughter. When she crossed her own threshold, Williams still needed oxygen and intravenous antibiotics. But she was home.
When I was in there [the hospital] with COVID, I was like, `Oh, Lord, please dont take me. I have a 12-year-old to raise. Just let me make it out of here.
WASHINGTON, DC - MAY 19, 2021: Centers for Disease Control and Prevention Director Dr. Rochelle ... [+] Walensky answers a question during a Senate Appropriations Subcommittee hearing to examine the FY 2022 budget request for the Centers for Disease Control and Prevention on May 19, 2021 in Washington, DC. (Photo by Greg Nash-Pool/Getty Images)
At a Congressional hearing on Wednesday, March 30th, House Democrats and Republicans criticized each other for political interference in Covid-19 policy. Theyre both right, but for totally different reasons. Public health has been hijacked by politics, and it has occurred throughout the Covid-19 pandemic, during both the Trump and Biden Administrations. At times, the Trump Administration blatantly disregarded science, even going so far as to undermine public health officials. The Biden Administration hasnt sabotaged public health measures. Yet, it has allowed politics to trump public health in pernicious ways.
In order to renew the publics trust in public health, its vital that agencies such as the Centers for Disease Control and Prevention (CDC) be as independent and apolitical as possible.
Coinciding with the drop in Omicron cases, the White House announced last month that the CDC would ease federal mask-wearing guidelines. Furthermore, virtually all states (including ones run by Democratic governors) lifted mask mandates. Are these instances of following the science? Or, are public health officials and political leaders simply putting the pandemic in the rear-view mirror, a potential Omicron BA.2 wave, notwithstanding?
Whats clear is that theres enormous political pressure to return to normality, after two years of Covid-19 rules. Moving on - the Democratic Partys talking point suggests easing pandemic exhaustion - is an understandable human urge. But, that doesnt mean its science-based. And, this isnt the first instance of political behavior masquerading as science-based guidance.
When delivering statements on masking and vaccine efficacy against transmission of the coronavirus, the CDC has repeatedly used the phrase follow the science. Yet, the agency has changed course repeatedly on masks and moved the goalposts on vaccine efficacy. The end-result has been muddled messaging thats not necessarily rooted in science. As a consequence, this has contributed to public mistrust.
Experts have said that part of the resistance to masks, social distancing measures, and vaccines stems from confusing public messaging disseminated by public health officials throughout the pandemic.
The problem is exacerbated when multiple government agencies are involved in messaging and they contradict each other. An illustrative example of miscommunication, lack of coordination, and politicization was the first booster rollout in the autumn of 2021. In August 2021, President Biden said the Administration would begin offering boosters en masse on September 20th, pending Food and Drug Administration (FDA) and CDC authorization. A couple of weeks later, the FDA and CDC tried reining in the White House, saying that there wasnt enough data yet to make a blanket recommendation on boosters. And then, at the end of September 2021, the two government agencies themselves issued contradictory recommendations on boosters, which led to confusion. First, a panel of advisers to the FDA recommended booster shots for those over 65, at high risk of Covid-19 complications, or employed in sectors that put that at risk of severe Covid-19 teachers. Subsequently, about a week later, a different panel, the Advisory Committee on Immunization Practices (ACIP) - which is part of and advises CDC - stated that people employed in professions that may expose them to more risk of severe Covid-19, ought not to get boosters. A day later, the CDC director Walensky overruled ACIP.
This is merely one instance in which the FDA, CDC (and ACIP within CDC), and the White House clearly didnt communicate or coordinate optimally, and seemingly had different interpretations of follow the science.
To be fair, the CDC has been up against a vocal and influential anti-science movement, which makes messaging all that much more difficult. Bizarrely, for instance, in right-wing political circles, ivermectin became increasingly popular as an antidote to Covid-19. The drug has been embroiled in a Covid-19 culture war that pits unproven treatments, such as ivermectin, against proven measures, such as vaccines.
Also, many have called into question efforts to mitigate Covid-19 spread as well as vaccine mandates, asserting such public health measures intrude on individual rights. This has been a driving force behind the curbing of public health powers by state and local authorities. And, in the extreme, an anti-science mob has accused the worldwide public health movement of being fascist, likening vaccine mandates to the wearing of yellow stars of David, for instance.
