Transplant patients ‘desperate’ for COVID vaccine protection are getting illicit 3rd doses – and it might be working for some

a man with a heart transplant seen getting a COVID-19 shot
A doctor administers a second COVID-19 vaccine injection to a heart transplant recipient on February 20, 2021 at a hospital in Strasbourg, France.

  • It can be hard for people with transplant organs to derive the same benefits from vaccines as other people.
  • A new study suggests giving them 3 doses of COVID-19 vaccines, instead of 2, can help.
  • See more stories on Insider’s business page.

For tens of thousands of Americans with suppressed or compromised immune systems, getting fully vaccinated against COVID-19 hasn’t led to disease protection. Receiving a third vaccine dose might help fix the problem, at least for some of those patients.

A new study – conducted on patients with organ transplants who took it upon themselves to get illicit vaccine booster shots in the US – suggests that the third try may be the charm when it comes to some immunocompromised people and vaccination.

Out of the 30 patients enrolled in the study, published Monday in the Annals of Internal Medicine, 12 achieved high antibody levels after the third vaccine, two patients had low but detectable antibodies, and the remaining 16 patients remained antibody negative after their third dose booster.

It didn’t really seem to matter whether the participants mixed and matched their shots. There was limited success with all different combinations of third doses of Pfizer, Moderna, and Johnson & Johnson (none of the patients had J&J initially).

“People want to return to their lives, and they will go to great lengths to do so: to go back to work, to go back to church, to see the grandkids,” Dr. William Werbel, an infectious disease clinician at Johns Hopkins who led the new study, said. “They were somewhere on the spectrum between frustrated and desperate.”

Hoping that a third dose might be the ticket to resuming some of their bygone activities, many rolled up their sleeves once again. Their mixed success in the third dose trial is a promising signal that COVID-19 booster shots can be safe and effective, and that the side effect profile of a third shot could be quite similar to a second.

Hundreds of transplant patients have already gotten a third vaccine dose

lung transplant patient smiling, arms crossed, getting ready for a run
Edgardo Diaz, 30, gets ready for a run in his Oak Forest, Illinois, neighborhood on June 17, 2020. He is believed to be the first lung transplant patient to receive plasma for COVID-19 and recover.

Werbel said there were already “hundreds” of transplant recipients around the US who’d made up their minds to get a third vaccine, even though the practice is not federally recommended.

Rather, because many transplant patients are active on a nationwide organ network that connects patients and doctors to share experiences and best practices, he already knew it was happening.

“We basically had the privilege of working with patients who said, ‘Hey, I’m going to get vaccinated next week. How can I help contribute to studying whether this works?'” Werbel said. “I have to plead somewhat ignorance about how people were doing it, because it’s not authorized that way.”

He called the new study findings, which are still preliminary, “encouraging.” But the third doses were not a smashing success, only markedly improving antibody levels in about half of the participants.

That doesn’t necessarily mean that the 16 patients in the study who remained antibody negative gained no benefit from taking the third vaccine dose; antibodies aren’t the only piece of the puzzle in determining a person’s immunity to COVID-19. But it does suggest there might be something about the way their immune systems operate that isn’t giving them great vaccine protection.

“These patients take medicine specifically designed to prevent rejection of their heart, or their lung, or their kidney, whatever was given to them,” Werbel said. “These medicines are explicitly designed to reduce the potential to react to new things. That’s why patients don’t always create good response to vaccine antigens, the proteins in the vaccines.”

In France, the government does endorse third doses of COVID-19 vaccines for organ transplant recipients and others with compromised immune systems.

Proof of concept that boosters can work

Dr. Rishi Seth of Sanford, gets COVID vaccine
Dr. Rishi Seth, a hospitalist at Sanford Health Fargo, gets a COVID-19 shot.

The study is one of the first to show that mixing and matching booster doses of COVID-19 vaccines is both safe and effective – at least for some people.

“It’s a little hard to generalize to the healthy population, just because the healthy population cranks out so much antibody and other immune response to these vaccines,” Werbel said.

Side effects after a third vaccine dose were similar to those experienced after a second, including mild to moderate fatigue and arm pain. One patient rejected her donated organ – a heart – seven days after her booster vaccination, but it’s unclear whether that was related to the vaccine administration. (She is now recovering.)

Werbel cautioned that it is still too soon to say how well-protected from disease these patients may be through vaccination.

“Transplant patients really shouldn’t consider themselves to be fully protected or vaccinated until we learn more, and that honestly means it’s important for people around them – really important for people around them – to get vaccinated,” he said.

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I am immunocompromised, and the vaccine may not keep me safe. As the country reopens and mask mandates lift, millions of people like me feel scared and abandoned.

A crowd of people wearing masks are in various lines at a bus station.
Commuters line up at a transport hub wearing masks. In the US, mask mandates are lifting as more people get vaccinated, leaving those with weakened immune systems behind.

