At this point, it’s kind of hard to absorb good news about the pandemic. But here is some to brighten your weekend: More than one-third of all people in the United States have received at least one dose of a COVID vaccine as of Friday, according to CDC data. That’s not just one-third of eligible adults. It’s one-third of everyone—kids included.
We’re still a heck of a long way from “herd immunity,” a threshold for blocking most coronavirus transmission that probably requires about 60 to 70 percent of the population to be fully vaccinated. Whether we ever get there is complicated by variants and disparities in global vaccination rates, and so CDC guidelines on mask-wearing, physical distancing, and avoiding crowds are still very much in effect. But after 558,000 deaths and recent dire warnings about surging infections in a handful of states, I’ll take whatever positive signs I can get.
Accordingly, states and cities are expanding eligibility for who can get a shot. As of Saturday, Los Angeles opened up appointments to all people 16 and older. At least 39 states are now allowing all adults to get the vaccine. Oklahoma and New Hampshire plan to start vaccinating outside residents. (Republican New Hampshire Gov. Chris Sununu had previously been criticized for refusing to vaccinate out-of-state college students, insisting they travel home to get their vaccines.)
All in all, the US is administering an average of around 3 million vaccines each day. Less than .004 percent of people—fewer than 1 in 28,000—have reported serious adverse reactions to the vaccine, according to the Department of Health and Human Services.
But questions remain about whether the surge of vaccines are going where they are needed most. On Sunday morning, former Food and Drug Administration commissioner Scott Gottlieb estimated that the US would reach a point “where supply outstrips demand” for the vaccine in as few as three weeks. But for now, he recommended surging vaccine supplies to states like Michigan, currently in the throes of a COVID fourth wave. “I think a lot of states are going to see themselves with excess supply and excess appointments,” Gottlieb said on CBS. “So it’s going to be a shame to look back and in retrospect, realize that we probably should have put more vaccine into some of these hot spots to snuff them out.”
“It’s been sort of a Hunger Games for vaccines among states so far,” Gottlieb added. “And we need to think differently about this pandemic.”
Mother Jones illustration; University of California San Francisco
As the world grapples with the devastation of thecoronavirus, one thing is clear: The United States simply wasn’t prepared. Despite repeated warnings from infectious disease experts over the years, we lacked essential beds, equipment, and medication; public health advice was confusing; and our leadership offered no clear direction while sidelining credible health professionals and institutions. Infectious disease experts agree that it’s only a matter of time before the next pandemic hits, and that one could be even more deadly. So how do we fix what COVID-19 has shown was broken? In this Mother Jones series, we’re asking experts from a wide range of disciplines one question: What are the most important steps we can take to make sure we’re better prepared next time around?
After a year that, for must of us, has been a blur of panic-inducing headlines, good news about the coronavirus sounds like an oxymoron. Monica Gandhi, an infectious disease specialist and the associate division chief of the Division of HIV, Infectious Diseases, and Global Medicine at UCSF/San Francisco General Hospital, wants to change that. After decades of working on the HIV epidemic, Gandhi has learned that fear-based messaging isn’t always effective, and she hopes to help the public health community learn from past mistakes rather than repeating them. Her prolific Twitter feed is full reasons to be hopeful, even as the pandemic persists. But she’s no Pollyanna. “I’m not a fake optimist,” she says. “I’m just looking at data dispassionately.” I reached out to her to talk about the fourth wave, vaccines and variants, and how optimistic messaging could actually help slow the spread of the virus.
On the lessons from HIV that we should be applying to COVID-19: We learned about not using shame-based messaging. [Yet we’re still saying] “Look at all these young people on the beach, how awful that they want to kill the elderly.” [From HIV] we learned a lot about fear-based messaging—that it didn’t work. “You’re gonna die if you do this.” No! “Let me tell you how to keep yourself safe.” There were ways to say: “I am so sorry you miss your family so much. Let me tell you some ways to stay safe and still have some family time.” We have not put that all together. Instead, the message was, “Stay at home.” I think it’s because we’re hoping that people will be scared to death. It works for some people, but it sure has led to a lot of anxiety and depression, where we could have been more nuanced.
On the coming fourth wave of COVID-19: The data is really clearly showing us two things: One is that as cases rise in some states, hospitalizations, luckily, are not rising as much. The other is that those who are getting severe disease are those who aren’t vaccinated yet. So I find this surge fairly different from any other, where you could predictably say, “Oh, this many hospitalizations per case, let’s prepare for this terrible onslaught.” Two countries [the United Kingdom and Israel] are ahead of us in vaccination rates, and we are seeing encouraging signs in both of them. Importantly, in Israel, the cases were going up in January. Then, there was this moment when the vaccine stopping transmission caught up with the cases. Then the cases just came tumbling down. So all we have to do, in my mind, is just look at data in the two countries ahead of us. Everything is looking different and better.
On immunizations and variants: There are two arms of the immune system: There are antibodies that kind of go up and down, and there are T-cells that generate a super complex response. Why did we not think about this before? Because it’s hard to measure T-cells. It requires flow cytometry [highly specialized equipment used to analyze cells]in a big lab, so there were only a couple of studies on this. And luckily, they’ve been released in the last three weeks—one was just last week!—[and revealed] that our T-cells are going to work against those variants. I’m not too worried about [the variants escaping from vaccines]. I think about T-cells a lot, because I’m an HIV doctor, and we hate T-cells going away. That’s what HIV does—it hurts our T-cells.
On the importance of global access to vaccines: This is simply not an infection that we can ever just get through without thinking about the rest of the planet. Vaccine equity has always been an incredibly important principle of infectious disease. But this couldn’t be any more urgent, because unlike any other time in history, we’re rolling vaccines out in the middle of a pandemic. Each place in the world can threaten progress in every other. The United States can really be a world player on this. We haven’t yet, but we can change in a lot of ways. I think we should join the WHO COVID-19 Technology Access Pool, which allows other pharmaceutical companies and other countries to have the formula for vaccines. And the vaccine doses that we don’t need—give them away. This should be a constant, ongoing conversation—that we’re all in this together.
On vaccine equity in the United States: There has never been a time that I remember when there was a national reckoning with systemic racism going on at the same time as an infectious disease outbreak. This is the time to apply that reckoning with systemic racism to our response, which would be mobile vans and increased community access and having members of Black and Brown communities be the ones who convey the message. We need to take time out to ensure that we’re not just putting out vaccines in a way that white people and rich people can come in and get them. Those two things are colliding in the United States at once; we have to put them together.
On combatting vaccine hesitancy: Sometimes it’s just a matter of people who represent communities doing the messaging. The Tyler Perry campaign was really powerful, as was [Moderna vaccine lead scientist] Kizzy Corbett, an African American, talking about how she developed the vaccine. And Dr. Fauci joining with Lin-Manuel Miranda to do a campaign. We’ve learned this in HIV. We actually never had, a white man message to the Black community. (Well, we did at the beginning, but then we stopped.) This is the time to take all those innovative lessons from HIV. We need white male Republicans, many of whom, at the national level have gotten vaccinated—I think almost all of Congress is vaccinated. They didn’t decline it. I also think that we’re overblowing vaccine hesitancy a little bit. The more people who get a vaccine—then you have a friend and a neighbor and your family member. All these people have had it, and they’re fine. They’re safe. It’s effective. So I’m not as worried as others about that.
On applying the lessons from this pandemic to the next one: We get to learn from two pandemics, HIV and COVID. And what we would want to do with COVID is unlearn a lot of the things we did [with HIV]. I would unlearn shame-based and fear-based messaging. I would unlearn non-nuanced discussions. We’re a highly politicized nation, but the fault has to be on both sides. It doesn’t help to yell at each other or exaggerate when there’s data right in front of you. We have clear numbers about risk, age, how to keep people safe. We have all the data, we had the data quite early on, actually. What I would hope is that those who get to inform the field and inform policies don’t do it on cable news or on social media, but rather in a really serious way, by dispassionate, data-observing scientists. I don’t know if it’s just the politicization of this country, because I think it happened across the world. But we sure had a really difficult response and a lot of sad and hurt people.
On the Biden Administration’s COVID response so far: What I see as really hopeful is the signing of the Defense Production Act and getting the vaccines out quickly. I truly believe the rollout is going as well as it could be, except that I think we should get the first dose first and wait on the second. And I’m delighted with the attention on the economic insecurity of people that resulted from the pandemic. All of that is amazing. But I still see a somewhat non-nuanced look at the data. Last week was a very confusing week for the American people: “Impending doom” on Monday; by Friday, you could travel if you’re vaccinated. That was tremendously confusing; it was just amazingly confusing! We don’t have to use scary words or sound bites. We can just literally explain it: “Hey, here’s a map of the United States. Let’s admit it. Some places are surging, some are not actually, to be honest, and it’s very complicated why.” We’re not dumb. American people are very smart.
A woman receives a COVID-19 vaccine at Fort Sam Houston, Texas. United States Army/ ZUMA
This story was published in partnership with ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up for ProPublica’s Big Story newsletter to receive stories like this one in your inbox as soon as they are published.
As the United States seeks to end its coronavirus crisis and outrun variants, public health officials recognize it is essential for as many people as possible to get vaccinated. Making that easy is a major part of the plan. According to the Coronavirus Aid, Relief, and Economic Security Act, the vaccine is supposed to be free to everyone, whether they’re insured or not. And the Biden administration has directed all vaccination sites to accept undocumented immigrants as a “moral and public health imperative.” But this promise has not always been fulfilled, ProPublica has found.
At vaccination sites around the country, people have been turned away after being asked for documentation that they shouldn’t need to provide, or asked to pay when they owed nothing.
In part, this has happened as businesses administering the vaccine try to recoup administrative fees they are allowed to charge to the government and private insurers. To aid them in passing along the bill, major pharmacies ask those being vaccinated for their Social Security numbers and insurance information. They aren’t supposed to deny a shot to people who aren’t covered or try to make them pay the fees. But both of those things have happened.
Workers at vaccine sites have also turned away people who they felt didn’t provide sufficient proof that they belonged to an eligible group, demanding to see medical records or other evidence of underlying conditions. While the vast majority of states don’t require such documentation, government officials haven’t always communicated that clearly.