But, its clear the problems of communication and messaging didnt help matters, and they began almost as soon as the pandemic struck.
Early in the pandemic, public health officials said masks were not necessary for anyone who was not showing symptoms. They in fact discouraged people from buying them.
The CDC then changed course in early April 2020, saying that new research showed asymptomatic carriers were common spreaders of the virus, though some experts say the evidence for proper mask usage had already been demonstrated.
One year later, CDC Director Walensky stated that vaccinated people do not carry the virus. On May 13th 2021, people were told they no longer needed to wear masks indoors or outdoors if they had been vaccinated. At the time, many scientists criticized the comments, saying it was too soon to know for certain what effect the vaccines may have on transmission. And, it turns out that vaccinated individuals infected with the Delta variant were found to be able to transmit the virus as easily as those who are unvaccinated.
Walensky soon announced a reversal in guidance on masking among people who are vaccinated. The new guidance reflected a strategic retreat. Walensky stated that even people who are vaccinated should wear masks indoors in communities with substantial viral spread.
But, this wasnt the only mask blunder made by the CDC Director. Last month, Walensky called the mask the scarlet letter of this pandemic. This was a bizarre reference for something that doesnt evoke shame. Moreover, it was an exceedingly poor analogy. In Hawthornes famous book, at first, the scarlet letter that Hester Prynne wore was a punitive emblem; a symbol of shame for a sin committed. Surely, masks arent that. Then, the letter evolved over time to become a source of rejuvenation for Prynne. Masks arent that, either.
Besides poor messaging and unfortunately chosen metaphors, the CDC has also been hiding key data the agency has collected on hospitalizations stratified by age, sex, race and vaccination status. Similarly, the CDC has not released comprehensive efficacy data on boosters. To illustrate, two months ago, when the CDC published the data on the effectiveness of boosters in adults younger than 65, it left out the numbers for the 18 to 49 year old group. This kind of information could help state and local health officials better target their efforts to bring the virus under control. Nonetheless, the CDC has been reluctant to release this data for fear it may be misinterpreted.
Candor, based on nuanced and detailed analyses, builds trust. For example, it would be better to openly acknowledge vaccines limitations - theyre much better at preventing hospitalization than decreasing transmission - than to gloss over the issue. Whats worse, concealing or selectively cherry-picking data leads to a breach of trust, which the anti-science crowd seizes upon as it rails against the medical establishment.
CDC could do its part by being as neutral an arbiter as possible while improving messaging. In turn, this would lessen the mistrust that exists.
Its important to not allow questions of science to become captives of partisan politics on either side of the aisle, as this will have negative implications for future public health policies. Public health authorities should be consistent, truthful, and transparent, and not change mid-course due to political pressure. Otherwise, the publics confidence in government decision-makers erodes over time.
Full coverage and live updates on the Coronavirus
MONTGOMERY, Ala. Protection offered by COVID-19 vaccine decreases over time, and the Alabama Department of Public Health cautions that even in times of low community transmission, the risk for older and immunocompromised persons to become severely ill with COVID-19 is not zero. In order to maintain the highest level of protection from vaccinations, the U.S. Food and Drug Administration (FDA) has authorized a second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines for individuals ages 50 and older and certain immunocompromised individuals.
The Centers for Disease Control and Prevention (CDC) also updated its recommendations for expanded booster eligibility, as described in a recent news release:https://www.cdc.gov/media/releases/2022/s0328-covid-19-boosters.html.Adults who received a primary vaccine and booster dose of Johnson & Johnsons Janssen COVID-19 vaccine at least 4 months ago may now receive a second booster dose using an mRNA COVID-19 vaccine.
The FDA previously authorized a single booster dose for certain immunocompromised individuals following completion of a three-dose primary vaccination series. This action will now make a second booster dose of these vaccines available to other populations at higher risk for severe disease, hospitalization and death. Emerging evidence suggests that a second booster dose of an mRNA COVID-19 vaccine improves protection against severe COVID-19 and is not associated with new safety concerns.