  • Research indicates the COVID-19 vaccines do not work well for many immunocompromised people.
  • As mask mandates lift, people who are immunocompromised are feeling scared and left behind.
  • There are steps that businesses, health officials, and the CDC need to take to keep us safe.
  • Kathryn Mayer is a Denver-based writer and editor.
  • This is an opinion column. The thoughts expressed are those of the author.
  • See more stories on Insider’s business page.

The vaccines are here, businesses are reopening, and now the Centers for Disease Control and Prevention (CDC) says vaccinated people don’t have to wear masks in public places. All of this messaging shouts: The pandemic is over! It’s safe for vaccinated people! Let’s move on with our lives without precaution!

But all this premature optimism and jubilation is leaving out one important group: immunocompromised individuals who suffer weakened immune systems and are among the most vulnerable to serious illness and death from COVID-19.

Worse yet, emerging research indicates that COVID-19 vaccines may not be as effective for immunosuppressed patients – for many people in this group, the vaccines do not produce much, if any, immune response against the virus – leaving many of them just as vulnerable as if they hadn’t been vaccinated.

This is an important finding in part because the group is not insignificant in numbers: About 10 million people in the US are immunocompromised, typically because of organ transplants or illnesses like cancer and autoimmune diseases, as well as the immune-suppressing medications many use to help treat these conditions.

I’m one of them – I have two autoimmune diseases in which my body attacks healthy tissue and cartilage, and more broadly wreaks havoc on my system. To help treat these illnesses, I take immune-suppressing drugs that in turn make me even more vulnerable and prone to long-lasting viruses, infections, and other illnesses.

Like many others in my shoes, I’ve already felt left behind in many respects over the past year. Since last March, I’ve done my due diligence and followed all the recommendations, rules, and guidelines, including forgoing travel, visiting restaurants, and visits from family and friends – even as those around me gave up one precaution after another, lured by vacations, indoor holiday gatherings, and crowded bars and restaurants.

But the latest guidance from the CDC allowing vaccinated people to shed their masks in indoor, public places – and worse yet, essentially allowing unvaccinated people to remove masks in public as well since businesses typically do not require proof of inoculation – has made individuals like me feel even more left behind, anxious, and forgotten. I’m vaccinated, but it’s not clear what kind of protection that provides for me. (Immunocompromised individuals were excluded from the vaccine trials, but a new study is now underway from the National Institutes of Health).

The things I’ve been looking forward to doing once I was vaccinated now seem far out of reach, knowing the extra precaution of masks is no longer required. Yes, I can and will wear one, but being around scores of maskless people is a risk too many immunocompromised people can’t take. After a year of “we’re all in this together” and “let’s keep each other safe,” people are now rushing to take off their masks without thinking of those who still need to be protected. It’s not as simple as vaccinated or unvaccinated – there’s a murky middle camp of chronically ill patients who are inoculated, but who simply don’t have the normal defenses that allow the vaccines to work.

President Biden said recently that the new mask guidance means the unvaccinated “will end up paying the price,” but he’s wrong – he’s leaving out the vulnerable immunocompromised community. It’s a real punch in the gut for these people after an especially challenging and frightening year.

How to keep immunocompromised people safe

Despite these failings, there are steps that health officials, government, and businesses can take to make me and the 10 million others like me feel more safe and seen in this phase of the pandemic.

First of all, both public health officials and businesses should not rush to take away every precaution. Although this seems simple enough, it’s worth saying. Don’t take away every precaution and health and safety protocol that makes us feel ever-so-slightly more safe. If people can go maskless, don’t take away precautions like capacity limits and alternate options like virtual events and curbside pickup until vaccination rates are significantly higher and research has been conducted on vaccine efficacy for immunocompromised individuals.

For companies that want to return workers to the office – and plan to forgo mask mandates – allow your immunocompromised workers to continue to work from home.

Another suggestion is for the government to consider a widespread vaccination passport policy. I know, I know: No one can agree on this. But relying on the honor system to keep public spaces safe is not going to cut it. Chronically ill people, who for years have gotten extremely ill from being around sick people, no longer trust others to keep us healthy – especially during a pandemic.

Remember at the beginning of the pandemic when there were special hours at stores for elderly and immunocompromised people (because at one point, we mattered)? I’d love to see this return for grocery stores and other businesses. For places that are following the updated CDC guidance and allowing people to go maskless, offering a mask-mandated hour for chronically ill and immunocompromised individuals – or just anyone who feels safer wearing a mask – will help keep us safe.

Certain types of businesses that make appointments in advance – hair salons or financial institutions, for instance – should make it a policy to ask customers their mask preference during the booking process.

The CDC should update health guidance to inform the public about immunocompromised risks and how people can help. When the CDC released its new mask guidance, it included a line addressed to immunocompromised people, telling them they are still vulnerable and to “be aware of the potential for reduced immune responses to the vaccine, as well as the need to continue following current guidance to protect themselves against COVID-19” – um, thanks?. But besides the “you’re on your own!” message, it did not inform the public about what risks they pose to this vulnerable group of people or what they can do to help. This needs to be rectified.

