Pressing pause, antibody wars and other things you need to know about the COVID-19 vaccine

Half. 

That’s the total of the U.S. population that has gotten at least one dose of the vaccine. On the one hand, this is great news. We’re so much closer to this magical herd immunity – most researchers agree it’s at least 70% for this particular coronavirus – we’ve been hearing about. But on the other hand, it brings a sobering reality: As a nation, we’re now officially to the point where we’re dealing with those who are on the fence about getting vaccinated. 

 

States that came charging out of the gates, like West Virginia and Louisiana, are now the poster children for vaccine hesitancy. In fact, several of those states are now asking for fewer doses of vaccine each week because of waning demand. 

Researchers knew this was inevitable. It was only a matter of time. But now the rubber has met the road, and we as a nation are entering a new phase in vaccine implementation.  

“It’s time for us to switch strategies,” said Danielle Scheurer, M.D., MUSC Health System chief quality officer. “In the beginning, we set up a bunch of high-volume sites and it worked great, but they aren’t filling up as much. So now we’re looking to go to the people instead of having them come to us.”

That means you might start to see MUSC vaccination sites pop up at community grocery stores, gas stations and highway rest areas. 

“Instead of us looking at this as ‘if we build it, they will come,’ we need to get it to them,” she said.

With the vaccine landscape changing almost daily, each week we are checking in with Scheurer to ask her the most pertinent questions that are hanging in the balance.

Q. Roughly, how many people is MUSC vaccinating every week at this point?

A. I’d say around 20,000. But the truth is every day there are open slots at all of our sites. So we’re looking into offering walk-ups at all of them as well as implementing vans as mobile sites that can be quickly set up in high-traffic areas in the places of greatest need. Bottom line: We need to make it easier for people.

Q. Let’s pretend for a moment that everybody in this country wants to get vaccinated. How quickly do you think we could make that happen?

A. We finally have ample supply of vaccine across the nation. So I’d say that within a couple of months, we could have everybody vaccinated. It is harder in COVID-stricken areas, but we could get it done. 

Q. With cases on the rise again and variants largely responsible, what do you think our future looks like? Will there be any more lockdowns in this country?

A. I hate to say this, but I think it’s entirely possible. We’re not at herd immunity, and we’re running into tremendous hesitancy issues. And society has largely reopened. Couple that with complacency around masking and social distancing, and I’d say we’re not in the clear yet. 

Q. Pfizer has requested FDA approval to green light its vaccine for 12- to 15-year-olds. Is this too fast, or are you not worried?

A. It’s totally fine. The only thing I’m unsure of is how long it will take. I heard it might be a couple of weeks for it to get through all the hoops. But on the topic of young adults, in the very near future we’re going to be working with the Charleston County School District – just like we did with its teachers – to go from school to school and offer vaccinations to students 16 and older. Obviously, they’ll need parental consent, but that’s just one more step in the right direction. 

Q. How do you as a health care provider feel about the pausing of the Johnson & Johnson vaccine? What is an acceptable level of risk in the midst of a global pandemic?

A. You know, I was surprised that they suspended vaccinations. Just looking at the numbers, of the 7-plus million people who got the J&J vaccine, six got blood clots and one died. There was a study published last week that looked at the incidents of these same clots in patients with COVID. The risk of getting clots like this with COVID is about 35 cases per million. People who have been vaccinated have a one in a million chance of getting clots. So although these vaccines may cause unusual clots, the risk is even higher with COVID. We might just be looking at this the wrong way. 

Q. Has anybody been tracking the long-term differences between people who have been vaccinated and those who have contracted COVID to see if one immune system is better equipped for the long haul?

A. It’s a great question. It’s going to take us a while to figure that out. We need to look at long-term reinfection rates. We can draw blood and look at antibodies, but that’s just a small piece of the immunological pie. There’s a T-cell immunity phenomenon we know about, and that’s something we can’t measure. There are several components of immunity that make figuring the answer to this question quite difficult. Time will tell.

Q. I read that some people in Michigan who were vaccinated subsequently got COVID and died. Had you heard that, and what does that mean to the big picture?

A. I did hear that. We haven’t seen any known deaths from the vaccine, but we have seen deaths in those who get COVID even after being fully vaccinated. We know from both clinical trials, and post-trial population studies, that the vaccine is not 100% effective. More like 95%. Just looking at the numbers in the U.S., we’ve had about 130 million cases of COVID and about a half-million deaths; compare that to about 200 million doses of vaccine administered and single-digit hospitalizations and no known deaths. So if I had to pick COVID or the vaccine? I’d choose the vaccine every time.