The resulting barriers can be higher for those less equipped to advocate for themselves, such as undocumented people and those who do not speak English. Because of this, even as vaccines have become more widely available, they are still not easy for some of the most vulnerable people to access.
You Do Not Need a Social Security Number or Insurance to Get a Free COVID Vaccine. Your Immigration Status Does Not Matter, Either.
Camille lives in Baltimore with her 77-year-old mother. (She asked to be identified only by her first name for privacy reasons.) When a nonprofit organization helped her mother get a vaccination appointment an hour away in College Park, Maryland, Camille took time off from work to drive her there. They’d only brought along her mother’s state ID card. But when they went up to the counter at the CVS pharmacy, an employee asked for insurance information and a Social Security number. Camille’s mother, who is from Togo and is seeking asylum in the United States, doesn’t have either of those. Camille said the employee told her they’d have to pay if they wanted a vaccine.
No one is supposed to be charged for the COVID-19 vaccine, according to the CARES Act, and immigration status shouldn’t affect eligibility. Many vaccination sites ask for insurance and Social Security information so they can charge administrative fees to insurance companies or the federal government, but those aren’t requirements for being able to get vaccinated.
Camille told the CVS employee she wasn’t going to pay for a vaccine. Her mother, a French speaker who takes weekly English lessons, needed Camille to translate what was happening. “I felt so embarrassed, and my mom also when I was explaining to her,” she said. “She was like, ‘I’m not going to have it because of insurance?’”
Not wanting to drive an hour back without the vaccine, Camille called Tiffany Nelms, executive director of the Baltimore-based nonprofit Asylee Women Enterprise, which had set up the appointment for them. When Nelms asked the CVS employee why they were having trouble getting a vaccine without a Social Security number, the employee “quickly backpedaled,” Nelms said. The staffer told Nelms a supervisor would override the CVS computer system’s request for an insurance or Social Security number.
Nelms said she’s worried about others who have less access to support. “Not everyone has a bilingual relative to go with them who is even comfortable advocating in that way and also has an advocate that’s a phone call away,” Nelms said. “A lot of our clients, especially those who don’t have legal status yet, if they were asked a question like that, they would just leave.”
Camille said she’s thankful her mother got the one-dose Johnson & Johnson vaccine so they don’t have to go back to the CVS for a second shot.
“We are aware of these isolated incidents in Maryland and are committed to addressing inequities related to COVID-19 vaccine access in vulnerable communities, with a particular focus on Black and Hispanic populations,” a spokesperson for CVS said in a written statement regarding Camille’s experience and two other incidents that took place at Maryland CVS locations. “No patient, whether they are insured or uninsured, has been charged directly for a COVID-19 vaccine. If a patient does not have insurance, we are required by the Health Resources and Services Administration to ask the patient to provide either a Social Security number or valid driver’s license/state ID #. However, uninsured patients are not required to provide this information in order to receive a vaccine from us.”
Vaccination sites’ arbitrary documentation requirements have been a barrier for other Marylanders trying to get vaccinated as well. Several Montgomery County public school teachers formed Vaccine Hunters-Las Caza Vacunas to help find appointments for eligible Marylanders. In March, eight of their clients were initially denied vaccines when they showed up for appointments. Most were told they needed documentation that isn’t required by the state. All of them were immigrants, and most eventually got the vaccine after contacting someone from the group to advocate on their behalf.
In one incident Vaccine Hunters volunteers said they intervened in, a woman arrived for her appointment at a CVS in White Plains, Maryland, and presented her ID, a Salvadoran passport. She was told she would need an insurance card or Social Security number, which she does not have. In another, a woman who primarily speaks Spanish was initially turned away by a College Park CVS because she couldn’t respond when asked, in English, to identify her eligibility category.
The group’s volunteers have received complaints from local residents who were turned away for other reasons as well. At a Giant grocery store in Hyattsville, two Latina pastors were initially turned away because they did not have a letter from their employer, even though they brought W-2 forms proving their employment status.
“A COVID-19 vaccine provider may not refuse an individual a vaccine based on their citizenship or immigration status,” said Charles Gischlar, deputy director of communications for the Maryland Department of Health. However, Gischlar said, Maryland vaccine providers are required to take “reasonable steps” to determine whether someone is actually in a priority group: “A COVID-19 vaccine provider may require additional documentation or employee identification and may require that organizations submit institutional plans with identified individuals.”
A spokesperson for Giant Food said that its stores check patient information from their IDs or letters from their employers to identify who is being vaccinated and report demographics back to the Centers for Disease Control and Prevention. “Our goal is to assist in getting people immunized, not to police the vaccine by any means,” communications and community relations manager Daniel Wolk said. “As you can imagine, guidance from the state legislators and the Department of Health changes daily. We do our best to effectively communicate these changes to our over 400 pharmacists via email and weekly calls.”
Across the country in the Mission Hills neighborhood of Los Angeles, Rite Aid turned away a woman on March 14 after asking her to provide a Social Security number and a U.S.-issued ID, which she does not have. She had brought her consular ID, which Los Angeles County sites are supposed to accept for vaccination appointments.
“After being on a waitlist for a week, my mom was turned away because she has no social security and because she is UNDOCUMENTED,” her son Sebastian Araujo wrote on Instagram, adding on Twitter, “My mom was literally sobbing and I’m literally appalled.” After Araujo shared the incident on social media, Rite Aid responded to him on Twitter with an apology and reached out to reschedule a time to vaccinate his mother.
A Rite Aid spokesperson said the company advises its employees not to turn anyone away from a vaccine appointment, regardless of whether they have an ID, Social Security number or insurance. “This was an isolated incident, was a mistake and did not have anything to do with immigration status,” said Rite Aid public relations director Chris Savarese. “The store staff and regional teams have been retrained on our policy to not turn anyone away.”
A week after the Los Angeles incident, a Rite Aid in Orange County, California denied the vaccine to another woman who did not have a Social Security card or insurance, though she had brought her out-of-state ID and a letter from her employer.
At first, Araujo said, he was hesitant to post publicly about his mother’s experience because of the hateful comments he anticipated facing online. “But I think raising awareness is very, very important,” Araujo said in an interview with ProPublica. “If we would’ve just stayed quiet, honestly, nothing would have happened. Rite Aid probably would have continued rejecting people and LA County would’ve never brought this issue into a conversation.”
After Araujo and local media outlets publicized the incident, Los Angeles County officials spoke out and posted on social media to emphasize that proof of citizenship is not required to get a vaccine.
A COVID Vaccine Should Never Cost You Money — Ever. It’s the Law.
While the CDC has made it clear that vaccine providers should not charge patients anything, including administrative fees or copays, some patients have still received bills for the COVID-19 vaccine.
The day after Rosanne Dombek, 85, received her second shot at InterMed, a primary care practice in Maine, she opened her mail and found a bill. For “Covid-19 Pfizer Admin, 1st dose,” her charge was $71.01. “If your outstanding balance becomes 120 days past due, the balance will be transferred to the Thomas Agency for further collection action,” the bottom of the bill said. “It sounded rather final,” said Dombek, who is the mother of Lynn Dombek, ProPublica’s research editor. She immediately wrote out a check. “I was surprised to get the bill, but I’m old enough now that I don’t want any more battles.”
When asked about Dombek’s bill, InterMed spokesperson John Lamb first said that the $71 should have been billed to the patient’s insurance company, and that “the correspondence you referenced is likely a request for insurance information.” When shown a copy of Dombek’s bill, which did not include any such request, Lamb responded, “The statement should have included a notice to call us with her insurance information. We’re looking into why that was missing.” Yet InterMed’s website seemed to indicate that the bill was intentional. In its coronavirus FAQ section, the site said:
“The COVID vaccine will be provided to patients at no cost. However, there will be a vaccine administration fee charged to the patient.” When ProPublica questioned InterMed about this language, Lamb responded, “Good catch. It was confusing. We’ve corrected it to reflect the billing to the insurance provider.” The website was subsequently updated. Dombek did not end up mailing her check to InterMed. Some residents in New Mexico have also reported receiving bills after getting vaccinated. It’s unclear how the CDC or its parent agency, the Department of Health and Human Services, aims to prevent patients from being billed. A CDC spokesperson noted that individuals can call an HHS hotline to report any billing-related violations, but referred oversight questions to HHS. HHS didn’t respond to requests for comment.
Fear of potential bills has kept others from getting vaccinated to begin with. Nancy Largo of Bellport, New York, doesn’t have insurance, already carries about $7,000 in medical debt and has been out of work for almost two years because of a workplace injury. She knows the vaccine is supposed to be free, but she’s still worried. “What happens if they charge me?” Largo asked in Spanish.
Largo doesn’t speak English, and medical providers don’t always have Spanish-speaking staff, so she’s not confident that she’ll be able to ask questions about billing and other details once she gets to a vaccination site.
Though nearby pharmacies are offering the vaccine, Largo is limiting herself to finding a shot through one clinic that she knows treats people without insurance and has Spanish-speaking staff. So far, they haven’t had an appointment for her.
In Nearly Every State, Providers Are Required to Believe What You Say About Underlying Conditions.
Sara Waldecker was worried about how she could prove that she was a high-risk patient eligible for a COVID-19 shot. Michigan had just opened up vaccinations to anyone ages 16 and up with disabilities or medical conditions that qualified. Waldecker, 37, said that a childhood illness left her with lung scarring and asthma, but she wasn’t sure how to get hold of those medical records because “the primary doctor I saw, up to five years ago, has died.” After that, Waldecker switched hospital systems, and her old records didn’t transfer with her. Then Waldecker’s husband lost his job during the pandemic, leaving them without health insurance. She said she couldn’t afford to see a doctor and have tests run to get diagnosed again. She’d spent the entirety of the pandemic isolated, buffeted by conflicted emotions. “If I catch it, there’s an overwhelming chance I’m not going to make it, but I also feel guilt from keeping my kid from her favorite places,” she said. “She’s healthy, the rest of my family is healthy — I’m the weak link. I’m the one keeping them in isolation.” In fact, Waldecker didn’t need to prove anything. In Michigan, “individuals attest to any medical conditions upon registration,” according to Lynn Sutfin, public information officer for the state’s
Department of Health and Human Services. “They do not need to provide proof.” That information is not evident on the state health department’s website, nor is it clear on the website of the health department for Macomb County, where Waldecker lives.