Most importantly, I urge the CDC and health officials to share information about the continued risks for vaccinated immunocompromised people to the general public, so people are aware of this underreported issue and understand that they can help keep this group safe by continuing to wear masks (even though they are not required to). I would also urge the CDC to update their mask guidance to tell the public that those who continue to wear masks, especially in public places or in circumstances where they might be in contact with an immunocompromised person, will help protect this vulnerable population.

It may be too late to reverse the mask guidance, but it’s not too late to do the right thing to help keep millions of people like me safe. Our lives might actually depend on it.

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People who’ve had COVID-19 vaccines should get a state-issued ‘driver’s license’ to party, top bioethicist says

covid vaccine license
COVID-19 vaccine cards from the CDC are bulky, and subject to fraud. Maybe the DMV should be in charge?

Dr. Ezekiel Emanuel is ready to step out and party – well, almost.

The chair of the department of medical ethics and health policy at the University of Pennsylvania hasn’t been to the theater in over a year and he says he’s “dying to go.” He’s also planning to travel to Switzerland this summer.

But first, he has to sort out a big open question – both for himself, and for anyone he’s going to share some air with.

“How am I supposed to prove that I’ve been vaccinated?” he asks. “What I have now is a CDC cardboard piece of paper, right? It’s ridiculous.”

Emanuel says it shouldn’t be so hard for authorities to develop a reliable, relatively fraud-proof and secure driver’s license-style verification system for gauging COVID-19 immunity status. Ideally, such a system could replace the Centers for Disease Control and Prevention’s white vaccine cards, which are both easy to fabricate and too big to fit in standard wallets.

A vaccine license from the DMV?

ezekiel emanuel
Dr. Ezekiel Emanuel on June 15, 2015 in Philadelphia, Pennsylvania.

Ezekiel, a former White House health policy advisor, imagines a world where “I could just have a QR code, and show it, and it would flash green,” offering permission to do all sorts of indoor activities in a secure, encrypted, and private way. It sounds like the kind of thing the DMV could pop onto a credit card-sized ID and print out.

“So, perhaps the DMV should have been in control of this?” I asked him, as I imagined the ensuing bureaucratic headaches.

“Look, you’re laughing, but … we know how to print those things,” he said.

The idea of COVID-19 immunity licensure is something he’s been considering since at least May 2020, when he wrote a viewpoint submitted to the medical journal JAMA on the subject.

“People must be allowed to pursue their life plans unless doing so is incompatible with public health,” he said at the time. “In the absence of licensing, businesses and individuals may instead elect to use unregulated evidence of immunity, such as test results, or to use assumptions about immunity or vulnerability that are likely to be arbitrary and biased.”

‘I want to know that everyone at work who’s going to be in a closed room with me is going to be vaccinated’

vaccine license like driver's license
Lindsay Lohan with Jay Leno on April 20, 2004.

At a time when herd immunity is far from accomplished in the US, licensure is the kind of safeguard that could allow people to do more together, without as much risk of getting sick.

“I want to know that everyone at work who’s going to be in a closed room with me is going to be vaccinated,” Emanuel said. “I’d love to go to the theater, but I also would love to go to the theater safely and knowing that everyone in the theater is vaccinated – you’re not allowed in the theater unless you’re vaccinated, or had COVID.”

Some US universities and hospital systems (like his) have started mandating COVID-19 vaccination for students and staff, but it is far from the norm for businesses or events nationwide yet. No US states have any requirement for hospital staff to be COVID-19 vaccinated, but that could change if and when vaccines receive a full Food and Drug Administration approval. Already, a majority of healthcare workers nationwide are required to get annual flu shots.

“If anything, this vaccine is better, safer, and forestalls a worse disease than the influenza vaccine, and yet fewer are mandating it,” Emanuel said. “I think that’s unethical.”

Unvaccinated people could still be accommodated

Excelsior Pass app which provides digital proof of COVID-19 vaccination or negative test results seen displayed on a smartphone screen in front of the US flag.
Excelsior Pass app which provides digital proof of COVID-19 vaccination or negative test results seen displayed on a smartphone screen in front of the US flag.

Much like the DMV does for driver’s licenses, COVID licenses could come with different designations and exemptions.

In fact, digital immunity cards that are similar to what Emanuel imagines already exist in some places.

New York has an “Excelsior Pass” app that operates with a QR code. It shows proof of vaccination or negative test results, which can be scanned like a boarding pass at businesses or venues (it’s already being used at the Barclays Center and Madison Square Garden in New York City.)

The European Union has a “Digital COVID Certificate,” which allows people to travel more freely by showing a QR code proving they’ve either been vaccinated, gotten a negative test result, or recovered from the virus. The new system is up and running in seven EU countries so far.

There might need to be different kinds of licensure for people with natural immunity from infection (versus vaccination), and special dispensations for immunocompromised individuals who don’t benefit from vaccines in the same way as others do, Ezekiel said. The unvaccinated need not be categorically excluded.

