The federal government should develop a new infrastructure for rapidly gathering public health data, suggests a paper on the lessons from the COVID-19 pandemic discussed at the Brookings Papers on Economic Activity (BPEA) conference on March 28.
The improvised strategy to fight COVID-19public and private behavioral changes to slow transmission until vaccines could be deployedprevented close to 800,000 deaths in the United States, write the authors, Andrew Atkeson of UCLA and Stephen Kissler of the University of Colorado-Boulder.
Absent that two-pronged strategy, their epidemiological model (using blood test data on disease exposure and vaccination) suggests that 1.98 million COVID-related deaths would have occurred over the past four years rather than the 1.18 million deaths that did occur.
However, the authors write in The Impact of Vaccines and Behavior on U.S. Cumulative Deaths from COVID-19, the ad hoc efforts effectiveness came as a surprise. Public health officials could not precisely target mitigation because they lacked precise information on the routes and mechanisms of the diseases transmission.
In a highly decentralized system, the federal government collates vital statistics gathered by counties and states, Atkeson noted in an interview with The Brookings Institution. For instance, it took the Centers for Disease Control and Prevention four to five months to get nationwide hospitalization statistics, he said.
We stumbled through it without a plan, he said. We were basically flying blind.
Kissler, in an interview, said a new infrastructure should offer much faster diagnostic testing and contact tracingwithin daysso health officials can understand where and how a new disease is spreading. And data collection should be ongoing, before the next pandemic, so officials can compare data from any new disease against a baseline.
We argue that we need to make investments now not only in vaccine development but also in data infrastructure so that we can precisely target mitigation efforts to minimize the economic and social impacts of mitigation with the next pathogen, the authors write in the paper.
Looking back at the COVID-19 pandemic, the authors note that without behavioral changes to slow transmission in 2020, the vast majority of the U.S. population would have become infected before vaccines were deployed during the first half of 2021. But, without the vaccines, behavioral changes alone would have slowed but not prevented the spread of the disease.
It was the combination of behavioral changes and rapid vaccine development that saved lives. However, vaccine hesitancy and the slowdown in their deployment during the second half of 2021 cost an additional 273,000 preventable deaths from the Delta and Omicron variants, they write.
Download the conference draft
Atkeson, Andrew and Stephen Kissler. 2024. The impact of vaccines and behavior on US cumulative deaths from COVID-19. BPEA Conference Draft, Spring.
The Centers for Disease Control and Prevention (CDC) today warned healthcare providers about a rise in invasive meningococcal disease, mainly from Neisseria meningitidisserogroup Y, with some patients having symptoms that aren't typical for meningitis.
In a Health Alert Network (HAN) notice, the CDC said that, for 2023, it recorded the most US serogroup Y cases since 2014, and so far cases this year are tracking ahead of last year's numbers. As of March 25, the CDC has received reports of 143 cases for 2024, 62 more than the 81 cases reported at this time last year.
Most of the cases involve a specific meningococcal strain, ST 1466, which is disproportionately affecting adults ages 30 to 60, Black or African American people, and those with HIV.
Most of the patients with ST 1466 infections last year had symptoms other than meningitis, especially bacteremia but also septic arthritis in some instances.
The CDC recorded 422 cases in all of 2023. Among 74 patients with known outcomes, 17 (18%) died, a higher case-fatality rate than the 11% seen for serogroup Y from 2017 to 2021.
The CDC said ST 1466 has contributed to previously reported increases in meningococcal disease in people with HIV. Of 24 HIV patients infected with the subtype in 2022 and 2023, only 4 had received the vaccine against serogroups A, C, W, Y (MenACWY), and, of those, none were up to date with their doses. "To date, no other ST-1466 cases have been identified in people who previously received MenACWY vaccine," the CDC said.
It urged healthcare providers to have a heightened suspicion for meningococcal disease in the disproportionately affected groups, to be aware of atypical symptoms, and to ensure that all people recommended to receive the MenACWY vaccine are vaccinated, especially those with HIV.
US states with a 10% increase in Republican voting reported a 5% increase in COVID-19 vaccinerelated adverse events (AEs), a 25% increase in severe AEs, and a 21% higher proportion of AEs characterized as severe, with more pronounced associations in older people, a study today in JAMA Network Open concludes.
A University of Pennsylvanialed research team analyzed 620,456 AE reports filed by adult vaccine recipients or their clinicians in the Vaccine Adverse Event Reporting System (VAERS) database from 2020 to 2022, and compared them with AEs after influenza vaccination from 2019 to 2022. They examined the AEs against state-level proportions of Republican votes in the 2020 US presidential election.