ProPublica surveyed all 50 states and found that, among those currently providing vaccines to individuals with underlying health conditions, almost all only require a patient to self-attest that they meet the criteria, and do not require any documentation or proof. Florida is one exception. It limits eligibility to “persons determined to be extremely vulnerable by a physician” and provides a form for doctors to fill out.
In Delaware, health providers and hospital systems are the only places where patients with health conditions can get a vaccine. “Delaware health providers, including hospitals, have been advised to use their clinical judgement to vaccinate individuals 16-64 with underlying health conditions, as they will have access to the patient’s medical information,” state public health department spokesperson Robin Bryson wrote in an email. Even in states that only require an attestation of someone’s underlying condition, that information was hard to find on state websites. Many did not mention it at all, and ProPublica was only able to learn about it by contacting press offices.
Whatever a state says, however, specific vaccination sites may sometimes ignore official guidelines. When Ric Galvan, 20, went to the Alamodome stadium in San Antonio, Texas, for his shot on March 2, he recalled, he was questioned by a firefighter who was helping with intake: “He first sort of condescendingly asked, ‘How old are you, buddy?’ — likely because I’m young.” Galvan provided his ID and stated that he had chronic asthma. “He then asked if I had an inhaler or some sort of proof of having asthma, to which I said, ‘No, not with me.’ He then told me that the vaccine is only for ‘real asthmatics’ who ‘need their inhaler with them at all times.’”“As someone who has been under pulmonologist care since I was 4 years old, this really upset me,” Galvan said. He tried to push back, telling the firefighter that none of the confirmation emails said anything about medical proof, but the firefighter told him to leave the site. A full-time student who also works part time, Galvan added that he was frustrated because it had been so hard to get an appointment in the first place, and now he had to start over again.
“We must ensure individuals that have registered do in fact meet the criteria set by the state of 1A and 1B. This process entails verification of name, age, and if under 65, qualified pre-existing conditions,” replied Michelle Vigil, a spokesperson for the city of San Antonio. “Unfortunately we have seen instances where these conditions cannot be verified. In order to ensure that we are in compliance we have had to turn a very small number of people away.”
But Texas sites aren’t supposed to ask for proof of underlying medical conditions, according to Douglas Loveday, spokesperson for Texas’ health department. People seeking vaccinations “can self-disclose their qualifying medical condition,” he said. “They do not need to provide documents to prove that they qualify.”
Juany Torres, a community organizer and advocate in San Antonio, said she’s heard of several similar cases at the Alamodome.“Some undocoumented folks that showed up were questioned about their diabetes or their asthma, and they were turned away and lost their appointment,” Torres said. They had been diagnosed in their home country and didn’t have their medical records on hand, she said. None have health insurance or a primary care doctor in the U.S. “They lost the time they had taken off work, they were embarrassed, and I had to re-convince them that they were worthy to go and that they should get their shot,” she said. In Texas, at least, requests for medical documentation should no longer be an issue: On March 29, the state transitioned to allow everyone age 16 and older to sign up for a vaccine.
The International Air Transport Association's TravelPass will let travelers store and manage verified certifications for COVID-19 tests or proof of vaccination.Pavlo Gonchar/Sopa/Zuma
Yellow fever is a deadly virus. Transmitted via infected mosquitoes, symptoms can be so mild that people don’t even know they’re sick. But serious cases are nasty. The whites of the eyes turn yellow. The skin grows yellow and hemorrhages. The liver, heart, and kidneys fail. There is no medicine to treat or cure yellow fever. But there is a highly effective vaccine, which is why 40 countries in sub-Saharan Africa and South and Central America, where yellow fever is endemic, require travelers to prove they’ve received the yellow fever vaccine. To do so, they require an official document created by the World Health Organization. It’s called International Certificate of Vaccination or Prophylaxis—or, colloquially, the “yellow card.”
Vaccine passports are hardly a novel concept. Countries around the globe, to curb the spread of deadly diseases, require foreign visitors to present certificates of vaccination. Many of our own states have vaccination requirements for kids to attend school.
But a technology implementation that will allow people to present a QR code on their smartphone to prove they’ve been vaccinated is something new. The past two months have witnessed a proliferation of plans by states, countries, companies, and international consortia to develop digital vaccine passports. Though the building blocks for digital vaccine passes have been around for a while, such a technology has never been deployed on such a large scale, and with such a big potential impact on people’s lives. This is what has some people concerned. Equity-minded folks are concerned about stratifying society between vaccine haves and have-nots. Privacy activists are worried about increased surveillance. Republicanpoliticians are crying government overreach.
Every vaccine passport technologist I’ve interviewed has asked me not to call them vaccine passports. Drummond Reed is the chief trust officer at Evernym—the technology underlying the International Air Transport Association (IATA)’s TravelPass initiative. He prefers “vaccine pass” because it’s more accurate. “Passports are inherently discriminatory,” says Reed. They have age and citizenship requirements, “and that’s not consistent with being able to get a vaccination or a COVID test.” Unlike vaccine passes, passports also require strong proof of identity and are issued only by governments.
Vaccine passes, whether digital or analog, are a tool that people can use to prove that they have been vaccinated or have received a recent negative COVID-19 test. The idea is that they will gain people access to certain things that have been off-limits during the pandemic, like attending concerts at Madison Square Garden, eating in a crowded restaurant, or going to a packed sports event.
This week, New York rolled out its Excelsior Pass, a branded version of IBM’s Digital Health Pass. President Joe Biden’s official pandemic strategy includes a paragraph about how the State Department, Health and Human Services, and Homeland Security will assess the feasibility of “linking COVID-19 vaccination to International Certificates of Vaccination or Prophylaxis (ICVP) and producing electronic versions of ICVPs.”
Biden administration officials have said that they are in the process of coming up with the criteria for vaccine passes, but will leave the tech development to private companies and nonprofits.Andy Slavitt, a White House senior adviser for COVID response, specified at a March 29 briefing that “unlike other parts of the world, the government here is not viewing its role as the place to create a passport, nor a place to hold the data of citizens.”
Vaccine credentials already exist in the United States in the form of the paper card people receive once vaccinated. You may have seen friends and family posting photos of their cards on social media, which the FTC strongly recommended not doing because the personal information printed on them is like catnip for identity fraudsters.
Brian Behlendorf, general manager for blockchain, health care, and identity at the Linux Foundation and an active coordinator of the Good Health Pass Collaborative, points out that the paper cards are less secure than a digital solution, and were never meant as official vaccine passes. “The point was to help people keep track of if they’ve been immunized, if the batch that they took was a bad batch,” he says. “It wasn’t intended to be a high security type of document.”
Given the accessibility barriers inherent to smartphone apps—not everyone has a smartphone or reliable cell service—vaccine pass developers are being careful to offer analog alternatives. “There are paper-based options,” notes Kaliya Young, an identity tech expert and the ecosystems director of COVID Credentials Initiative, which is also part of Good Health Pass Collaborative. “There’s a way to express digital information on paper so you don’t have to have a digital wallet. That’s going to be a really critical part of the solution.”
Sean McDonald, the CEO of a company called FrontlineSMS, is skeptical that deploying a relatively untested tech solution is the right move. During the 2014 Ebola outbreak, McDonald partnered with religious leaders in West Africa—his SMS platform was used to send people messages about how to participate in traditional burial practices without getting infected. He recalls there was a lot of buzz around using cellphone location data to track people spreading Ebola, but that was largely just big data hype—woefully inept at tracking transmissions. “Generally speaking, if you’re inventing the solution at the time you learn about the problem, you’re a little bit late,” he says.
The vaccine-pass technology is complicated and the process jargony, but it’s important to understand the basics to ask the right questions and be informed. Here’s a brief glossary of terms:
Issuer: The entity that gives out the vaccine certificate. In the case of COVID-19, it will likely be a health care provider, testing site, or health department.
Verifier: The entity that needs to verify that someone has been vaccinated or has received a negative test. This might be an airline, restaurant, concert venue, or school.
QR codes: A matrix of squares that encode information like a word, phrase, URL, or long string of numbers. Vaccine pass projects use QR codes because they’re easy to store and scan from a smartphone, and can contain a digital signature.
Digital signatures: An algorithm that confirms that information is authentic and hasn’t been corrupted. Digital signatures can be embedded in QR codes and verify data about a vaccine certificate, such as who signed it and when.
Blockchain: A method of storing information about a transaction in a decentralized database, also known as a distributed ledger. For vaccine passes, the blockchain also stores the tools needed to verify that whoever dispensed that vaccine (such as a hospital) was authorized to do so. This allows a ticket-taker at an arena to verify a vaccine certificate. Vaccine passes needn’t use blockchain technology but as far as I can tell most of the digital ones in development do. Documents that describe how transactions on different blockchain platforms are validated—known in blockchain world as a consensus protocol—are publicdocuments.
Elizabeth Renieris, a technology and human rights fellow at Harvard’s Carr Center for Human Rights Policy and former policy counsel for Evernym, points out that governing bodies like the EU Commission have never rolled out technology close to this before—no interoperable digital passports, ID cards, or driver’s licenses. “How can there be such an accelerated rollout for something that has never been done before for any other purpose?” Renieris asks. “To attempt this for the first time, and to do it at such high stakes with such potentially severe risks to very fundamental freedoms, just feels like a very rash move.”
Problems with the earliest iterations of the vaccine passes are to be expected, Behlendorf says. He encourages consumer watchdog groups and public health authorities to ask hard questions about how these apps work, and report any concerns. His expectations for the initial rollout “would be low,” he says, but he expects the apps to improve and move toward open-source solutions. “This will be a process. My hope is that through public pressure, and through technologists working together, we’ll have the second wave of apps towards the end of this year.”
I called New York’s Excelsior Pass hotline for more information on how the Excelsior Pass will work. The customer-service agent who answered told me the EP isn’t really a vaccine passport: “It’s completely voluntary, not mandatory at all. It’s just more or less a convenient app.”