“You wear an N95 mask, or, we accommodate you in working from home. I mean, look, we have laws that mean you have to make reasonable accommodations for people,” he said. “These aren’t new problems.”

Even if there was a clear, secure system for keeping track of immunity, there’s still one big mystery left to settle. Scientists haven’t yet figured out how, exactly, immunity to the coronavirus works. They don’t know when a COVID-19 license might expire, or how will we know if it has.

“We’re uncertain what the expiration date is, right? All the more reason to have it electronically, where we can change them,” Emanuel said.

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Anthony Fauci said he thinks universities, cruise ships, and airlines will require proof of COVID-19 vaccines before letting people in

GettyImages anthony fauci
Anthony Fauci thinks airlines and cruise ships will require customers to get vaccinated.

  • Anthony Fauci said he expects airlines and cruise ships to require passengers get a COVID vaccine.
  • Fauci expects many individual businesses will require customers show proof of vaccination.
  • Many universities have already started to require students get vaccinated to attend in-person class.
  • See more stories on Insider’s business page.

Anthony Fauci said though the US is not requiring everyone get the COVID-19 vaccine, he expects individual businesses will.

Fauci, the chief medical advisor to President Joe Biden, said he expects businesses like airlines and cruise ships to require customers to show proof of getting a COVID-19 vaccine before coming on-board. Many universities, he added, have already started to require students get vaccinated if they’d like to attend in-person classrooms.

“There are organizations, particularly universities and colleges who are saying, not withstanding what the federal government is requiring, if you want to come into campus and be in in-person learning, you’re going to have to show proof of vaccination,” Fauci said during the the Bloomberg Businessweek conference on Thursday.

“Cruise ships will likely be doing that. Airlines will likely be doing that. So you’re going to have at, a local, independent-level, things that the federal government is not going to be mandating,” he said.

Read more: Novavax could have the ‘best’ COVID-19 shot, but new delays are raising questions about the $10 billion biotech’s path to profits

The Centers for Disease Control and Prevention recently updated its COVID-19 guidelines for the cruise line industry to allow ship to sail if 98% of crew and 95% of passengers are vaccinated against COVID-19.

Many major cruise lines are planning to resume sailing this summer by departing from international ports instead of US waters due to CDC restrictions, Insider’s Brittany Chang reported.

The CDC recently said fully vaccinated people can remove masks in most indoor and outdoor places, but made an exception for health care facilities, public transportation, and airports.

Airlines, many of which lost revenue due to travel restrictions last year, are offering cheap fares to get Americans in the air again. The Transportation Security Administration announced on May 18 it screened more than 1.8 million people at airport security checkpoints, a new record high number of travelers since March 2020.

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A ‘more rapidly spreading virus’ is fueling India’s mega COVID-19 surge, WHO chief scientist says

Relatives bow their heads and pray next to a cremation pyre for a relative who died of COVID-19.
Relatives prepare a pyre for cremation of a relative who died of COVID-19 at a crematorium in Ajmer, Rajasthan on May 8, 2021.

  • A coronavirus variant first identified in India has “mutations which increase transmission, the WHO’s chief scientist said.
  • The B.1.617 variant might also be antibody resistant, giving it the power to reinfect people.
  • But more vaccination will still help control its transmission, and prevent severe disease and death.
  • See more stories on Insider’s business page.

The World Health Organization is sounding the alarm about a coronavirus variant first identified in India, which is now spreading around the globe.

The variant, B.1.617, is “likely to be a variant of concern,” the WHO’s chief scientist Dr. Soumya Swaminathan told AFP on Saturday, “because it has some mutations which increase transmission.”

Those mutations could also potentially make the variant “resistant to antibodies that are generated by vaccination or by natural infection,” she added.

But even if the current vaccines don’t work quite as well against B.1.617 as they did against the original virus strains that shots were designed to combat, more doses in arms will still help cut down on disease spread, and make COVID-19 cases milder, if and when they do happen. Scientists agree this is one key reason that India needs more vaccines, fast.

The B.1.617 variant spreads rapidly

A passenger receives his COVID-19 vaccine at a drive-in vaccine clinic on May 8, 2021 in Mumbai, India.
A senior citizen receives a COVID-19 vaccine at a drive-in vaccine clinic at the Willingdon Sports club on May 8, 2021 in Mumbai, India.

The Centers for Disease Control and Prevention has called B.1.617 a variant of “interest” but hasn’t gone so far as to label it a “variant of concern” yet, like the agency has done for the B.1.1.7 variant (first tracked in the UK), the B.1.351 variant (spotted in South Africa), and the P.1 variant (picked up in Brazil). But, the CDC did recently recommend restricting travel into the US from India, citing worries about more spread of viral variants there, and the White House banned most travel from India to the US on May 4.

“It’s an extremely rapidly spreading variant,” Swaminathan said.

Still, B.1.617 cannot be blamed entirely for the current outbreak in India, as there are other factors playing a major role in the mammoth wave of COVID-19 infections and deaths, including “huge social mixing and large gatherings,” as she pointed out.