The average age of vaccine recipients was 52 years, and women made up 70.2% of AE reporters. Vaccinees were able to file more than one report.
VAERS reports have not been verified, the Centers for Disease Control and Prevention (CDC) notes. "Anyone, including healthcare providers, vaccine manufacturers, and the public, can submit reports to the system," the CDC says. "While very important in monitoring vaccine safety, VAERS reports alone cannot be used to determine if a vaccine caused or contributed to an adverse event or illness."
"Antivaccine sentiment is increasingly associated with conservative political positions," the study authors wrote. "COVID-19 mortality has been higher in US jurisdictions that are more conservative in their party registration,voting history,or representation.These differences are likely explained, in part, by differences in vaccination rates."
Significant links were seen between state political inclination and state AE reporting for all three outcomes: a 10% increase in Republican voting was tied to greater chances of AE reports (odds ratio [OR], 1.05), severe AE reports (OR, 1.25), and the percentage of AEs characterized as severe (OR, 1.21).
These results suggest that either the perception of vaccine AEs or the motivation to report them was associated with political inclination.
While these associations were seen across all age-groups, they were more pronounced among older people. There was no such association for the flu vaccine.
"These results suggest that either the perception of vaccine AEs or the motivation to report them was associated with political inclination," the researchers wrote.
They added that the link between observation and belief is bidirectional. "The adage 'seeing is believing' recognizes that our individual experiences inform our sense of truth, and 'believing is seeing' recognizes that our preconceptions modulate what we experience in the first place," they wrote.
"In finding that Republican-inclined states show higher COVID-19 AE reporting than Democrat-inclined states, this study suggests that Republicans are more likely to perceive or report those AEs and that Democrats are less likely to," they concluded.
Nairobi, Kenya. Photo by Amani Nation via Unsplash.
By Naomi Frim-Abrams
On March 20, 2024, the Spring 2024 Human Capital Initiative Research Seminar Series hosted Elisa Maffioli, Assistant Professor of Health Management and Policy at the University of Michigan, to discuss her forthcoming study on the effect of social influence on vaccination behavior during COVID-19 in Kenya. The study evaluates a campaign where healthcare providers would visit homes and invite adults to be vaccinated at a site nearby, randomizing the announcement of the visit ahead of time.
COVID-19 vaccines are a vital public health intervention, but are not yet widespread globally, especially in the study area of Kenya. At the time of the study, in Summer 2022, there were 337,000 confirmed cases and 5,670 deaths from COVID-19 in Kenya, and 56 percent of the study sample population had never received a dose of a COVID-19 vaccine.
There are positive externalities to vaccines, and social influence can play a role in vaccine uptake. Maffioli and her research partners focused their study on two research questions: Can convenient access and invitations increase vaccination uptake, and does social influence promote vaccination?
The literature review examined supply and demand barriers to vaccine uptake, as well as the role of social pressure with a specific focus on the influence of healthcare providers. Prior research explored obstacles such as vaccine hesitancy and access; Maffiolis project builds on these ideas by providing both convenience of vaccination and personal invitations through healthcare workers.
Elisa and her fellow researchers decided to follow the Kenyan governments footsteps and mimicked their national COVID-19 vaccine deployment campaign. The researchers tried to address issues of both supply (setting up local vaccination sites) and demand (nudges by sending healthcare workers door-to-door) to improve vaccine uptake. They utilized a one-day vaccination campaign intervention to see the effects of the healthcare workers home visits more clearly, as the researchers could control for the spread of information and make sure that the campaign was being promoted by the healthcare workers alone, rather than news spreading through other community members. Researchers met with village elders to determine ideal sites for vaccinations that were public and identifiable such as churches, schools and community meeting spaces. The sample included randomly selected residents within a 15-minute walking radius of these sites.
The treatment used in this study, whether a healthcare workers visits were announced or unannounced, was randomized, and participants were not aware of which group they were part. Participants in the announced group were informed that a healthcare worker would visit their home within 30 minutes to ask if they wanted to receive a COVID-19 vaccine at the nearby site. Participants in the unannounced group received the health worker visit without being informed ahead of time.