A woman draws red hearts representing individual coronavirus deaths onto the newly-unveiled National Covid Memorial Wall opposite the Houses of Parliament in London, England, on March 30, 2021. David Cliff/NurPhoto/ZUMA
Earlier this week, CDC director Dr. Rochelle Walensky went off-script during a news conference to issue an emotional warning: a fourth coronavirus surge could be coming. She described a “recurring feeling I have of impending doom,” saying that while there was “so much to look forward to,” the country was entering a dangerous new phase. “I’m scared,” she said.
Meanwhile, the country has seen week-on-week vaccination records tumble, and officials predict that half of Americans will be fully protected within the next two months. Nearly 150 million doses have been administered so far.
So Americans find themselves confronting yet another precarious era in the war on COVID-19, in which hope and fear are colliding. There’s light at the end of the tunnel, but many questions remain. Can we vaccinate fast enough to combat the threat of dangerous new variants? What’s the deal with the AstraZeneca vaccine drama? Why is the United States populations getting vaccinated at a much faster rate than the rest of the world? When—if ever—can we ditch the masks?
We try to answer some of those questions on this week’s episode of the Mother Jones Podcast, with Dr. Peter Hotez, a vaccine scientist and the founding dean of the national school of tropical medicine at the Baylor College of Medicine in Texas. He’s been leading a team that uses older vaccine technology to create a COVID-19 vaccine that would be cheaper to make and distribute.
“By the summer I think we could potentially vaccinate ourselves out of the epidemic,” Hotez told Kiera Butler, our senior editor and public health reporter, during a taped livestream event last week. But that doesn’t mean we are out of the woods. Though coronavirus cases have dropped 80 percent from the latest surge, case numbers are at the same level that they were last summer and variants are spreading quickly. “We’re at a dangerous time right now,” he said.
What about the variants? The B.1.1.7 variant, which was first identified in the UK, is spreading quickly in the United States. The P1 and B.1.351 variants, first identified in Brazil and South Africa respectively, though not as prevalent in the United States right now, are still concerning because they’ve shown to be less susceptible to the vaccines. “Don’t be surprised if later on this year we all wind up getting another booster,” Hotez said.
Hotez speaks to both the hope and the fear of the moment. While he says that the United States population could vaccinate itself out of the pandemic by the summer, he’s concerned about the slowness with which vaccines are reaching the global population. Current estimates are showing that vaccinating 70 percent of the global population, which is what it will take to reach herd immunity, could take years.
“I’m worried because we know what happens if we only vaccinate the United States, the UK, and western Europe. That’s not going to go well because this virus will continue to circulate, we’ll sow more and more variants, and it will be a humanitarian catastrophe,” Hotez said.
Butler’s interview with Hotez was first recorded for a Mother Joneslivestream event on March 24, 2021.
Geriatrician Megan Young, left, gives Edouard Joseph, 91, a COVID-19 vaccination Thursday, Feb. 11, 2021, at his home in the Mattapan neighborhood of Boston.Steven Senne/AP
As spring begins to take hold across the United States and vaccination rates continue to improve, it might be tempting to think that the coronavirus pandemic is over and some semblance of normal can return.
But officials are warning that cases are actually going back up, and things could get worse if we’re not careful. In fact, the United States is averaging roughly 57,000 new cases per day, a seven percent increase from the week before.
“I remain deeply concerned about this trajectory,” US Centers for Disease Control and Prevention Director Rochelle Walensky said this week. “We have seen cases and hospitalizations from historic declines, to stagnations, to increases. And we know form prior surges that if we don’t control things now, there is a real potential for the epidemic curve to soar again.”
More than 1,200 new deaths were reported on Friday, according to the New York Times, along with 75,2724 new cases. Since early March, the United States has averaged between 54,000 and 59,000 new cases per day, and some states are seeing major rises in case numbers. On Wednesday, the Michigan Health & Hospital Association reported that between March 1 and March 24, coronavirus hospitalizations increased by 633 percent for those aged 30 to 39, and 800 percent for those aged 40 to 49, the Detroit Free Press reported this week. Even with rising vaccine rates in the state, Dr. Nick Gilpin, the medical director of infection prevention and epidemiology for Beaumont Health, one of the large health systems in the state, said cases are “rising at a pretty alarming rate” likely due to COVID-19 variants and eased restrictions.
“It’s people gathering more amongst one another, and it’s also the presence of these variants,” he said. “I know people are starting to go crazy. I know the weather is starting to get warm. And I know people want to get outside and some restrictions have been lifted. But as we start to see these cases rise, people in Michigan … need to consider that there’s still a possibility of infection out there.”
The news comes as vaccination rates continue to rise. More than 48 million people have been fully vaccinated—nearly 15 percent of the US population—with total vaccinations coming in at more 2 million per day, according to NPR. President Joe Biden said Thursday that he was setting a new vaccination goal of 200 million doses administered by his 100th day in office, doubling the previous goal.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and one of the US government’s main voices on coronavirus protocols, told the Washington Post in a story posted this morning that he believes the United States is on track to meet Biden’s aim of limited backyard gatherings for the July 4th holiday, but backsliding could happen. “It depends on how well we do in maintaining public health measures and continuing the vaccine program,” he said. “It’s possible that vaccine hesitancy won’t allow us to get enough people vaccinated.”
Speaking on Fox News Sunday, Dr. Anthony Faucisupported President Biden’s projections that American adults will have access to the vaccine by the beginning of May and the nation could achieve a sense of normalcy by July 4.
As of Sunday, 107 million Americans—more than a quarter of the country’s adults—have received at least one dose of the vaccine, according to the Centers for Disease Control and Prevention.
But we’re not out of the woods yet. Fauci warned against opening up too quickly in the face of all the good news. “When you pull back on things like masking and not paying attention to congregate settings, it is very risky to get another surge,” he said. “If you wait just a bit longer to give the vaccine program a chance to increase protection in the community, then it makes going back much less risky. But if you do it prematurely, there really is a danger of triggering another surge.” Such warnings did not deter Texas Gov. Greg Abbott, who earlier this month made headlines when he lifted the state’s mask mandate and increased capacity in businesses to 100 percent.
And even though vaccine distribution is at a record high, the doses aren’t being distributed equally. Of those Americans who have received both doses, roughly 7 percent are Latino and another 7 percent are Black—despite those groups making up 19 and 13 percent of the US population, respectively. Stories abound of white “vaccine chasers” flooding vaccination sites intended to serve communities of color, from Washington, DC, to South Dallas.
Last week, at a church in West Oakland that opened a first-come-first-serve vaccination site intended for Black and Latino community members, 60 percent of doses went to white people. “I’ve had people camping out starting at 2:30 a.m. to be first in line,” Pastor Michael Wallace of Mount Zion Missionary Baptist church told the San Francisco Chronicle.
The trend maps the contours of the preexisting disparities that made the coronavirus so disproportionately devastating to Black and brown communities. As my colleagues Edwin Rios and Dave Gilson wrote, Black and Latino Americans took on greater risk of exposure as frontline workers and were more likely to be infected and killed by the virus. Harvard health professor Dr. Mary Bassett told Mother Jones, none of these inequities are caused by the virus itself. Rather, she said, “It’s because of the social consequences of race in our society, which has been reinforced by decades, centuries of bad practices and policies.”
Renowned cellist Yo-Yo Ma gave a surprise concert to a gym full of coronavirus vaccine recipients on Saturday. After getting his vaccine, Ma played during the 15-minute observation period at the Berkshire Community College in Pittsfield, Massachusetts. Click the arrows to see several videos of his playing:
As vaccination rates pick up across the United States, the Centers for Disease Control and Prevention on Monday issued its much-anticipated guidelines for the more than 30 million people now fully-vaccinated for COVID-19. Those recommendations include how vaccinated people can gather with those who have yet to receive the COVID vaccine and mask-wearing.
Perhaps most notably, the new guidelines greenlight fully-vaccinated people gathering in private, small scenarios where everyone is fully-vaccinated without masks or social distancing. The CDC defines fully-vaccinated people as those who are two weeks out of their second dose of the Pfizer or Moderna vaccines and two weeks out of receiving the single-shot Johnson & Johnson vaccine.
Fully-vaccinated people are also safe to interact with those who are not vaccinated, but those gatherings are limited to one household where members do not belong to a high-risk COVID category. “Here’s an example,” CDC Director Rochelle Walensky said in a White House virtual event announcing the guidelines. “If grandparents have been vaccinated, they can visit their daughter and her family, even if they have not been vaccinated, so long as the daughter and her family are not at risk for severe disease.”
Fully-vaccinated people are also okay to refrain from quarantine measures if exposed to a potential outbreak, as long as they do not exhibit symptoms. Public mask-wearing and keeping physical distance in large gatherings should still be observed.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, listens as President Joe Biden speaks during an event to commemorate the 50 millionth COVID-19 shot.Evan Vucci/AP
On Sunday, Dr. Anthony Fauci, chief medical adviser to President Joe Biden, echoed a warning that rolling back public health restrictions on mask-wearing and mass gatherings too quickly could lead to a spike in COVID cases as the nation races to vaccinate millions of people each day and a more contagious and potentially dangerous COVID variant spreads throughout the United States.
As of Sunday, the United States reported, on average, 60,000 new COVID cases and 2,000 deaths per day. Although the numbers have declined in recent weeks, the decline seems to be leveling off too early. “Historically if you look at the different surges, plateauing at a level of 60,000 to 70,000 cases per day is not an acceptable level,” Fauci said. He pointed to a disturbing trend in Europe, where cases have increased 9 percent in the last week after a plateau.
Another infection spike? A fourth wave? Dr. Anthony Fauci reiterates his concern that COVID-19 cases have declined and plateaued around 60k or 70k cases — he says that's “unacceptable.” pic.twitter.com/bzbcEh0AJ3
Decisions this week from states such as Texas and Mississippi to end mask mandates and reopen businesses risk increasing the rate of spread. A British variant of the virus, known as B.1.1.7, is reportedly doubling its share of new US cases every 10 days. Researchers predicted that B.1.1.7 could become the predominant strain of the virus in March. “We do want to come back carefully and slowly about pulling back on mitigation methods, but don’t turn the switch on and off,” Fauci said on Face the Nation on Sunday. “It would be risky to have yet another surge.”