“Early signs were missed until it reached the point at which it was taking off vertically,” Swaminathan said of the Indian outbreak. “At that point it’s very hard to suppress, because it’s then involving tens of thousands of people and it’s multiplying at a rate at which it’s very difficult to stop.”

Vaccines can still help control the spread of new viral variants, and make them less deadly

A COVID-19 patient on oxygen.
A COVID-19 patient on oxygen support, May 8, 2021, Gurugram, India.

Even though the B.1.617 variant is easier to catch than older versions of the coronavirus, more vaccines in arms will still help control its spread.

Leading variant researchers at Ravindra Gupta’s Cambridge University lab recently tweeted fresh evidence of this, saying early data suggests that the variant can be controlled well by the vaccines we already have, even if that protection isn’t perfect.

“The vaccines which are currently approved will protect a majority of people against getting severely ill,” Swaminathan told India Today. “You may still get the infection, but it will prevent you from landing in that ICU.”

Still, top virus watchers are worried that if the world does not get vaccinated quickly enough, other new and concerning viral mutations could arise, and eventually, our vaccines may not work so well against them anymore. Essentially, as the virus spreads and spreads, it gets more and more new opportunities to learn how to evade any immune protection we may have.

“Variants which accumulate a lot of mutations may ultimately become resistant to the current vaccines that we have,” Swaminathan told AFP. “That’s going to be a problem for the whole world.”

India has fully vaccinated just 2.6% of its population so far, according to Bloomberg’s global COVID-19 vaccine tracker, while the US has fully vaccinated roughly a third of its people.

Dr. Anthony Fauci, America’s top infectious disease expert, said on Sunday that vaccine makers need to figure out how to “get literally hundreds of millions of doses” to India, and fast.

“The end game of this all,” he told ABC’s This Week, “is going to be to get people vaccinated.”

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Who’s to blame for the drop off in new vaccinations? Start with public health officials like the CDC.

COVID vaccine
Amanda Richardson, employee at Life Care of Action, a skilled nursing and rehab center, gets her Pfizer coronavirus vaccine in Acton, Massachusetts on December 28, 2020.

  • The COVID-19 vaccines are among the most effective ever invented.
  • But when people hear that getting vaccinated may not usher in a return to normalcy or could harm their health, they grow reluctant to get the shots, slowing our march to herd immunity.
  • An ABC News/Washington Post poll found that 73% of unvaccinated Americans wouldn’t take the Johnson & Johnson shot.
  • Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute.
  • This is an opinion column. The thoughts expressed are those of the author.
  • See more stories on Insider’s business page.

Don’t throw those masks away just yet. Last week, the Centers for Disease Control and Prevention (CDC) relaxed mask-wearing guidance for those who have been fully vaccinated. But only outside. And only in settings that aren’t crowded.

However, the CDC could’ve issued much of this new guidance months ago. Epidemiologists have known since last summer that it’s nearly impossible to contract the virus outdoors, even for an unvaccinated person.

Waiting to ease mask restrictions is part and parcel of a doomsday mentality that’s permeated the government response to the pandemic. It’s also fueling vaccine hesitancy. When people hear from public health officials that getting vaccinated may not usher in a return to normalcy, may not prevent COVID-19, and could harm their health in other ways, they grow reluctant to get their shots.

That slows our march to herd immunity — and ensures the pandemic will be with us longer than necessary.

Unclear guidance

The COVID-19 vaccines are among the most effective ever invented. Real-world data have borne out what the clinical trials showed. Every vaccine approved for emergency use in the United States stops hospitalization or death from COVID-19 nearly 100% of the time.

Still, the number of people who say they won’t take the vaccine remains high. According to the latest CBS News/YouGov poll, 18% of Americans say they might get the vaccine, and 22% say they will not. While the share of “Maybes” has decreased four percentage points since March, the share of “Nos” has stayed constant.

Guidance from public health officials may contribute to this stickiness in public opinion. They’ve been encouraging people to get vaccinated – but cautioning that it shouldn’t change their behavior afterward.

Most people concluded months ago that going for a mask-less run or hanging out with a few friends in the backyard posed little to no risk. And after high-profile mass gatherings like the Black Lives Matter protests last summer turned out not to be super-spreader events, it seemed clear that masking up outdoors was probably overkill. Yet the CDC is only now relaxing its mask advice?

Then there’s the guidance for indoor masking. The CDC says even vaccinated people should still cover their faces. But there’s scant evidence to suggest that fully vaccinated individuals spread the virus inside.

A February study out of Israel found that vaccinated people had viral loads in the nose and throat 60% smaller than those who weren’t vaccinated. Since the virus mainly transmits through the nose and throat, the findings suggest that vaccines reduce transmission.

The CDC ran a similar study of 4,000 vaccinated healthcare workers and found that the Moderna and Pfizer vaccines prevented infection, including asymptomatic infection, 90% of the time.

Encouraging masks for reasons of social solidarity may be wise, but that’s not the CDC’s reason for asking vaccinated people to wear masks. The agency doesn’t really offer one.

