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Mandating COVID Shots – Part II

There is a major new development that may impact the number of employers mandating COVID-19 vaccinations. Just this Monday (August 23), the Food and Drug Administration (FDA) granted full approval to the Pfizer/BioNTech COVID-19 vaccine for individuals, ages 16 years and older. Prior to this, the vaccine was available under emergency use only, which is still the case for individuals, ages 12 through 15, and for “the administration of a third dose in certain immunocompromised individuals.”

This full approval cannot come soon enough. According to the Iowa Capital Dispatch, about 2,200 new COVID-19 cases are occurring each day in Iowa. A recent study published in Health Affairs found that COVID-19 vaccines prevented nearly 140,000 deaths during the first five months of the vaccine campaign. This number is approximately the size of Cedar Rapids. Finally, a Kaiser Family Foundation research brief published last week reveals that about 113,000 Americans could have avoided being hospitalized in June and July if they had received the COVID vaccine – which amounted to an estimated cost of $2.3 billion.

For individuals and employers on the fence about whether to obtain (or mandate) vaccinations, this latest move by the FDA signals that the (Pfizer) vaccine was determined to be both safe and effective – far outweighing the potential risks. The two shots together were found to be 91 percent effective at preventing COVID-19 and potentially serious outcomes, including hospitalization and death. The full approval by the FDA provides a stronger, fortified reason for employers to consider implementing – if desired – a vaccine mandate at the workplace.

New Reports that may Help Employers

I must give a big thanks to the May 20 podcast of Tradeoffs that addressed the employer mandate issue. This particular episode provides much of the background information that I am about to share on WHY employers might seriously consider mandating vaccine shots to their employees.

  1. Requiring Vaccines Actually Works

    Many studies show that, by mandating vaccinations at work – such as the flu shot – more people get vaccinated. Nursing homes and other healthcare settings (hospitals included) spell this out. For employers in other sectors, having more workers vaccinated will translate to having a safer work environment that results in fewer sick days and a smaller probability of new virus strains developing.

  2. Vaccines Reduce Community Spread

    According to a new study in The Journal of Human Resources by Corey White, a Cal Poly, San Luis Obispo health economist, California hospitals and counties that implemented influenza vaccine mandates for their employees found there was an uptick of flu shots by about 10 percentage points. But just as importantly, there was a 40 percent drop in the number of patients who caught the flu at the hospital, in addition to a 20 percent drop in people coming into the hospital with the flu. White calls this a ‘positive externality’ benefit, as it benefits not only the person getting the vaccine, but also reduces the risk of spreading the disease to others. It must be noted this may not be a perfect generalized finding for non-medical employers, but it does suggest that any employer, regardless of size and industry, may greatly impact their own community with such a mandate. This is especially true if many customers visit popular businesses throughout the community – such as restaurants and grocery stores.

    We also know that because COVID has become more politicized than the flu, mandating COVID shots may elicit a stronger response from employees than a simple flu mandate.

  1. Provide Exemptions, But Stay Vigilant About Asking Employees

    Brandyn Churchill, a Vanderbilt PhD candidate, released a study that found an 11 percent increase in the number of Washington D.C. school girls receiving the HPV vaccine by allowing parents to make the decision once a year, rather than only asking one time. The study suggests that employers, who may be concerned with employee backlash, can provide ‘generous exemptions’ to their mandates – such as for medical reasons or religious objections – but still increase vaccination rates if they repeatedly approach their employees about getting vaccinated. According to Churchill, how opt-outs are designed can actually lead more employees to getting vaccinated. From his study, it is unknown whether the uptick resulted from the HPV vaccine becoming more normalized during a period of time and therefore more accepted by parents, or because parents were asked more frequently to vaccinate their daughters. Churchill believes both reasons helped push the vaccination rate upwards. The takeaway from this study is that vaccine-hesitant people should be given plenty of opportunities and have options that are based on credible and relevant information. Over time, the vaccination rates will rise.

Final Thoughts…

It is true that in the new world in which we live, COVID is a wild-card on how employees will accept a workplace vaccination mandate. Will our ‘liberties’ be lost, or will we finally gain our freedom from this pandemic? Because the information on COVID-19 is so imperfect and ever-evolving, the delicate balance of providing caveats and caution must be used by employers to ensure that trust is built and maintained for a more informed workforce. The full approval by the FDA for the Pfizer vaccine is a good step toward increasing the vaccination rate. Hopefully, when thorough and appropriate analysis has been completed on the other two vaccines, additional approvals will be forthcoming.

From this, we can all benefit.

NOTE: For additional background on this topic, please see my August 4 blog, Can Employers Mandate COVID Shots?