As U.S. coronavirus cases remain at a low not seen since October, a more contagious variant first reported in the United Kingdom has likely grown to account for more than 20% of new U.S. cases as of this week. https://t.co/nUfPxtXFZ7
The Centers for Disease Control and Prevention is expected to release guidelines for how vaccinated people are supposed to interact with others “within the next couple of days,” Fauci noted. Currently, the United States has so far administered nearly 88 million vaccines, at a rate of 2 million people per day. “You have more and more protection of individuals but also communities. We need to hang in there a bit longer,” Fauci said. “It’s not going to be like this indefinitely.”
Although vaccinations are taking place at a rapid clip, the rollout has proven as uneven as COVID’s impact on communities of color. Black, Latino, and Native Americans have been dying of COVID-19 at twice the rate of white Americans. The disparities are even worse for younger people. A New York Times analysis found that Black and Latino people have been vaccinated at no more than half the rate of white people. Fauci noted that doses would dramatically increase in the coming months, and Biden said on Saturday that the nation would have enough for every adult by mid-May, pushing up his previous timeline.
A Tyson Foods employee received the Johnson & Johnson vaccine in Iowa.Tyson Foods/Zuma
Local governments are doing what public health officials had feared: turning down the Johnson & Johnson vaccine under the false assumption that the single-dose, relatively shelf-stable shot isn’t the “best.”
Mayor Mike Duggan of Detroit declined 6,200 J&J shots that would have added to the city’s arsenal of Pfizer and Moderna vaccines, according to the Detroit Free Press and Crain’s Detroit. “Johnson & Johnson is a very good vaccine,” Duggan said at a Thursday briefing. “Moderna and Pfizer are the best. And I am going to do everything I can to make sure the residents of the city of Detroit get the best.”
This isn’t a good way of thinking about the coronavirus vaccines. Public health officials are purposely shying away from describing one vaccine as any better or worse than another, because they are all highly effective at preventing severe illness and death. As former FDA chief scientists Dr. Jesse Goodman told me earlier this week, all the vaccines work.
“All three vaccines that are currently available under emergency use in the US are very effective in preventing against severe disease, and that’s the main thing individuals need to worry about,” Goodman told me. “What we really want to do is prevent people from getting really sick, and getting hospitalized or dying, and the J&J vaccine appears to do a perfectly fine job with that.”
Plus, the vaccines can’t be compared head to head because each was tested in its own clinical trial. And, as public health officials have pointed out, the J&J vaccine was tested in countries where more contagious variants of the virus were spreading—variants against which the mRNA vaccines may also be somewhat less effective.
Re: J&J 72% vs Pfizer/Moderna 95% – it's sorta like comparing scores of golfers who teed off during a calm morning to those who teed off at 1pm when winds were howling. While it's hard to make precise adjustment, it's clear that equally good play will result in different scores.
Dr. Anthony Fauci explained at a White House press briefing earlier this week that despite their different mechanisms, the mRNA and the J&J vaccines share the same “ultimate end game.” “Both the vaccines ultimately result in a spike protein in the right conformation that gives the body the opportunity to feel that this is the actual virus that it’s seeing when it’s not—it’s the protein,” he said.
So, now is not the time to base public health decisions on which vaccine politicians think is “best.”
A Houston, Texas, Bartender talks with customers shortly after Governor Greg Abbott lifted the state's mask mandate. AP
Earlier this week, Texas and Mississippi became the first states in recent months to lift mask mandates, reopen indoor dining, and do away with a host of other statewide coronavirus restrictions. Connecticut also loosened some restrictions. “With this executive order, we are ensuring that all businesses and families in Texas have the freedom to determine their own destiny,” Texas Gov. Greg Abbott tweeted triumphantly. Some people cheered this move as a long overdue return to pre-pandemic life. After all, why not get back to normal since coronavirus cases and deaths are down since the winter surge, and, at the same time, we’re making great strides on getting highly effective vaccines into more American arms. Right?
Well, not exactly. All that progress is great news. But these actions have spurred public health experts to warn that returning to normal now is a very bad idea. Like, really bad. The governors are “potentially infecting other people in ways that could kill them,” said Sarah Cobey, a computational biologist who studies infectious disease at the University of Chicago. “I’m not a lawyer, but I think it’s a form of battery.”
There are many reasons that reopening now is dangerous. As my colleague Jackie Mogensen recently reported, lifting restrictions is exactly what the virus wants us to do—as we’re seeing the world over, more community spread creates the perfect conditions for the virus to accumulate mutations that can lead to more transmissible and potentially more lethal strains.
But there’s another reason that may be more scientifically complex yet is just as urgent. It has to do with that concept known as herd immunity, which happens when enough people in a population gain immunity—through prior infection or vaccination—so that the virus can no longer run rampant. In order for us to reach herd immunity, vaccines need to work in concert with social distancing strategies. Here’s one important reason why.
From the vaccine trials, we learned that Pfizer and Moderna both offered protection of greater than 90 percent against the virus, compared to placebo shots, while Johnson & Johnson offers protection of 66 percent. Those figures reflect what’s called relative risk—which is when you’re comparing an intervention to no intervention at all.
That’s different from absolute risk. In this case, absolute risk means how effective the shots would be in a world without any virus restrictions in place, a circumstance that would have been impossible when vaccines were being developed. The trials happened in the real world of 2020, where some level of social distancing requirements—mask mandates, for instance, or limits on gatherings, and restaurant restrictions—existed in some form or another almost everywhere. If, all of a sudden, we lift all those restrictions and repeated the trial, the relative efficacy of the shots—the figures above 90 percent for Pfizer and Moderna and 66 percent for Johnson and Johnson—would likely remain the same. But the absolute risk of becoming infected—for both the placebo and vaccine recipients—would almost certainly increase, meaning more cases for both groups.
Last week, Isreali infectious disease epidemiologist Eran Segal noted this problem in a tweet. “Remember that vaccine efficacy was measured under conditions of masks and social distancing,” he said. “Efficacy is the sum of biological protection of the vaccine and protection resulting from public behavior. If behavior changes, efficacy will likely decline, perhaps even significantly.”
Segal didn’t respond to my request for comment, but the experts I talked to agreed that lifting restrictions could influence even vaccinated people’s absolute risk of contracting COVID-19. Ashleigh Tuite, an infectious disease epidemiologist at the University of Toronto, said that she didn’t believe that lifting restrictions would change anything about the shot’s ability to prevent severe cases of COVID-19, but she was convinced that it would almost certainly increase the overall number of severe infections. “If you have more infections overall, you’re more likely to see people who are vaccinated having severe outcomes—not because the vaccine isn’t working, but because the vaccines are not perfect,” said Tuite.
Cobey added that she worries that people may assume they have near perfect protection from infection once they’re vaccinated. But in places with high levels of community spread, that may not necessarily hold up. “A couple months ago, I was thinking that once enough people got vaccinated that they could be socializing more with other people who are vaccinated,” she told me. But she said she was still concerned that “the absolute risk” would be high for everyone in a community where there is a high level of transmission.
Which brings me to the second reason that lifting restrictions now would be a bad idea. In order to determine the level of COVID-19 in a particular community, epidemiologists rely on seroprevalence surveys—a process involving the recruitment of volunteers in order to test their blood for COVID-19 antibodies. This kind of study, says Cobey, suffers from a well-known methodological flaw called enrollment or participation bias: The kind of people who volunteer to participate in a survey like this do not tend to behave in the same way that the general population does. In this case, seroprevalence survey volunteers are likely to be the kind of people who follow virus news closely, and therefore are making personal choices to protect themselves in ways that others in their community may not—like by voluntarily wearing masks and choosing not to dine indoors. “Any of the seroprevalence studies where they’re inviting people to enroll will disproportionately be enrolling people who are at lower risk of infection,” says Cobey.
In communities with restrictions in place, survey participants will likely behave more similarly to everyone else—because rules like mask mandates ensure that everyone is taking at least some precautions. But the differences between the survey participants and the general population are likely to be greater in communities where restrictions are lifted—we must assume that once these rules no longer exist, many people will no longer voluntarily take precautions on their own. So in Texas and Mississippi, with the virus restrictions no longer in place, seroprevalence surveys may suggest a low level of community spread—when actually it’s much higher because of the lack of restrictions.
The difference between relative and absolute risk and the problem of enrollment bias are not typically things that regular people think about—rather, they’re finer points of epidemiological methodology. That’s why leaders have public health experts on their staff—to make sure pandemic decisions are based on sound epidemiology. Individual citizens determining “their own destiny,” on the other hand, don’t have the benefit of a staff of public health experts to help make informed decisions about whether to wear a mask or eat at a restaurant. Which brings us back to why, says Cobey, the lifting of requirements in Texas and Mississippi is so foolish. “It’s completely ridiculous to reduce responsibility to the individual,” she says. “It’s deeply unfair.”
A patient at the Lebanon VA Medical Center receives a COVID-19 vaccine.Doug Wagner/Veterans Administrat/Planet Pix/ZUMA
This is a week of good news and not-so-good news as we approach the one year anniversary of the coronavirus pandemic in the US. The good news is that a new one-dose coronavirus vaccine from Johnson & Johnson has recently been approved, and President Joe Biden says there’ll be enough vaccine for every American adult by the end of May. But what’s concerning is that a new coronavirus variant in New York City has been identified—and is spreading—with no clarity about how effective vaccines might be against this variant. Also, new data shows significant structural and racial disparities in who is receiving the vaccine, and who is still waiting in line.
On this week’s episode of the Mother Jones Podcast, Kiera Butler and Edwin Rios, two reporters who have been on the pandemic beat for the past year, join host Jamilah King to provide much-needed context about what this all means.
Butler, a senior editor and public health reporter, explains that while the Johnson & Johnson vaccine has lower efficacy rates than the Pfizer or Moderna vaccines, it is still highly effective at fending off the worst outcomes of coronavirus infections. “It prevents hospitalization and death 100 percent of the time,” she tells Jamilah King on the podcast.
