The COVID-19 Pandemic: Independence Day from COVID-19?Jul 6, 2021
With a majority of adults vaccinated, there is a complementary minority who are not. Dr. Anthony Fauci commented on the implications of this split in the population during the July 4th Meet the Press broadcast, noting that the pandemic would inevitably flare among the non-vaccinated. Across the nation and in Colorado, we face a risk-stratified population: the vaccinated who can safely return to their pre-pandemic lives, and the unvaccinated among whom the pandemic continues. The power of vaccination is shown in the figure below, which captures the relationship between the prevalence of vaccination and the rates of cases and hospitalizations in Colorado's 15 largest counties. The inverse relationship is evident. Note that Mesa County is an outlier, well above the line relating vaccination and hospitalization, perhaps reflecting the early dominance of the Delta variant in the county.
Work continues to address vaccine hesitancy and incentives are being used widely, including lotteries, scholarships, and cash incentives. I remain dismayed that people are rejecting potentially life-saving vaccinations. Listening to why they will not be vaccinated, I see much work ahead for public health. Some refusers will seemingly not be swayed by evidence-based persuasion—“I don’t trust the vaccines”—while others bring political explanations related to limits of governmental interventions to advance public health—“It is my right to not be vaccinated.” The refusers do not acknowledge their broader societal responsibility for the protection of others.
Previously, I mentioned the book, The Premonition: A Pandemic Story, by Michael Lewis, a wonderful storyteller. Having finished the book, I am taking it off my recommended reading list (even though it is in the top 10 among non-fiction on the New York Times Best Sellers list). Like other books by Lewis, he describes a set of seeming visionaries who are out in front of the establishment—in the case of COVID-19, in anticipating a pandemic and thinking about what should be done to rein it in. Their opposition is the establishment—the Centers for Disease Control and Prevention (CDC) and a tribe of epidemiologists. He offers “heroes,” starting the book with Laura Glass, a 13-year-old in Albuquerque who works with her father to build an epidemic model that shows the impact of social distancing, and then moving on to a small White House team working on pandemic preparedness, and to Charity Dean who, as assistant director of the California Department of Public Health, provided early warning of the coming pandemic. Other protagonists include Joe DeRisi and the CZ Biohub.
The “opposition” is the staid institutions of “the establishment” and its leaders. Some are called out, most notably D.A. Henderson, who led the World Health Organization’s smallpox eradication campaign. D.A., a friend from my Johns Hopkins days, is taken to task for skepticism concerning epidemic models. Lewis revisits the 1977 swine flu vaccination campaign, the unexpected epidemic of Guillain-Barré syndrome that followed, and the firing of CDC Director David Sencer—events that set the stage for politics to reach the CDC. He does not deeply probe the CDC and its Director, Robert Redfield, during the COVID-19 pandemic. Books covering that topic will be coming soon, I expect. I am looking for a more substantive analysis than what Lewis offers—one that will take us to lessons learned and institutional change to avoid another pandemic of COVID-19’s scale.
I find myself (anonymously) in the book on the “bad guy” side. Laura Glass enters her modeling work into the national science fair sponsored by the Robert Wood Johnson Foundation—the Young Epidemiology Scholars Competition—and does not win. Per Lewis, the judges were harsh, but Laura acknowledges that she might have done a better job with some tough questions. I was a judge in the competition for its duration and typically engaged the participants with more mathematical projects; did I miss a critical innovation?
Here in Colorado, the epidemic curve’s descent is again stalled and the Delta variant is maintaining its lead. Independence from COVID-19 awaits.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health