Dean's COVID-19 Commentary

For the United States, vaccine supply is ramping up quickly with President Biden promising that all adults will be eligible for vaccination by May 1, and that there will be a semblance of normalcy by July 4. In Colorado, 1.2 million people have received at least one dose of vaccine and about 725,000 are fully immunized. The pace of vaccination will accelerate by month’s end when the single-dose Johnson & Johnson Janssen vaccine becomes more available. Vaccine hesitancy remains an issue, as chronicled in Weekend Edition on National Public Radio. In a story focusing on rural areas, an interview with a 70-year-old in Ft. Scott, Kanas, was striking. She expressed doubt about the existence and nature of COVID-19 itself, while acknowledging that she knew people who had died from it. She plans not to be vaccinated and questioned the safety of the vaccines since they were so rapidly developed. She was skeptical as to whether efficacy was actually established. The interview is a reminder that achieving the needed level of vaccination requires more than the sufficient availability of vaccines.    

Looking globally, the picture is mixed with “haves” and “have-nots.” Israel is in the lead with nearly half of its population fully vaccinated. Few countries have reached double-digit levels, and many are below 1%. I spoke with a friend in France over the weekend; restaurants are still closed and the percentage fully vaccinated is only 3.2%. I also spoke with a friend in Mexico who is working on a vaccination plan for the 20 million residents of the State of Mexico.  Mexico has fully vaccinated only 0.5% of its population and faces limited supply, relying on vaccines from China and Russia and also the Pfizer and Astra-Zeneca vaccines.  

Not surprisingly, rates are very low, or data are lacking for many low- and middle-income countries. In many of these countries, capacity for clinical care is extremely limited, particularly for those needing intensive care. In Sunday’s Los Angeles Times, Peter Hotez, a pediatrician and vaccine expert at the Baylor College of Medicine, comments on the necessity of providing vaccines for all. He highlights a gap that threatens global health security: no system for producing and distributing vaccines within low- and middle-income countries. He notes that only Rwanda has received any doses of the mRNA vaccines and there is the barrier of maintaining the supply line and cold chain for these vaccines. Hotez points towards efforts to address the vaccine needs of less-developed countries, including Gavi and COVAX. Inequities have surfaced at every level around vaccine allocation and vaccination—they all need to be addressed to end the pandemic. 

In the United States, race and ethnicity have been highlighted repeatedly around the COVID-19 pandemic—as linked to more disease and poorer outcomes—and now as affecting access to vaccination. One group, Asian-Americans, has faced discrimination and violence since the pandemic’s start. The pandemic’s origins in China have wrongly led to repeated and sustained slurs and attacks on Asian-Americans. At the pandemic’s start and subsequently, President Trump and others in his administration repeatedly use the term “China virus” in referring to SARS-CoV-2. The World Health Organization’s best practices advise against using locations in naming viruses, in part to avoid stigmatization. The International Committee on Taxonomy of Viruses (ICTV) also provides structure for naming viruses.  

The consequences of the stigmatization of Asian-Americans have been grave. Hatred and violence have reached to diverse groups perceived as falling in some ill-conceived umbrella of hate around Asians. One place to learn more is in this New York Times “Lesson of the Day.” Such stigmatization of Asian people within the United States is hardly new.  Plague surfaced in San Francisco’s Chinatown in 1900, leading to militaristic control measures directed against its residents. Risse chronicles this story in Plague, Fear, and Politics in San Francisco’s Chinatown. Unfortunately, we have a new epidemic with the same consequences—enough is enough.  

Books about epidemics have been high on my reading list during the last year. I just finished The Pull of the Stars by the Irish writer Emma Donoghue. The book chronicles three days in a maternity ward in an Irish hospital for influenza-infected pregnant women during the Great Influenza. The backdrop is set by the raging epidemic while the story line brings together a nurse, pregnant women, and others in the hospital. The individual stories of the women capture the social fault lines of impoverished Ireland during World War I. The nurse’s thoughts about her patients likely mirror those on the frontline today with COVID-19 patients. It’s a remarkably written book that challenges with its intensity.  

Another one-year anniversary has just been passed; Colorado’s first death from COVID-19. Enjoy the snowstorms of March. 

Jonathan Samet, MD, MS
Dean, Colorado School of Public Health