While millions of vaccine dosages have been shipped out this week, and vaccination rates are on the rise, there are concerning reports of low vaccination rates among communities of color—the very the same communities that have been disproportionately affected by the coronavirus pandemic itself. Black, Latino, and Native Americans have been dying of COVID-19 at twice the rate of white Americans. Those disparities widen in younger age groups. Despite the fact that Black Americans account for 16 percent of COVID deaths, they have received just six percent of the first dose rollout. “The pandemic exacerbates preexisting inequities,” Rios says. “It’s not as if those barriers to access go away when the vaccine rollout starts.”
One such major barrier for some trying to schedule their vaccine appointments is as simple as internet access. In Butler’s reporting on a rural town in Georgia, she found that lack of reliable access to the internet was an impediment for many who were trying to make vaccine appointments online. These difficulties were even more serious for older adults who are less comfortable with the online booking process. “Elderly folks with younger people in their lives who have the time and wherewithal to constantly refresh websites and try to make appointments, they are getting the vaccine,” says Butler. “Whereas folks who don’t have that are having a much harder time.”
Finding ways around the social and economic inequities in vaccine distribution will require some ingenuity, and Biden has already announced it as a priority for his administration. He is granting millions of dollars to groups that aim to counter vaccine hesitancy in Black, Hispanic, Asian, and Native American communities. Rios says the key will be making sure that those groups actually reach trusted messengers with clear, consistent, and multi-lingual information. “Go where the people are at. If they’re at churches, go to churches,” he tells Jamilah King on the podcast. “What you want to do is eliminate the barriers that have been put in place before.”
On Sunday, the Food and Drug Administration authorized a third coronavirus vaccine, produced by Johnson & Johnson, for emergency use. This one’s a little different: It’s more shelf-stable than the mRNA vaccines already in distribution, and requires just one dose. Sounds great, right?
Yet questions abound about the new vaccine—and the old ones, too. To clear up existing doubts about how these vaccines trigger an immune response and protect against the coronavirus, we consulted an expert—Dr. Jesse Goodman—who is the director of the Center on Medical Product Access, Safety and Stewardship at Georgetown University and a former chief scientist at the FDA.
Mother Jones: Public health experts, including Dr. Anthony Fauci, have said the best vaccine is whichever one you can get. Why is that?
Jesse Goodman: The needs and the demand for vaccine are far above what’s available. The virus is circulating at high levels, and vaccination is the best way people can protect themselves. All three vaccines that are currently available under emergency use in the US are very effective in preventing against severe disease, and that’s the main thing individuals need to worry about.
MJ: How does the technology of the Johnson and Johnson vaccine differ from that of the Pfizer or the Moderna vaccines?
JG: The Pfizer and Moderna vaccines use mRNA, which is the message the virus uses to make a protein. The vaccine mixes the RNA with little globules of fat, and when the mixture is injected into a cell, the cell produces the same spike protein that is normally present on the surface of the virus. The body’s immune system then makes antibodies and T cells that can kill the virus that has that same protein on its surface when it comes along.
Instead of using this naked RNA mixed in fat, the Johnson & Johnson vaccine uses DNA that carries the same genetic code for the spike protein inserted into the DNA of a kind of cold virus, an adenovirus, that has been engineered so it can’t replicate in a person. After vaccination, this adenovirus enters your cells, which use the DNA to make mRNA for the spike protein. The cell then uses that mRNA to produce the protein itself, and your body makes antibodies and T cells that, as with the mRNA vaccines, can then react to the spike protein and kill the virus when it tries to infect you.
RNA is very fragile, which is part of the reason that the Moderna and Pfizer vaccines require frozen storage and have limited shelf life once they’re thawed. Because the Johnson & Johnson vaccine doesn’t have that naked RNA, it’s much hardier. It can be frozen under normal conditions and then refrigerated for about three months. That provides advantages in transportation and handling in clinics and healthcare setting where freezing is not as practical. The other thing is that the Johnson & Johnson adenovirus vaccine produces a strong immune response after one dose.
MJ: Because the J&J vaccine is easier to ship and store, it’s likely to be deployed in harder-to-reach communities. How would you respond to the suggestion that this creates a two-tiered system in which marginalized people get the short end of the stick in terms of vaccine effectiveness?
JG: What we really want to do is prevent people from getting really sick, and getting hospitalized or dying, and the J&J vaccine appears to do a perfectly fine job with that. I’ve already been vaccinated, but if J&J had been available when I was vaccinated, I would have gladly taken it.
MJ: How does the Johnson & Johnson version stack up in terms of efficacy?
JG: The vaccines were not compared head to head; these were different studies done in different places at different times. But it does appear that in preventing all infections, the J&J vaccine in the one-dose regimen may not be as effective as the two-dose regimen of the RNA vaccine. In the part of the clinical study that took place in the United States, the J&J vaccine was about 72 percent effective in reducing overall infection, as opposed to 94 or 95 percent with the RNA vaccines. However, they all appear very highly effective in preventing severe manifestations that might require hospitalization or [cause] death.
MJ: Would taking two doses of the J&J vaccine boost its overall efficacy?
JG: We don’t know yet. J&J has a study going on now that looks at two doses. Still, there’s a tremendous advantage to getting vaccinated, if you can get any of these vaccines, because all three seem to really prevent the serious infections and complications that both make people sick and stress our health care system.
MJ: How effective are the mRNA vaccines if just one shot is administered?
JG: Information about that is limited, because virtually everyone in the clinical trials got a second shot. Between the first and second shot, depending on the vaccine and on how we look at the data, there was protection against infection on the order of somewhere from 50 to maybe 80 percent. So even after one dose, within a couple of weeks, there is some protection. What we don’t know is how long would that last without the second dose.
There is also some concern that incomplete immunity could worsen the problem by selecting for variant viruses. In other words, variant viruses might have an advantage over non-variant viruses in overcoming that low-level antibody that’s present after just one dose. It’s not proven, but it’s a reasonable concern.
MJ: How does the efficacy of a vaccine in a clinical trial relate to its effectiveness in the real world?
JG: Vaccines and drugs frequently look better in their clinical trials than they do when they’re out in the broader population because patients in clinical trials are often healthier. But so far, it looks like the very high levels of efficacy that were present in the clinical trials are being maintained as it’s brought out in the broader population. Part of the reason is that these trials were done with an emphasis on trying to incorporate people of all ages, including older people who often don’t respond as well to vaccines.
MJ: Does getting vaccinated lower the risk of having an asymptomatic infection and spreading the virus to others?
JG: We don’t have data yet on transmission. Our sense is that the vaccines will decrease transmission in the community and contribute to the health of both individuals and the public. Whether vaccines with higher efficacy will do a better job of that, we’ll hopefully know more in the future.
MJ: How long does immunity last?
JG: We don’t know. It could be that it differs among the vaccines, but right now there’s not a lot of strong information that there should be a strong preference for one or the other.
MJ: Are these vaccines safe and effective for pregnant women?
JG: Animal studies show no evidence of reproductive risk to mother or fetuses. There are no studies performed yet in pregnant women. However, a number of pregnant women have been vaccinated, and to date there is no evidence of adverse effects on the mother or fetus from the vaccines.
JG: Studies are underway, but there’s no data yet—with the exception of the Pfizer vaccine, which is authorized for people 16 and up.
MJ: When might we expect to see a vaccine approved for use in children?
JG: Those studies will probably not be available until late in the year.
MJ: Is there any fear that a variant could emerge that’s more dangerous for kids?
JG: The virus has kept throwing new things at us, and we still do not understand the multi-system inflammatory syndrome that COVID causes—fortunately, rarely—in children, so this question will need continuous monitoring.
MJ: How do these vaccines hold up against the more contagious variants of the virus?
JG: Some of the genetic variants somewhat lower the effectiveness of the vaccine. The J&J vaccine trials included people in South Africa and Brazil, where some of these variants seem to have originated. While effectiveness was reduced somewhat in those countries, maybe by about 10 percent, the good news is that the vaccines were still effective in preventing hospitalizations and deaths.
MJ: Suppose a vaccine-resistant variant were to emerge. Could we easily just tweak the existing vaccines?
JG: Studies are underway now at most of the major companies using vaccine variants to tweak the vaccines in case it’s needed. It wouldn’t be a completely new vaccine; it would be more like what we do for flu vaccines every year. If the virus changes, we make adjustments, and that can be done quite quickly, particularly for RNA vaccines.
MJ: How big of a threat is vaccine hesitancy to achieving herd immunity?
JG: That’s a real hurdle. There still are people who are concerned, and there needs to be an effective strategy of communication to those people if vaccines are really gonna have impact they can have. Being sure that people understand the ways in which vaccines may or may not be different, understand their benefits, understand their safety profile, those things are really important.
The pandemic seems to have these ups and downs that nobody fully understands. I worry that we could get to a place where events are not as dramatic as they were a month or two ago or back in the spring, and people could feel less urgency about getting vaccinated.
We really need to help people understand that there will be likely upticks again, there is the threat of these variants globally, and that being immunized is smart both to protect yourself, and your loved ones and your community.
For months, we’ve known that the coronavirus spreads via airborne droplets, invisible molecules or globules of liquid that fall or hang suspended in the air whenever we exhale, talk, or sneeze. As more schools and businesses prepare to safely reopen, they’re looking for ways to purify indoor air—and the market has answered with a dizzying array of devices that go far beyond traditional HVAC (heating, ventilation, and air conditioning) systems and HEPA (high-efficiency particulate air) filters. Sellers of devices like bipolar ionizers, hydroxyl generators, and disinfectant foggers have claimed they can safely destroy the coronavirus or pathogens like it.
Across the country, schools are snapping up these purportedly air-cleaning products. The school district in Chilton County, Alabama, used funds from the CARES Act to buy their custodians agricultural backpack foggers that fill classrooms with chemicals. In Ocean City, New Jersey, schools put hydroxyl generators in nurses’ offices. Four school districts in the Lehigh Valley, Pennsylvania, have collectively spent more than $1.3 million to install bipolar ionizers in their HVAC systems.
But how many of these technologies are really snake oil, and are any them potentially dangerous? To find out, I spoke with Delphine Farmer, an atmospheric chemist at Colorado State University, and the coauthor of a forthcoming study on bipolar ionization. Lately, Farmer has been taking calls from school districts looking for advice on whether these new technologies can effectively keep students and teachers safe. “There’s a definite feeling that if all these other organizations are buying into this technology, then it must be okay,” Farmer says. “I’m like, “Nope, there’s no guarantee.'”