The Food and Drug Administration has been similarly opaque with the public. The nation’s top drug regulator famously suspended administration of Johnson & Johnson’s COVID-19 vaccine for 10 days while it investigated reports of rare blood clots. Of the 7.5 million people who have received the shot, seven women have reported the blood clot symptoms. That means 99.9999% of recipients of the vaccine didn’t see any severe side effects.

That pause ended with a warning label being placed on the vaccine. But the damage has been done. The number of first doses of vaccine administered daily plummeted 40% after the pause. An ABC News/Washington Post poll out this week found that 73% of unvaccinated Americans wouldn’t take the Johnson & Johnson shot. Just 46% of all Americans believe it is very or somewhat safe.

Government guidance that restricts safe behavior and sows doubt about vaccine safety – even unintentionally – will undermine the campaign to vaccinate the population. Public health officials are fond of saying they’re just following the science. They should level with the public and actually do so.

Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes.

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Dr. Fauci explains why COVID-19 vaccines work much better than natural immunity to protect you from the coronavirus

fauci gets his first vaccine
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, gives a thumbs up after receiving his first dose of a COVID-19 vaccine at the National Institutes of Health on December 22, 2020 in Bethesda, Maryland.

  • Dr. Anthony Fauci discussed new data suggesting that COVID-19 vaccines “can do better than nature.”
  • People who’ve had prior infections saw their immune response to COVID-19 drastically improve after receiving mRNA vaccines.
  • The finds are a beacon of hope, as new variants (which may reinfect people) circulate the globe.
  • See more stories on Insider’s business page.

Dr. Anthony Fauci is calling it: mRNA COVID-19 vaccines can provide people with better protection against new viral variants than a prior coronavirus infection alone can.

During a White House COVID-19 briefing on Tuesday, Fauci pointed to several new studies, which, when taken together, suggest that the mRNA vaccines from Pfizer and Moderna provide great immune protection against newly circulating viral variants.

According to the data, the vaccines bump up any natural protection people may have had from prior infection substantially.

“Vaccines, actually, at least with regard to SARS-CoV-2 [the coronavirus] can do better than nature,” Fauci, America’s leading infectious disease expert, said. “Vaccination in people previously infected significantly boosts the immune response.”

Two of the studies that Fauci referenced during the briefing have been peer-reviewed, meaning other independent scientists have given them a thumbs up, while two others are still awaiting peer approval. But they all tell a very similar story.

Four studies all show superior protection against variants from vaccines

One study found that people who’d had two doses of an mRNA coronavirus vaccine (either Pfizer’s or Moderna’s) had antibody titer levels “up to 10 times” that of a natural infection, Fauci said, suggesting those vaccines give people’s bodies more fighting power against viral variants than a prior illness can.

“You had interesting increased protection against the variants of concern,” Fauci said.

Another small study showed that previously infected people who got vaccinated were exceptionally well protected against three of the five major variants of concern: the P1 variant, first identified in Brazil, the B.1.1.7 variant from the UK which is now dominant in the US, and the B.1.351 variant, first found in South Africa.

But that’s not all. In another study that Fauci mentioned, people who’d been previously infected with COVID also displayed better T-cell immunity after a single dose of Pfizer’s mRNA vaccine. (T cells can help make infections milder, if people do ever get reinfected.)

“Now, remember these are only laboratory data, have not been proven in the clinic,” Fauci said, pointing out that the new studies are based on blood tests, so it’s hard to know exactly how everything would play out with real-world infections and variants. “But they are really very interesting, and things that we need to follow up on,” he added.

The final study Fauci cited suggested that people who have recovered from a prior COVID-19 infection who then get vaccinated may receive great broadband protection, not just against concerning viral variants, but also against other coronaviruses, like SARS, from their COVID-19 vaccination. That’s a virus-fighting power that people who’ve been infected but not vaccinated don’t get.

“Vaccines are highly efficacious,” Fauci concluded. “They are better than the traditional response you get from natural infection.”

fauci showed this slide during wednesday's briefing, which has a graph showing better antibody protection against variants in previously infected people after vaccination
Messenger RNA vaccines (mRNA) are standing up to variants really well, so far.

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Why declaring racism a public health crisis is an important step to closing racial gaps in healthcare

Racism is a virus AAPI stop the hate protest
Racism is as much a public health issue as it is a social justice issue.

  • On April 8, CDC Director Dr. Rochelle P. Walensky declared racism a public health threat.
  • This declaration will create a sharper focus on healthcare inequality, says Dr. Paul Halverson.
  • Treating racism as a disease will also boost public health funding and lead to healthier communities.
  • See more stories on Insider’s business page.

The Centers for Disease Control and Prevention has joined hundreds of cities and counties across the country in declaring racism a public health threat. On April 8, 2021, CDC Director Dr. Rochelle P. Walensky called racism an epidemic that affects “the entire health of our nation.”

Declaring racism a public health threat will create a sharper strategic and operational focus on understanding and combating racism. Walensky said the CDC will invest more in communities of color and will work to create more diversity within the CDC.