Overall, the authors found an increase in dose uptake at the day of the campaign, and the effects were consistent after three months since the intervention. However, they found no evidence of social pressure by healthcare workers: those in the announced group were instead more likely to go and get vaccinated. Maffioli also discussed cost-effectiveness and policy implications. The researchers calculated that the marginal cost per marginal dose of their intervention, based on their data on recorded costs and the number of doses, was $41.76; for context, the most similar study on COVID-19 vaccinations in Sierra Leone estimated the implementation cost to be $33 per additional person vaccinated. In terms of policy, she spoke to the need to test alternative approaches to find even more cost-effective strategies, such as training community health volunteers or using alternative public transportation.
Throughout the presentation, the audience raised various questions about both the study elements and results. Maffioli first addressed comments as to whether historically there has been backlash against vaccination campaigns in Kenya, and if there is mistrust of medical personnel; she responded that there are actually high levels of trust in medical interventions, however, this was not entirely relevant to her research, as her team was addressing social pressure in uptake through the announced treatment. Others inquired about the privacy of the healthcare worker visit, and whether news of the intervention spread through community members overhearing or seeing the healthcare worker. She acknowledged that this was a strong point of feedback for the study, and they had not asked the healthcare workers to record whether they noticed others unintentionally witnessing their interactions with the participant. In terms of study design, an audience member asked about the randomization of the vaccination sites, as the locations were non-randomized and chosen after discussions with community elders.
Maffiolis research speaks to the health challenges of today, examining how an interdisciplinary approach can aid understanding of social barriers to health interventions. She commented in her conclusion that the delivery and acceptance of new vaccines should be a top global priority. A mode of vaccine delivery, such as the one explored in the study, that addresses barriers to vaccine supply and demand, and receives no backlash if provided by healthcare workers, remains a cost-effective strategy to increase vaccinations.
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Posted3 days ago on Thursday, March 28th, 2024
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In February, the Centers for Disease Control and Prevention, or CDC, recommended adults aged 65 and older receive a vaccine dose.
Adults aged 65 and older are considered the most vulnerable population when it comes to COVID-19 complications. This group has a higher prevalence of chronic conditions and a diminished immune response, making them more susceptible to severe infections, hospitalization and mortality.
Their immune systems are not as robust as the younger population, explains infectious diseases physician Carlos A. Gomez, MD. Because of this, vaccine efficacy could be lower and wane over time.
A report published by the CDC in February examined the updated vaccines effectiveness. The study found that the vaccine was 50% effective in preventing emergency department and urgent care visits, primary indicators of COVID-19 complications.
Dr. Gomez emphasizes that, while the updated vaccine does not entirely prevent COVID-19 infection, the studys findings are encouraging, showing decreased health care utilization.
While 50% effectiveness is not a perfect outcome, it means that patients who receive the booster have half the risk compared with those who didnt, Dr. Gomez says. They still may become infected, but its quite encouraging that they have half the risk of going to the emergency department or urgent care.
The adverse side effects of the updated COVID-19 vaccine remain consistent with previous versions and may include:
Side effects are very mild and go away within two or three days, so this version is very similar to other vaccines we have in the health care system and previous COVID-19 boosters, Dr. Gomez says.
It is recommended that individuals get their booster shot within two months of receiving either their initial vaccination or a previous booster shot. This timeline ensures that the immune response remains robust and provides optimal protection against COVID-19.
And what if you have had a COVID-19 infection are the antibodies your body produced naturally enough to protect you?
If you fall into a group that needs the vaccine, it is better to get it now, even if you have had COVID-19 before, Dr. Gomez says. Between an infection and the vaccine, you will have a greater variety of antibodies and a more robust immune response.
While the CDC specifically emphasized the importance of boosters for adults aged 65 and older, other groups may also benefit from the updated vaccine, such as:
Around 3% of the U.S. population is immunocompromised, Dr. Gomez says. These patients should have an updated COVID-19 vaccine to protect them from bad outcomes.
If you are unsure whether you need a COVID-19 booster, your primary care provider can help you make the determination.
One dose of the updated, single-strain COVID-19 vaccine introduced last fall is 38% effective against hospitalization in the 7 to 59 days after receipt and 34% effective at 60 to 119 days in adults with weakened immune systems, yet uptake in this group is low, estimates a study published today in Morbidity and Mortality Weekly Report.
US Centers for Disease Control and Prevention (CDC) researchers led the study, which was based on data from the Virtual SARS-CoV-2, Influenza, and Other respiratory viruses Network (VISION) collected from September 2023 to February 2024. VISION is a multisiteelectronic health care recordsbased network that uses a test-negative design to estimate COVID-19 vaccine effectiveness (VE).