When we’re thinking about cleaning indoor air, what options do we have?
Think about if you’re cooking, and you’re making soup. If you have too much salt in your soup, then you can add more water, or you can add another flavor that kind of counterbalances the salt. You have these different techniques, the exact same way we have indoors. You can dilute the air—that’s where we pull in cleaner, outdoor air,opening windows and increasing ventilation. That’s just like adding more water to your salty soup. Another approach is to think about removing the salt—like finding a way to remove those particles and just filtering it out. For that we use HEPA filters.
And then you get to the other ways of doing this. And that’s where you start to get into what I would politely call “creative solutions” that take advantage of chemistry and developing new technology. But this is also where there’s a lot of potential unintended consequences, and unintended chemistry that can play a role.
What are these “creative solutions” that are on the market today?
So there are supposedly cleaning systems, which use ozone, or they use hydroxyl radicals—that’s another new one. What they’re trying to do is add chemistry that oxidizes organic molecules and the virus and destroys them. At the end of the day, it’s going to make molecules fall apart, or take on extra oxygen atoms, and then they change form. Eventually, if you make organic molecules react with the oxidant long enough, they’ll end up making carbon monoxide or carbon dioxide—which is safer than, say, coronaviruses.
But it’s hard to oxidize organic molecules all the way. Those are all the steps of chemical reactions that create smog in urban environments. There’s a lot of toxic byproducts. Take a big organic molecule like limonene—the molecule that makes anything citrus scented. It’s all over personal care products, and when you cook. It’s very prevalent in the indoor environment. You interact it with one of these ozone or [hydroxyl radical]generators, and you’re going to make formaldehyde.
Also, the oxidants themselves are quite toxic. Ozone is a well-known air pollutant in outdoor air, very well established to be dangerous. And then hydroxyl radicals are something that you would not want reacting with the tissues of your lungs.
Because they can damage the lungs?
They’re going to chemically react with your lung tissue, and certainly cause damage.
Is there any situation in which those are an appropriate way to clean indoor air?
In general, I can think of no situations where one would want an ozone generator in a house, or in a place where people are present. Same thing with these other oxidant generators. They’re either dangerous, or they’re operated in such a way that they’re not going to be effective.
What other devices are in this universe?
We’ve got another class of air cleaning devices that are foggers, or misters, or sprayers. There’s this thing called List N on the EPA webpage. It will tell you, if you take this commercial product, or you take this bleach mixture, it has this active ingredient, at this concentration. If you follow this set of instructions, and you mix it with water at this concentration, and you put it on a surface for this amount of time, it will destroy SARS-CoV-2.
Now what’s happened is a lot of companies are taking advantage of the fact that these types of chemicals will kill SARS-CoV-2. They then go and put them into sprayers or foggers. These are little devices that will release the chemical straight into the air, either as gases, or more frequently as little tiny droplets, little aerosol particles. The idea is that if you put enough of these, you spray them into a room, then you would kill any SARS-CoV-2 that’s in the air, in exhaled aerosol particles. And they would hit all the surfaces in the room and also destroy SARS-CoV-2.
It sounds like not a bad idea until you start thinking about it. First off, there’s a problem as to whether or not these work at all—because [according to] that EPA List N, you had to have a certain concentration and for a certain amount of contact time. Any of these airborne sprayers are certainly not meeting that concentration or contact time. So we don’t know that they work at all. Then there’s the problem that if you have people in the room, they are now going to be inhaling these droplets of these disinfectants—and some of them are quite toxic in and of themselves. Then you have that third issue—that these chemicals can actually do chemical reactions in the air, and on the surfaces of your building, and in your room. They can actually make really toxic compounds. This is very definitely the case for hypochlorous acid, which is basically a version of bleach. But this has become really popular in dentist offices.
Exactly. It’s “I hear that bleach kills SARS-CoV-2—so let’s drink it and put it everywhere and inject it.” It’s that level of logic. The thing that is scary to me is that this is a level of logic that has turned into products that are being very aggressively marketed.
Okay, so there are ozone and hydroxyl radical generators. Foggers, misters, sprayers that put disinfectants out into the room. What else?
The last major set of air cleaning devices are ion generators—these ionizers that are being incredibly aggressively marketed, especially toward schools. The idea behind them sounds great. If you pass air through one of these devices, it will ionize an array of molecules. What that really means is you’re either knocking out an electron, or you’re adding on a proton. You’re giving these little molecules a charge. These ions now will have a tendency to go towards anything that is grounded. I think of them as being quite sticky. They’ll hit surfaces, and they’ll just stick there. Or the particles might attract get attracted to other particles, and then they’ll stick together and become larger and larger and larger, until they fall out of the air.
That’s the theory. The practice is a little bit different. It’s actually quite hard to push enough volume through to actually make this system work to remove particles. There are not a lot of tests that have been done independently, that have shown that the system actually works to remove aerosol particles from the air.
The other problem is that you do chemistry when you have ions in air. Ions will react with other molecules in the air in a series of reactions, and, again, they’ll generate some oxidized organic compounds. Some of those are potentially more toxic than what you had in the first place. The problem with those ionizers is that we just don’t understand the chemistry of them. We don’t understand whether they make air toxic in concentrations we should be worried about, or if they don’t.
As an environmental chemist, I think about the precautionary principle, where you say, “Well, if this might do harm, and you don’t need to do it, then you just shouldn’t use it.” You have to prove that something is benign—that it’s not going to hurt the environment, and it’s not going to hurt people before you use it. And I think this rush to market these air cleaning devices is very concerning. I think we’re creating devices that might—not guaranteed—but they might create some some dangerous byproducts. And they certainly haven’t been proven to be effective.
I’ve seen lots of references to ultraviolet light, which seems to be maybe more recommended than these other techniques. Is that true?
Ultraviolet is pretty established. It’s expensive, but there’s some useful guidelines out there. The idea is that ultraviolet light is really strong, [it] breaks down DNA, and it will tear apart the COVID particles. It’s very effective as a germicide and quite well understood. If it is installed carefully and properly can be very effective. What you want to really be careful of is improperly installed UV, or anything that would expose you as an individual to it.
Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, speaks during a White House press briefing, at the White House on January 21, 2021 in Washington, DC. Alex Wong/Getty Images
Dr. Anthony Fauci, President Joe Biden’s chief medical adviser, encouraged Americans not to hesitate to receive the Johnson & Johnson coronavirus vaccine that the FDA authorized for use on Saturday. Johnson & Johnson’s one-shot vaccine prevented severe illness and hospitalization in trials, but its overall efficacy was 72 percent in the United States, whereas the clinical trials for the Pfizer and Moderna vaccines showed higher efficacy rates. This raises concerns of vaccine hesitancy for the newest vaccine, which will be rolled out over the coming months with initial shipments expected as early as next week.
“The message that needs to prevail, Dana, is that these are three highly efficacious vaccines,” Fauci told CNN’s Dana Bash on State of the Union Sunday. Fauci said that if he weren’t already vaccinated, “and I had a choice of getting a J&J vaccine now or waiting for another vaccine, I would take whatever vaccine would be available to me as quickly as possible.”
Dr. Fauci addresses the concerns about the Johnson & Johnson Covid-19 vaccine and how effective it is compared to the other vaccines available: “The message that needs to prevail, Dana, is that these are three highly efficacious vaccines.” #CNNSOTUpic.twitter.com/FMuH8b0whf
Fauci took the same message to other Sunday shows, urging Americans to take the Johnson & Johnson vaccine and speed up vaccination rates overall, rather than trying to hold out for a different vaccine. He further emphasized that it’s hard to compare efficacy rates across different studies, because they were conducted under different circumstances.
He cautioned that states beginning to ease lockdown restrictions are doing so prematurely, and he fears that infection rates will begin to tick up yet again. Premature reopening, he said, was “really risky” and would put us “right back on the road to rebounding.”
As governors across the country begin to ease some coronavirus restrictions, Dr. Anthony Fauci says he thinks the efforts are premature: “It is really risky to say, ‘It’s over. We’re on our way out. Let’s pull back.’” #CNNSOTUpic.twitter.com/rKLzd6ft54
On Feb. 27, 2020, Donald Trump hosted a Black History Month event where he talked about the COVID-19 pandemic.Tia Dufour/White House/Planet Pix/Zuma
It’s the one-year anniversary of former President Donald Trump’s fateful remarks dismissing the COVID-19 pandemic. At a Black History Month event on February 27, 2020, Trump predicted:
And you know what? If we were doing a bad job, we should also be criticized. But we have done an incredible job. We’re going to continue. It’s going to disappear. One day—it’s like a miracle—it will disappear. And from our shores, we—you know, it could get worse before it gets better. It could maybe go away. We’ll see what happens. Nobody really knows.
The fact is, the greatest experts—I’ve spoken to them all. Nobody really knows.
Two days after Trump’s comments, health officials in Washington State announced the first known coronavirus death in the United States (though later on the first known death was revised to February 6). Now, at the one-year mark of Trump’s denial, the United States has had more than 500,000 people die from COVID-19, roughly equal to the population of a major city like Atlanta. The toll has been worse for people of color, disproportionately taking Black, Latino, and Native American lives.
It also wasn’t true that nobody really knew what would happen. While CDC Director Dr. Robert Redfield testified that same day before Congress that his agency “believes that the immediate risk of this new virus to the American public is low,” the Trump administration received warnings from top scientists and national security experts on the threat of a pandemic as early as January. Despite these warnings, the Trump administration failed to take needed steps to ensure the supply of medical supplies, issue mask mandates, and urge Americans away from large gatherings.
Johnson & Johnson’s one-shot coronavirus vaccine is highly effective at preventing severe disease and death from COVID-19, the Food and Drug Administration found in analyses published today.
An international study found the vaccine’s efficacy rate to be 72 percent in the United States and 64 percent in South Africa, where a more contagious variant is spreading. While these figures are lower than Pfizer’s and Moderna’s efficacy rates, the vaccine greatly reduces the risk of hospitalization and death from COVID-19 and could play a key role in keeping the pandemic at bay. In a clinical trial of 40,000 people, no one who took the vaccine was hospitalized or died of COVID-19 after the vaccine took effect.