The agency will create a portal on the CDC site called “Racism and Health” to help provide resources and to educate people.

As a professor and founding dean of the Fairbanks School of Public Health at Indiana University, I agree drawing attention to the racial gaps in healthcare is an important step in addressing them.

Read more: As Black Harvard Law School students, we’ve encountered racism at Harvard and elsewhere. But anti-Blackness goes far beyond our privileged Ivy League experiences – it’s deeply rooted in American law and policy.

Bringing up the rear

Acknowledging racism as a public health threat allows for the creation of workforce training programs in public health, medicine, nursing, and other fields. It also may require all health-related professional training programs to include structural racism identification and implied bias and anti-racism strategies within the curriculum. This will put a sharper focus on the measurement of the factors that influence racism. Designating racism as a public health emergency can create institutional focus on actions taken to address this long-overlooked issue.

The US pays more per capita for healthcare than any other industrialized nation in the world, but look at the health statistics and you’ll see the US brings up the rear. Canada, Japan, Malta, New Zealand, Singapore, and Switzerland do better. Among the industrialized countries, the US’s health system is currently ranked 37th in the world.

The reality is that health is a result of many factors. The most striking one has nothing to do with intelligence, diet, or job status. Instead, it’s a person’s ZIP code. Where someone lives is the greatest predictor of health and life expectancy. A person’s ZIP code is also a good predictor of their race and ethnicity. Those things too have a major impact on how long someone lives and, maybe even more importantly, how well.

I live in Indiana. Here, a baby born today in a southern urban neighborhood will live 14 years less than another baby born in the northern suburbs, less than 20 miles away. How a nation protects the health of its children tells you an enormous amount about that society. In the US, our infant mortality – babies who die before their first birthday – is among the highest in the world, with the highest rates in the Midwestern and Southern states. And across the board, infant mortality affects Black communities at a rate higher than other races.

Higher risks across the board

If you are an African American mother in Indiana, your baby is three times more likely to die before its first birthday. Being born Black also means you’re twice as likely to suffer from high blood pressure and have a stroke. Black Americans are also more than five times as likely to serve prison time and will earn substantially less money than their white neighbors. And people of color are up to 10 times more likely to test positive for COVID-19.

Where you live, how much you earn, your access to transportation, and your ability to shop at a supermarket in your neighborhood are all part of the social determinants of health, the most powerful predictor of how long and how well people live.

In the past century, US life expectancy went up 30 years. New medicines or gadgets had little to do with it. Most of those extra years came because of the protection afforded by the public health system. That includes clean water, a food supply that’s safe, and an improved environment.

Decades of discriminatory housing practices have burdened Black communities with poverty, substandard housing, and environmental hazards. Unfortunately, most federally assisted housing is located in segregated areas at a greater risk of lead poisoning, exposure to air pollution, or lack of access to healthy food.

Nearly 18% of the US economy goes toward healthcare spending. That is many times the investment of many other countries that enjoy substantially better health – such countries as France, Italy, Singapore, Colombia, Saudi Arabia, and Denmark.

Of the $3.8 trillion spent on healthcare, public health and prevention is allocated less than 3% of this gigantic budget. However, a 2018 report showed a 3-1 return on investment on public health funding.

Treating racism like the disease that the CDC says it is suggests boosting our investment in public health funding would be money well spent.

Paul K. Halverson, dean, Fairbanks School of Public Health, IUPUI

The Conversation
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CDC panel says Johnson & Johnson’s COVID-19 shot can be used again

johnson & johnson vaccine
A vial of Johnson & Johnson (Janssen’s) Covid-19 vaccine.

  • A panel of experts just voted to resume use of Johnson & Johnson’s COVID-19 vaccine.
  • The vaccine has been on pause for over a week, as the CDC collected more data on the prevalence of rare blood clots.
  • The clots are near one in a million, but they’re popping up most often in women in their 30s.
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Public health experts are recommending that the US resume using Johnson & Johnson’s coronavirus vaccine, after immunizations were halted to investigate reports of rare blood clots.

A Centers for Disease Control and Prevention advisory committee voted 10 to 4, with 1 abstention, on Friday that use of the shot should resume. US health regulators will now craft new language to be included along with the vaccine, warning of the risk of unusual clots in women under 50.

Use of the vaccine had been paused since April 13, amid rare reports that several people who’d gotten the shot had developed a rare type of blood clot, along with a drop in their platelet levels. Platelets are the part of your blood that binds together to form clots.

Officials have identified 15 cases of these clots, called cerebral venous sinus thrombosis (CVST), in women who’d received the shot. Three of the women have died. (A 16th case, in a young man, was observed during J&J’s clinical trials).

The risk is highest for women between the ages of 30 and 39, according to data presented to the committee Friday.

“The last 11 days, to me, have been reassuring because we haven’t identified hundreds of cases across the US,” said Dr. Grace Lee, an associate chief medical officer at Stanford Children’s Hospital , who serves on the committee.