FDA amended the emergency use authorizations as follows:
A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine may be administered to individuals 50 years of age and older at least 4 months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine. A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine may be administered to individuals 12 years of age and older with certain kinds of immunocompromise at least four months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine. These are people who have undergone solid organ transplantation, or who are living with conditions that are considered to have an equivalent level of immunocompromise. A second booster dose of the Moderna COVID-19 Vaccine may be administered at least four months after the first booster dose of any authorized or approved COVID-19 vaccine to individuals 18 years of age and older with the same certain kinds of immunocompromise.
For some immunocompromised persons, this will be a fifth dose of vaccine (three for the primary series and two booster doses). This authorization applies only to the Pfizer-BioNTech and Moderna COVID-19 vaccines and the authorization of a single booster dose for other age groups with these vaccines remains unchanged.
The FDA has determined that the known and potential benefits of a second COVID-19 vaccine booster dose with either of these vaccines outweigh their known and potential risks in these populations.For more information about COVID-19, please visit: https://www.alab.
FLINT, MI Vaccine distribution and COVID-19 testing clinics will continue at Flint police mini stations for the immediate future, officials said.
On Wednesdays and Fridays, from April 1 through May 31, Flint police mini stations will continue hosting vaccination and testing clinics.
The North End mini station clinic at 4535 Martin Luther King Avenue will be open on Wednesdays, from 5 p.m. to 8 p.m.
The Dort Mall mini station clinic at 3600 S. Dort Hwy. will operate from 11 a.m. to 2 p.m. on Fridays.
The clinics, supported by the City of Flint as well as the Michigan Department of Health and Human Services, first provided vaccines and COVID-19 testing in February.
The mini stations opened in late October 2021 as part of an initiative by Flint Police Chief Terence Green to engage with the public to help combat crime in the city.
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The discovery and approval of effective and safe covid-19 vaccines has provided a glimmer of hope during a seemingly intractable crisis. The vaccines were rapidly distributed across the globe, with priority given to the most at-risk populations in many rich countries.1 While many have called for the equitable distribution of vaccines across the globe through COVAX, and continue to do so, this continues to be far from the reality. As of 1 April 2022, 64.5% of the worlds population has received at least one dose of the vaccine; yet, this proportion is only 14.5% in low-income countries.2 It is in this context of vast vaccine inequity that we discuss Rwandas vaccination strategy and milestones over the past year.
Today, Rwanda has fully vaccinated over 60% of its population.2 In a continent that is a covid-19 vaccine desert, this result is due to the hard work and early preparation of those in charge of the vaccine programme. Months before receiving covid-19 vaccines in the country, the Scientific Advisory Group and National Task Force for covid-19 vaccination met weekly to devise a vaccination strategy, identify gaps, and strengthen cold chain capacity.3 Following these deliberations, Rwanda bought 437 new refrigerators, refrigerated vehicles, passive containers for transportation and 5 ultra-low temperature freezers to ensure readiness for the Pfizer vaccine which at that time needed be stored at 70C.34 By the time of arrival on 3 March 2021, the country was ready with the capacity to store over 5 million vaccines.
Following scientific advice aligned to the World Health Organisations (WHO) guidelines, Rwanda developed a vaccine priority list that included the most at-riskmedical professionals and community health workers, older populations, individuals with underlying conditionsincluding those in prisons and refugeesand all essential workers.4 As more people were vaccinated in the country, the priority list was expanded to all individuals over 60 and over time, this age limit was reduced to 18 years old.5 This national priority list was conceived rapidly and accurately using a nationwide demographic screening programme up to the community level and an up-to-date registry of non-communicable diseases at the facility level. This list is also currently being applied to the rollout of booster shots.6
To make this equitable and effective distribution a reality, Rwanda adopted a coordinated and organised plan. Every single individual, both within the ministry of health and in implementing partner institutions, knew what to do. More than a month before vaccination started, at least two vaccination teams were appointed at each health facility across the country to ensure that healthcare workers had the capacity to vaccinate, manage, and electronically track the vaccinated.3 Moreover, the location of vaccine delivery was adapted to reach communities that are most at-risk and hard-to-reach. For instance, door-to-door vaccination was adopted for those above 60 and those living with disabilities.7 When the Ministry of Health expanded the eligibility list to include those above 18, the campaign was first focused in Kigali which is the most densely populated region and carries the highest covid-19 burden.5 Afterwards, the delivery was done across the country following these criteria.