Plus, the vaccine requires only one shot and does not need special refrigeration—good news at a time when demand for vaccines greatly outstrips supply.
The FDA could authorize the vaccine for emergency use as early as Saturday, with 20 million doses available by the end of March and a total of 100 million doses delivered by the end of June.
Artist Suzanne Brennan Firstenberg walks among thousands of white flags planted in remembrance of Americans who have died of COVID-19 in October 2020.Patrick Semansky/AP
The United States’ COVID-19 death toll has surpassed 500,000, a staggering milestone.
“People decades from now are gonna be talking about this as a terribly historic milestone in the history of this country, to have these many people to have died from a respiratory-borne infection,” Dr. Anthony Fauci said in a CNN interview Monday morning. “It really is a terrible situation that we’ve been through, and that we’re still going through.”
It’s nearly impossible to conceive of the loss of half a million Americans. The virus has killed one in 670 people across the country. In places like New York City, the number is closer to one in 295. President Biden will hold a memorial ceremony this evening and will order flags on federal property to fly at half staff for five days.
COVID-19 infection rates in the US have fallen dramatically since their January peak, and more than 13 percent of the country’s population has received at least one vaccine dose. Still, public health officials are urging the public not to let their guard down. At a White House COVID-19 response team press briefing this afternoon, Fauci reiterated that people should continue wearing masks because of the possibility that people who have been vaccinated could still be infected and spread the disease asymptomatically.
“There will be things that you will not be able to do because the burden of virus in society will be very high,” he said. “We are still at an unacceptably high baseline level with the seven-day average being quite high.”
It was a little less than a year ago that then-President Trump declared that the coronavirus was “going to disappear.” Lockdowns in New York City, one of the initial epicenters, began in mid-March 2020. Since then, the world as we knew it has disappeared.
Dr. Jonathan Poon (right) next to his father, Dr. Glenn Poon (left), outside the Medical Center of Elberton in Elberton, GeorgiaMother Jones illustration
Update, February 19, 2021: After this piece was published, Dr. Poon reported that the Georgia Department of Health restored vaccines access to the Medical Center of Elberton. The clinic will be able to order shots starting March 8 and resume vaccinations March 15.
It was a gloriously sunny Wednesday in early February, but Dennis Fowler was worried. The 77-year-old retired transit worker sat in the waiting room at his doctor’s office at the Medical Center of Elberton, a bustling clinic in rural Elbert County, Georgia. He was there for a routine appointment, but he had also come to ask his doctor about his COVID-19 vaccine. Weeks earlier, as soon as they’d heard they were eligible, Fowler and his wife called to make appointments to get their shots. The prospect of an immunization was a big relief: Dennis’ wife had kidney failure, and the two had spent the last 11 months under strict quarantine to protect her. But a few days earlier, the Fowlers’ doctor had called to tell them the bad news. They may not get a vaccine after all and would likely have to start the process all over again. “We’re concerned that we’ll get the virus before we get our shot,” Fowler said.
The Fowlers are not the only ones in this Georgia community whose vaccinations were canceled. In late December, the county had finished vaccinating health care professionals and first responders, so the Elberton Medical Center opened up appointments to what they’d thought was the next tier: people over age 65 along with essential workers, including teachers. Most people in town cheered this development. The schools had been open since August, since remote learning was impossible for the community’s many children who lacked internet access. But the doctors at the medical center didn’t realize that the Georgia Department of Health had changed the guidelines in January, and teachers were not eligible after all. When the Georgia DPH found out that the Medical Center of Elberton had vaccinated 177 school workers with Pfizer and Moderna vaccines, state health officials meted out a harsh punishment. They suspended all vaccine shipments until July and seized most of the remaining doses in the clinic’s freezer, leaving only enough for those who had already gotten their first dose to receive a second.
The state’s seizure of the clinic’s vaccine supply comes at a critical time. At the urging of the Centers for Disease Control and Prevention, many states have opened vaccine appointments to broader swaths of the community to speed the process and prevent wasted doses. Yet some local leaders are cracking down hard on anyone who doesn’t rigidly adhere to guidelines. The New York Times recently reported that a physician in Houston was fired this month for giving away vaccine doses that otherwise would have gone to waste. Many public health experts question the logic of disciplining providers. “I think it’s really important that we stop punishing groups or individuals for vaccinating those outside state or [national] COVID-19 vaccination guidelines,” Peter Hotez, a vaccinologist and dean of the National School of Tropical Medicine at Baylor College of Medicine, told me for a previous story. The guidelines, he said, “mostly serve as a barrier or hindrance to vaccinations rather than their intended purpose.”
I visited the Medical Center of Elberton last week and chatted with Dr. Jonathan Poon, a physician who practices at the clinic, which is the largest in town and the main supplier of COVID-19 vaccines. He planned to distribute vaccines to the more than 3,000 patients the clinic sees every month. Now, like the Fowlers, most will struggle to get immunized elsewhere. About 70 percent lack private insurance, and many don’t have internet access they’d need to book appointments at other locations. “We’re in a very precarious situation,” he said.
Elbert County is in the far northeastern corner of Georgia, close to the South Carolina border. Many of its 20,000 residents are employed making tombstones and memorial statues out of stone—a mural downtown in Elberton, the county seat, boasts the town is “the monument capital of the world.” Trucks bearing slabs of granite rumble through the modest downtown, a square of municipal buildings and a few storefronts still open for business: Stan’s Music World, say, and Tena’s Fine Jewelry & Gifts. On Friday nights, people go to see the the Blue Devils football team from the high school play at the Granite Bowl stadium, which is carved out of 100,000 tons of blue granite. The people here live modestly: In 2018, the median household income was about $44,000, and nearly 20 percent lived below the poverty line.
On the day that I visited, I watched as residents stopped to greet each other around town. The older ladies had names like Sarabelle and Shelly Anne. “How’s your mama?” They asked neighbors at the pharmacy. “She managing okay?”
Almost everyone in this county knows Dr. Poon because he’s lived here almost his whole life. His family, originally from Hong Kong, moved to Elberton when Poon was 3 months old so his father could practice family medicine. Poon decided to follow in his father’s footsteps, and after medical school and residency, he moved back home to practice family medicine. Today, he sees patients down the hall from his father.
Poon, who has an unflappable air about him and speaks in a slow Southern drawl, isn’t used to being in the spotlight. He spends his days at the clinic, seeing local patients at all phases of life: children with sore throats, pregnant women, elderly people who need medication for diabetes. But in the last few weeks, Poon has appeared on TV news shows, talking about how much the people of Elbert County need the vaccines that the state took away. As he and I walked from the parking lot of the medical center to the pharmacy, neighbors greeted him like a conquering hero. “Thank you so much for what you’re doing for our town,” a man in a pickup truck said through his window. “I really mean it.”
When Poon and his colleagues heard in November that vaccines would be available by the end of the year, their planning went into overdrive. The clinic purchased a special freezer for $7,000, and a trailer to use as a vaccination clinic for $90,000. They wanted to make it as easy as possible for their patients to get vaccines, and they aimed to get the process started quickly. They saw how their community was suffering.
COVID-19 ripped through Elbert County this winter. So intense was the spread of disease that the small local hospital had to send patients to ICUs as far away as Jacksonville, Florida. The county EMS team has been stretched thin, transferring patients while also trying to provide regular emergency services to the county. In the three local nursing homes, the COVID-19 mortality rate was 30 percent. Poon estimates that 30 or 40 people died of the virus.
The county’s plight did not move the state public health department to reverse its decision despite Poon’s efforts. When I contacted the Georgia DPH for a previous story, spokesperson Nancy Nydam responded, “It is critical that DPH maintains the highest standards for vaccine accountability to ensure all federal and state requirements are adhered to by all parties, and vaccine is administered efficiently and equitably.” In other words, there was little hope for recourse.
When the state seized the medical center’s vaccines, the pharmacy next door, Madden’s, attempted to pick up some of the slack, applying to receive more vaccine doses from the state, a process that took several weeks. The gregarious head pharmacist, Don Piela, has been working hard to book appointments every day. As he stood behind the prescriptions counter, he told me he had to bring in help to cope with the demand for vaccine. His wife, who usually works as a pharmacist in another town, came into assist with booking appointments and performing vaccinations. The pharmacists also had to contend with unscrupulous line jumpers. An Atlanta couple in their 50s, for instance, drove two hours from the suburbs for a vaccine, claiming they were caregivers for the woman’s elderly mother, who lived in Tennessee. The pharmacists had to turn them away.
Piela told me he’s grateful that his pharmacy was able to help with vaccines, but he’s worried that the state’s decision to punish the medical center could have consequences beyond the pandemic. “If the state is coming in and suspending vaccines to a medical facility, there’s part of your population says, ‘Well, they must have been doing something wrong,’” he says. “If you damage the reputation of anybody, that’s damaging. But especially somebody that’s in health care, that’s really even more damaging.”
Poon and his colleagues are working hard to try to convince state officials to restore their vaccine supply. They’ve been meeting regularly with county leaders, who have appealed the state’s decision twice, with no luck. State public health representatives responded with a letter stating that the decision to withhold vaccines will stand. Poon is worried that all the delays are wasting valuable time. Every day that Elbert County residents don’t get vaccinated is another day they could contract the virus. Meanwhile, more contagious variants are spreading quickly; the one that originated in Africa already has been identified in neighboring South Carolina.
Fowler, the 77-year-old whose vaccine appointment was canceled, is frustrated about being stuck in the house indefinitely, always worried about the fragility of his wife—and himself. If the state doesn’t restore vaccine shipments, he’ll make an appointment at Madden’s, but he doesn’t know how long he’ll have to wait—it could be weeks. He misses seeing his neighbors and going for a date with his wife to the Outback Steakhouse. He’s eager to get back to church. “I’m hoping something will come through,” he said, “and we will be able to get our shots.”
Standing in front of the clinic, Poon looked at the vaccine trailer his practice had purchased and shook his head. He intends to keep trying to impress upon the state that his patients deserve vaccines, and that he and his colleagues never meant to flout any rules. “There’s nothing we’re doing for personal gain,” he said. “We’re just trying to do the right thing.”