Screen Shot 2021 04 23 at 2.40.16 PM
15 women have had rare blood clots after getting Johnson & Johnson’s COVID-19 vaccine.

The FDA will change the label on J&J’s shot

J&J’s vaccine was authorized for emergency use by the Food and Drug Administration in February. The FDA will need to update the emergency use authorization for J&J’s vaccine with information warning about the risk of rare blood clots.

Public confidence in the vaccine has dropped significantly in the week and a half since this pause began. Just 19% of Americans would now be willing to get the shot, according to data presented to the advisory group Friday.

j&j pause and vaccine confidence
Public confidence in Johnson & Johnson’s vaccine has fallen precipitously since the beginning of the pause.

J&J representatives said the company’s shot should be reintroduced because it holds up well against virus variants that are spreading in the US. The vaccine is also a single-shot that can be stored in standard refrigerators. That makes it easier to give to people who are homebound, homeless, scared of needles, or incarcerated.

Before the federal pause, 6% of Americans overall said they’d prefer to get a one dose coronavirus vaccine, a statistic that held true regardless of a person’s age, sex, or income.

johnson and johnson
A man receives Jonhson & Johnson’s (Janssen’s) Covid-19 vaccine, 22 April 2021, in Pamplona, Navarra, Spain.

These unusual cases of CVST clots in patients with low platelets have not been meaningfully connected in any way to the messenger RNA vaccines from Pfizer and Moderna. J&J’s shot is also significantly cheaper than both Pfizer and Moderna’s mRNA vaccines, making it a critical tool in fighting back the virus worldwide.

Without J&J’s vaccine, the CDC’s Dr. Sara Oliver estimated it would take 14 days longer to immunize all adults in the US.

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You don’t always have to wear a mask outside. Experts share ‘really simple’ ways to know when you need one and when you don’t.

People wearing masks outside
People in New York.

  • You don’t need to wear a mask whenever you step outside.
  • If you’re exercising alone it’s perfectly fine to go maskless.
  • Just bring your mask along and be prepared to pull it up if you meet others while you’re out and about.
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Don Milton is as serious as they come about wearing masks to prevent the spread of COVID-19 from person to person.

As one of the world’s leading experts on how viruses spread through the air, it makes sense that he’s adopted a conservative stance during the pandemic – he sports an N95 (the “gold standard” for masks) on his trips to the grocery store, for example.

But these days, when Milton goes for a bike ride around College Park and the University of Maryland, where he is a professor of environmental health and medicine, his mask remains out of sight. It’s tucked into a pocket in the back of his cycling jersey.

He doesn’t worry much about the fact that his strenuous exercise might be generating lots of aerosols (very light, floating particles) in the fresh air around him, because he’s riding solo. And besides, he knows that outdoors, there is infinite ventilation, in case someone were to ever ride up behind him.

“Hopefully, you can educate people, and we can do things that make sense,” he said.

Milton’s own rule for outdoor mask-wearing is simple and clear: “In a place where you might be close to other people, or where you might run into somebody you know and you might stop and want to talk to them for a while and one of you is going to be up or down wind of the other person, then you should probably have a mask on,” he told Insider.

Though Milton knows well that the risk of transmitting the virus outside is far lower than indoors, he stresses it’s still not zero.

“Barbecues last summer were showing up in the Maryland contact tracing data as a risk, something that people were reporting having done that were infected,” he said. “If you’re going to be close to other people outdoors and everybody is not vaccinated, then you certainly need to be wearing masks.”

Public health experts agree: there are simple rules for when we need to wear a mask outside and when we don’t

Outdoor dining
A restaurant during the COVID-19 pandemic.

Leana Wen, an emergency physician and public health professor at George Washington University, spoke to Insider about her own outdoor masking rule while out on an evening walk, unmasked.

“I think we can make this really simple,” Wen said. “If you are outdoors and you can keep at least six feet away from others, you don’t need to wear a mask.”

Wen and Milton are joining a growing number of public health experts around the globe in saying: outdoor mask mandates have never made much sense, and only serve to erode trust and respect for public health precautions.

Muge Cevik, an infectious disease researcher and science communicator at the University of St Andrews, told Insider that fewer than one in ten reported COVID-19 cases involve outdoor transmission, “and those are typically associated with prolonged close interactions, or settings where people mix both indoors and outdoors,” she said in an email.

“People make complex decisions regarding risks every day and should be informed and empowered to make the right decision for themselves for outdoor masks,” she added.

“People have common sense, and we don’t need for laws to be so overly broad,” Wen said. “What Israel has done in lifting the mask mandates after a large number of people have been vaccinated and the number of infections is much lower, I think that’s probably where we will end up going.”

When Wen spots a neighbor up the street, she either quickly puts her mask on, or she crosses the street. This is a simple “common courtesy” during a pandemic, she says.

“If there is a chance that you could be within six feet of others, you should bring a mask with you, and wear that mask if you cannot keep physical distancing.”

Andrea Michelson contributed reporting.

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