In the study, 1,392 case-patients were hospitalized for COVID-19 and tested negative for both respiratory syncytial virus (RSV) and influenza, while 13,194 control patients tested negative for both COVID-19 and flu. The most common immunocompromising conditions among case-patients and controls were solid-organ cancer (36% and 43%, respectively) and other immune conditions or immunodeficiency (38% and 35%, respectively).
In total, 195 case-patients (14%) had received an updated COVID-19 vaccine dose, compared with 2,401 (18%) of controls. Participants were categorized as having an impaired immune system based on certain diagnoses at hospital release.
One vaccine dose is recommended for all Americans aged 6 months or older, although people with weakened immune systems, who are at higher risk for severe COVID-19 due to their underlying conditions and to decreased immune responses to vaccination, might need additional doses at 2 months or more after the last recommended dose, the study authors noted.
Among those with an organ or stem cell transplant, a group known to be at particularly high risk for severe COVID-19, only 18% had received an updated dose, representing a missed opportunity to prevent severe COVID-19.
VE against COVID-related hospitalization was 38% in the 7 to 59 days after receipt of one dose and 34% at the 60 to 119 days.
"Relatively few persons in this analysis had received an updated COVID-19 vaccine dose, despite those with immunocompromising conditions being at higher risk for severe COVID-19," the researchers wrote. "For example, among those with an organ or stem cell transplant, a group known to be at particularly high risk for severe COVID-19, only 18% had received an updated dose, representing a missed opportunity to prevent severe COVID-19."
The CDC will continue to track the VE of updated COVID-19 vaccines in high-risk groups such as those with impaired immune systems. "All persons aged 6 months should receive updated 20232024 COVID-19 vaccination; persons with immunocompromising conditions may get additional updated COVID-19 vaccine doses 2 months after the last recommended COVID-19 vaccine," the authors concluded.
As the world marks four years since the spread of COVID-19, scientists, public health officials, and economists are taking stockwith decidedly mixed results. Millions of people around the world died from COVID-19 or related diseases. But millions were also saved by vaccines. In a study published in 2021, scientists put the chances of a major pandemic occurring in any given year at 2 percenta daunting figure, given the death and damage wrought by COVID-19.
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The latest United Nations Human Development Report details vastly uneven economic and social development that is leaving the worlds poorest people behind, worsening inequality and stoking political polarization.
The 2023/24 Human Development Report, Breaking the Gridlock: Reimagining cooperation in a polarized world, reveals that the post-pandemic rebound in the global Human Development Index (HDI)a summary measure reflected a countrys Gross National Income per capita, education and life expectancyhas been partial, incomplete and unequal.
The pandemic precipitated the worlds greatest recession since World War II, with global output falling three times more than during the 20072008 global financial crisis and far more abruptly, as economic activities came to a halt. Global unemployment rates have not yet returned to pre-pandemic levels, pushing more workers into the informal sector where they work for a pittance.
The report, despite the bland and under-stated language of such official publications, makes important points about the worlds growing interdependence amid prolonged power imbalances.
While the advanced countries are experiencing record-high levels of human development, half of the poorest countries have failed to reach their pre-COVID-19 levels. The pandemic led to at least 15 million deaths, the report states, more than all the recent pandemics combined (Asian Flu, Hong Kong Flu, Swine Flu, SARS, Ebola and MERS). The HDIs estimate of global COVID deaths is a conservative one with the more accurate Economist survey estimating approaching 30 million excess global deaths up to the end of 2023. It not only reduced life expectancy at birth in most countries but also impaired other components of the HDI, interrupting access to education and leaving enduring scars on the economy.
This was compounded by what the report described as the mismanagement of global interdependences, more accurately described as the criminality of the major powers in the interests of the financial oligarchy. It cited the refusal of the most advanced countries and pharmaceutical companies to ensure the universal and equitable access to effective COVID-19 vaccineswhose development was the result of international scientific cooperation--both within and between countries. Similarity it referred, without explanation, to the huge disparity in measures taken by governments, meaning the refusal of all governments to take the stringent measures initially embraced by China that would have stopped the virus spreading.
The global HDI value has rebounded to a projected highest level ever in 2023. But this is still below its projected trend pre-pandemic and masks profounds divergence across countries. All 38 members of the Organization for Economic Co-operation and Development (OECD) achieved higher HDI scores compared to their levels in 2019. But among the 35 least developed countries that saw their HDI decline during the pandemic, more than half (18 countries with 328 million people) have not yet recovered to their 2019 levels.