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Trusting Science – Who will be the next ‘Elvis’ in 2020-21?

Unfortunately, the race for a Covid-19 vaccine is sounding so political that it is proving to divide Americans by party voting preference. As we are now keenly aware, science and politics do not mix well.

Following the Democratic National Convention, V.P. Mike Pence told CNN: “We think there is a miracle around the corner. We believe it’s very likely that we’ll have one or more vaccines for the coronavirus before the end of this year.  All of that’s attributed to President Trump’s leadership.”

As of August 31, the number of confirmed Covid-19 infections in the U.S. has topped 6 million, while national fatalities approach 183,000. Based on state sources in Iowa, there have been 64,102 confirmed cases and 1,110 deaths.

Vaccine speed is desperately needed, but will it come at the expense of accuracy and safety? Should Americans be concerned? Yet, just as important as having an effective vaccine, is the trust that Americans have in believing that government officials will do what’s right, not just what is most expedient for political purposes.

Trusting science during this era of social media and partisan politics may be very difficult to overcome. But 64 years ago this coming October, Elvis Presley stepped up. The eventual King of Rock-and-Roll became an influencer for a segment of Americans. More on that later…

Herd Immunity

Having trust in our national infrastructure to develop and distribute effective and safe vaccines is paramount to reaching herd immunity, which is having enough people become immune to a disease to make its spread unlikely. Many experts estimate between 60% and 70% of the population need to be immune in order to achieve herd immunity.

Here’s the growing concern: We could have the most effective and safe vaccine available, but if few Americans take it, then it won’t matter.

During the past six months, Americans have seen highly-touted solutions fall short of the hype. The U.S. and the world are starving for good news concerning a Covid-19 vaccine. The haste for finding the silver bullet is causing both confusion and hesitation for Americans to feel comfortable enough to eventually obtain a vaccine when it does become available.

As intent as one political party is for news of a year-end vaccine that could help ‘save’ the presidential election, the opposing party is nervously hoping any promising news does not occur until AFTER the election. Both parties are in precarious and compromised positions. This tug of war competition uses science as the rope.

Polling on ‘Vaccine Hesitancy’

Vaccine hesitancy is showing up in national polling during August. The results indicate that about half of Americans are ‘highly likely’ to get vaccinated for Covid-19. An Associated Press/NORC Center for Public Affairs online poll in May indicated that half of Americans would hesitate to take or refuse a vaccine, while a King’s College London study found similar numbers in the United Kingdom. To make matters worse, a vaccine may likely need two doses, not just one. Convincing people to seek a vaccine twice will be quite challenging.

According to scientists and America’s own Dr. Anthony Fauci, a widespread uptake of a coronavirus vaccine is the most effective tool in combating infectious diseases. But so far, the type of information being shared with Americans is both inconsistent and, in many cases, inaccurate. This is not a good combination needed to build the necessary trust in achieving herd immunity.

Below is a short list of examples that will erode American public trust if and when a proven vaccine becomes available.

1. Operation Warp Speed (OWS)

Introduced in early April 2020, Operation Warp Speed was initiated by the Trump Administration to facilitate and accelerate the development, manufacturing, and distribution of Covid-19 vaccines, therapeutics, and diagnostics. As a public-private partnership consisting of federal agencies and private pharmaceutical firms, OWS promotes mass production of multiple vaccines based on preliminary evidence allowing for faster distribution if clinical trials confirm one of the vaccines is safe and effective. Congress has directed nearly $10 billion to fund OWS so that any vaccine or therapeutic doses purchased with U.S. taxpayer money will be given to Americans at little or no cost.

Four coronavirus candidate vaccines are expected to be in large-scale clinical trials by the middle of September – a remarkable timeline since the SARS-CoV-2 virus was discovered in December. However, the marketing of “Warp Speed” causes concerns for critics and some science experts that the government and its research partners may cut corners that would increase the likelihood that chosen vaccines are not really safe and effective.

2. Convalescent Blood Plasma Treatments

On the eve of the Republican National Convention, the FDA Commissioner, Dr. Stephen Hahn, reiterated President Trump’s proclamation that 35 people out of 100 (35 percent) would survive the coronavirus if they were treated with convalescent plasma. This “historic breakthrough” was based on preliminary findings of Mayo Clinic observations.

However, medical experts and scientists – including former FDA officials – pushed back saying the treatment’s value has not been established, and the claims vastly overstated preliminary findings of the Mayo Clinic.  One day later, Hahn backtracked from his comments, stating, “…The criticism is entirely justified. What I should have said better is that the data show a relative risk reduction not an absolute risk reduction.”