While many have claimed vaccine hesitancy to be the major hurdle to covid-19 vaccination in Africa, this is largely inaccurate. According to a 2018 Wellcome Trust study, the Rwandan population has the highest trust in the public health system, which explains the countrys high childhood vaccination rate.89 This high level of trust was further reinforced by the governments open communication. The Ministry of Health worked alongside various partners such as faith-based organizations, NGOs, local authorities, and the media to provide more information on the vaccines and dispel any misinformation. Examples of public engagement channels used include a one-page fact sheet and radio and TV channels.10
One example of the vaccine rollout is on the night of 3 March 2021, 340000 vaccines from COVAX from Pfizer BioNTech and Oxford/AstraZenecaarrived in Rwanda.11 They were kept overnight at the central storage facility and recorded in an electronic registry. By noon of 4 March, the vaccines were distributed to all district hospitals that in turn distributed them to all health centers the same afternoon, using health sector trucks and other modes of safe transport available including military helicopters. The quantity of vaccines allocatedto each district and health facility was based on a list created during the preparatory phase.3 On the morning of 5 March, Rwanda had started vaccinating healthcare workers across the country and within three weeks, Rwanda had vaccinated 348000 people, including doses donated by China at that time.
Rwanda has surpassed the 30% target it had set for the end of 2021 and is well on its way to achieving the 60% target for June 2022, having already vaccinated nearly 60% of its population. It is because of this efficiency and success that Rwanda Biomedical Center was named one of the covid-19 Vaccination Centers of Excellence by Africa Centers for Disease Control and Prevention (CDC).12
Competing interests: none declared.
Provenance and peer review: commissioned, not peer reviewed
Tony Blair Institute for Global Change. Vaccinating Africa: What Governments Can Learn From Rwandas Effective Rollout. https://institute.global/advisory/vaccinating-africa-what-governments-can-learn-rwandas-effective-rollout
shaunl / Getty Images / iStock
Headache is a common disorder and head pain is a common experience in the lives of almost everyone. The prevalence of headache within one year is 43% in people aged below 50, and on a given day, 6-17% of persons of any age may experience headache. Like all vaccinations, including those aimed to protect against SARS-CoV-2 (the virus responsible of COVID-19), there may be side effects.
Our latest systematic literature review with meta-analysis assesses the occurrences of developing headache after COVID-19 vaccination. Our results are based on 84 clinical trials testing the efficacy, effectiveness and safety of the vaccines that have been developed between 2020 and 2021, for a total of 1.57 million persons receiving one vaccine or a placebo.
In the week after the first administration, 22% of vaccine recipients developed headache while 10% among placebo recipients reported headache. After the second administration, these percentages raise to 29% and to 12% among vaccine and placebo recipients, respectively. Headache is the third most common side effect the most common being pain at injection site.
Generally, duration of headache onset within the first day from injection is below 24 hours, of a moderate intensity, and benefits from treatment with acetylsalicylic acid. It is bilateral (i.e. on both sides of the head) in 7075% of the cases, and 3040% of the patients describe a pulsating quality. Aggravation with activity is the most common accompanying symptom, followed by phono/photophobia (i.e. being bothered by light and noise) and nausea.
Taken as a whole, the features of such a headache do not resemble migraine-like headache in most of the cases; however, in approximately one third of the cases, migrainous features seem to be met, and this appears to be much more common among people with pre-existing migraine.
The causes of headache after vaccination against SARS-CoV-2 are poorly understood. However, it seems to related to a systemic inflammatory response with a still unclear mechanism, and it is a reversible mechanism: in other words, it will resolve in few hours.
Very few anecdotal exceptions to this common non-severe and reversible post-vaccination headache have been described as case reports of complications of vaccination, specifically as cases of cerebral venous thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (VITT). The main differences from the normal vaccine-associated headache lies in the delayed onset (5-10 days), and headache being described as severe, progressive and treatment-resistant.
In sum, headache is a common side effect of vaccination after SARS-CoV-2, and it is almost always a non-severe effect. It presents within the first day and resolves within a day with bed rest or acetylsalicylic acid in 18-27% of the cases after the first dose, and in 23-35% after the second dose. It may have migrainous features in around a third of the cases, particularly among persons who already suffer from migraine.