None of the developing regions have met their expected HDI levels based on their pre-2019 trend, shifting instead to a lower HDI trajectory and indicating that these losses are likely to be permanent. This is seen most sharply in Afghanistan and Ukraine, with Afghanistans HDI set back by a staggering 10 years and Ukraines HDI to its lowest level since 2004.
It warns that the global HDI value, while an important value, is a crude yardstick for measuring human development. It reflects incompletely, if at all, to important factors such as the debilitating effects of illnesses, including Long COVID, spikes in mental health disorders, violence against women and loss of schooling, while some lossesincluding 15 million lives lostcan never be recovered. Self-reported stress, sadness and worry rose in most countries, even before the pandemic, which along with the rising sense of dissatisfaction which recent Human Development Reports had covered, had resulted in numerous social protests in 2019.
The report warns that inequality is compounded by substantial economic concentration. For example, it states that almost 40 percent of global trade in goods is concentrated in three or four countries, while the market capitalization of each of the three largest tech companies in the world in 2023 surpassed the Gross Domestic Product (GDP) of more than 90 percent of countries in that year.
The UNHD also drew attention to the worlds growing interdependence.
* Trade in intermediate goods now slightly exceeds trade in final goods, with goods travelling twice as far as and across more borders than they did 60 years ago.
* Financial interdependence has grown, with levels of debt servicing by low and middle-income countries ballooning since central banks hiked interest rates to combat inflation following the outbreak of the US/NATO led war against Russia in Ukraine.
* Digital services exports now account for more than half of global trade in services. Almost everyone is now within range of a mobile broadband network, with 5.4 billion of the worlds 8 billion population using the internet in 2023.
Mehring Books
COVID, Capitalism, and Class War: A Social and Political Chronology of the Pandemic
A compilation of the World Socialist Web Site's coverage of this global crisis, available in epub and print formats.
* The number of people living outside their country of birth has tripled since 1970, from 84 million to nearly 280 million in 2020, equal to 3.6 percent of the worlds population. As well as increasing social, cultural and economic ties, it drives cross-border financial flows.
In addition, the report cites the pandemic, climate change, biodiversity loss, the cross-border implications of pollution and new and reemerging zoonotic diseases potentially resulting in future pandemics that recognize no borders. It warns that every corner of the globe is feeling the effects of dangerous planetary change driven by political choices, while geopolitical tensions, wars and conflicts harm human developmentboth for the countries directly involved and often for many others as well. These conflicts are spilling across not only geographical but generational boundaries, with the wars in Gaza, Ukraine and Yemen reversing human development gains made over generations and shrinking the prospects for young people.
The number of countries involved in conflicts outside their own borders has risen fivefold over the past decade. Of the 55 state-based conflicts in 2022, 22 were internationalized, compared with just 4 of the 37 state conflicts in 2000. This, along with persecution and human rights violations, forced 108 million people to flee their homes, the largest number since World War II and two and a half times that of 2010, not including the latest displacementsPalestinians in Gaza and the Armenia refugee crisis, among others.
One in five children globally lives in or is fleeing conflict. Around 80 percent of the worlds refugees are living in mostly low and middle-income countries. The number of people in need of humanitarian aid is expected to reach 300 million in 2024, while the funding available for humanitarian aid comes nowhere near the level needed.
The report laments the growth of populism, which it says has been fueled by social inequality and the pervasive uncertainty complex that has cast a very long shadow on human development writ large, with recent years marking perhaps an unfortunate and avoidable fork in its path rather than a short-lived setback. It cites research showing that countries with populist governments have lower GDP-growth rates10 percent lower than might be expected under a non-populist government scenario.
Like all such reports, its authors called for multilateralism to play the key role in developing and implementing a new generation of global public goods to confront these challenges and promote equity. Such a bankrupt perspective flies in the face of all the evidence that these same multilateral agencies, dominated by the major capitalist powers acting in the interests of their own global banks and corporations, have fueled the processes they have documented.
The elimination of global inequality demands the mass mobilization of the working class internationally against their exploiters, the capitalist class, its governments, corporations and banks responsible for the impoverishment of humanity and plunging the world into war. It requires an international socialist strategy, uniting workers and youth in the advanced and less developed countries to end the division of the world into antagonistic nation states and implement planned production for need, not profit through a struggle for world socialist revolution.
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