The FDA is under intense pressure from the White House to move the approval process along when deciding whether upcoming vaccines are safe and effective for Covid-19.

3. CDC Using Yesterday’s Technology to Fight Covid-19

The Centers for Disease Control and Prevention (CDC) is the federal agency that has primary responsibility for handling infectious diseases, which is a huge lift during this pandemic. Yet, according to authors Joel White and Doug Badger in a recent Op-Ed in the Chattanooga Times Free Press, “the CDC uses an antiquated system to collect information essential to fighting the coronavirus.” The CDC, since 2006, has ignored four separate laws requiring it to build a modern, efficient system for collecting information to combat disease. Currently, they argue that “medical workers literally phone or fax in their data. And when they do, it’s not the data we need.” Fax???

During the week of August 24, the CDC quietly released controversial new guidelines that caused an outcry from various medical groups and allegations of political intervention. The agency dropped its previous recommendation to test everyone who’s come into close contact with a person infected with Covid-19 – even those who don’t have symptoms. Confusion reigns on what one should do if they become recently exposed but have no symptoms.  In fact, several large states and providers rebuke this latest testing plan.

4. Hydroxychloroquine

On May 18, President Trump claimed that he has been taking doses of hydroxychloroquine, a drug he has highly touted as a potential coronavirus cure despite concerns from medical experts and the FDA, specifically regarding its efficacy and potential harmful side effects.

Initial data from observational studies have shown this drug has limited or unproven benefits for Covid-19 patients, and could be harmful when used in certain combinations.

5. Reporting Glitches from the Iowa Department of Public Health

Not to be outdone by the CDC, according to an August 28 Des Moines Register article authored by Lee Rood, the state health department has drawn widespread criticism from other Iowa county authorities because of data collection and reporting problems, resulting in thousands of coronavirus infections being misreported. The accuracy of underreported new infections has plagued the state for months.

6. U.S. Postal Service Delivery Problems

This summer, U.S. Postmaster General Louis DeJoy, a Republican, has been slashing budgets and services due to poor finances, causing concern on whether the USPS can handle mailed-in ballots of three-quarters of the voting population this coming November. In fact, the Postal Service informed 46 states and the District of Columbia that it did not have service capacity to meet the deadlines for voters to request and send in ballots, prompting almost two dozen states to sue DeJoy and the Postal Service. The fundamental infrastructure for voting now becomes highly questionable because the mail service has become politicized.

Who will be the next ‘Elvis Presley’?

The first half of the 20th century saw a series of polio epidemics affect hundreds of thousands of children across the world. As a result, many were left seriously incapacitated, with one victim being Franklin D. Roosevelt, the future U.S. president.  Major research was launched to combat polio, and in 1955, Dr. Jonas Salk announced that he developed a vaccine, that provided more than 90 percent protection after three shots.

At that time in America, the American public was somewhat indifferent towards the importance of vaccinations, in fact, there were organizations that lobbied against vaccinations in general, including polio.

Initiatives were launched for children to take the vaccine, but few U.S. teenagers and adults sought to be immunized, most believing they were not at risk. To boost teenager take-up of the polio vaccine, Elvis Presley was recruited, receiving massive media coverage while receiving the shot prior to his appearing on the Ed Sullivan Show 64 years ago this coming October 28. Newspapers all over the country published photos of the Presley vaccination. This publicity ‘stunt’ suggested that the vaccine was safe and helped promote public confidence. Presley, it should be mentioned, continued to work on behalf of the National Foundation for Infantile Paralysis and the vaccination became one of his advocacies.

Moving Forward

Even in ‘better’ times, there is a segment of the American population that believe vaccinations are not safe and can cause dangerous health problems, such as autism. In 2015, a Pew Research Center study found that about one in 10 Americans believe vaccines for diseases such as measles, mumps and rubella are not safe for healthy children.

By this November, the U.S. Department of Health and Human Services plans to launch a public-awareness campaign across television, radio and social media, with the intent of focusing on vaccine safety and efficacy. Medical experts will be paired with celebrities to help these messages resonate with the public. Based on the confusion, doubts and concerns mentioned earlier, this will be a formidable challenge to overcome.

Several health policy experts envision vaccine ‘mandates’ coming from the government, much like the current vaccine requirements for school-age children, military personnel, and hospital workers. Imagine restaurants and bars having signs at the entrance saying, “No Shirt, Not Shoes, No Inoculation, No Service.” Providing proof of inoculation (and booster shots) could be mandatory before entering the establishment. In essence, being inoculated becomes your reward for doing the right thing.

It’s time to put science ahead of politics. Trust, as we all know, must be diligently earned.

Will the next ‘Elvis’ be able to restore our sagging confidence?

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