Restricting vaccines while recommending them – make it make sense!
I’m sending this to the White House, my U.S. Senators, and my Representative in Congress.
The CDC recommends an additional summer vaccination dose for people with underlying conditions1 while simultaneously the CDC guidance restricted people with underlying conditions from getting that dose.2 People with high risk underlying conditions have been routinely turned down and many others don’t even bother trying because of being told this extra dose was NOT for people who are high risk!
What the CDC is saying here, about an additional dose being beneficial to those with underlying medical conditions is based on scientific results in the past showing “profound waning” of vaccine efficacy against illness by 6 months after the prior dose. This is far shorter than the yearly that’s been recommended by the CDC, and what’s therefore authorized by insurance and pharmacies. What CDC ACIP recommended fell short. And what this CDC recommendation said in contradiction is actually the scientifically correct recommendation. It’s the restriction for once a year that never made any sense.
I made this point in a public comment to CDC ACIP in February 2023.3 I wrote a public comment to CDC ACIP in April 2023 about how restricting the vaccine will create barriers for vulnerable people.4 I complained in May 2023 in a public comment that I felt that this 30,000 foot view of deciding who’s “worth it” to vaccinate enough is antithetical to representative government and also contradictory to the concept of a vaccination campaign.5 I wrote another public comment to CDC ACIP in February 2024 begging for there not to be a restriction to once a year.6 In June 2024 I made a comment to FDA VRBPAC urging recommendations based on science, not based on people believing vaccine disinformation.7 And in September 2023 I specifically complained about the narrative being floated in the media for splitting the difference between anti-vax and people who want to get vaccinated, and how I think the CDC should just recommend what’s medically sound, not cater to Qanon disinformation.8
Evolutionary epidemiologist Rob Wallace PhD submitted a public comment to FDA VRBPAC in January 2023, saying that yearly vaccination as a simplified course is the wrong approach because it would “further handcuff a public health response already limited by abandonment of nonpharmaceutical interventions” and that low uptake would be remedied by an actual public health campaign.9 That this needed to be a complaint central to my public comment at the CDC ACIP meeting in June 2024 where I again also asked for science based vaccination10 is not flattering to the Biden administration’s pandemic campaign promises.11 We need an actual vaccination campaign.
CDC recommending the additional spring boost dose, but only to 65+,12 was dropping the ball, clearly. There was severe lack of foresight in the provision for additional doses to go only to narrowly diagnosed immunocompromised patients13 based on healthcare provider decisions.14 Many people have healthcare providers who are anti-vax, and won’t recommend vaccination to anyone. There are numerous stories on social media and on forums out in the open about even transplant recipients encountering anti-vax and anti-mask doctors. And many healthcare providers are just not recommending covid vaccines at all anymore because they don’t even know they ought to,15 and there is no requirement to do so. This is seriously problematic, and this issue has been brought up at the CDC ACIP meetings in the context of the risks of not doing universal recommendations, most recently by Dr. Denise Jamieson at the CDC ACIP meeting in June 2024, where the doctor mentions being worried,”that if it were not a universal recommendation that the role of the healthcare provider in identifying and appropriately counseling those with risk would become even more problematic.”16 And it’s already problematic because most people have underlying conditions, and the risks of infection far outweigh any risk from vaccination, and yet the CDC restricted the additional dose while admitting that this cohort would benefit from it. And this is while vaccine uptake is actually far lower than what’s recommended.17
There’s really no reason that the additional dose should be restricted at all, and according to the CDC’s own recommendation it shouldn’t have been restricted from 50 to 64 year olds and people with risk medical conditions as described by CDC’s “People with Certain Conditions” list18 and the “Underlying Conditions” list in Information for Healthcare Providers, which includes being 50 or older on its own as an underlying condition associated with risk of severe illness.19
We have the CDC saying it: People who would benefit from a summer additional dose are people with underlying medical conditions. Why the restriction then? Make it make sense!
They need to stop waiting until there’s a summer surge to then start back peddling and scrambling, when we’re still at least a month out from the next vaccine formulas hitting pharmacies. I think this shows a clear need to stop wish-casting that covid is like the flu or a winter virus when it’s clearly not.
References:
1
CDC – National Center for Immunization and Respiratory Diseases – JULY 3, 2024 – COVID-19 can surge throughout the year Getting an updated COVID-19 vaccine in the fall can help better protect you through the winter peak. People who might benefit from additional doses of COVID-19 vaccine this summer include those who are: 65 years of age and older, Moderately or severely immunocompromised or with underlying medical conditions, Living in long-term care facilities, Of any age and have never received COVID-19 vaccine, and Pregnant, especially in late pregnancy.
2
CDC Newsroom – Older Adults Now Able to Receive Additional Dose of Updated COVID-19 Vaccine Media Statement For Immediate Release: Wednesday, February 28, 2024 Today, CDC Director Mandy Cohen endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation for adults ages 65 years and older to receive an additional updated 2023-2024 COVID-19 vaccine dose. The recommendation acknowledges the increased risk of severe disease from COVID-19 in older adults, along with the currently available data on vaccine effectiveness. Previous CDC recommendations ensured that people who are immunocompromised are already eligible for additional doses of the COVID-19 vaccine.
3
Regulations.gov – Comment from Humbert, Chloe – Posted by the Centers for Disease Control and Prevention on Feb 22, 2023 I want the option of more than a single COVID-19 booster shot per year based on the available science.
4
Regulations.gov – Comment from Humbert, Chloe – Posted by the Centers for Disease Control and Prevention on Apr 18, 2023 Scientific evidence indicates the vaccine should ideally be allowed, available, and fully covered by public funds or insurance, twice a year. CDC’s own presentation on waning makes clear we deserve access to the covid vaccines more than annually. If it’s restricted based on anti-vax right-wing political ideology or Great Barrington Declaration eugenics strategies, it WILL create barriers for vulnerable people
5
Chloe’s Public comment submitted to the ACIP June 21-23 meeting_05.05.2023 I do NOT want the government deciding that reducing my risks is “not worth it” on some “30,000 feet view” of “good enough” – that’s an egregiously immoral standpoint. I value my life and my health. And I expect my representative government to represent me and the fact that my life has value!
6
Regulations.gov – Comment from Humbert, Chloe Posted by the Centers for Disease Control and Prevention on Feb 27, 2024 We need more timely updated covid vaccines and boosters, and specifically ALL people in high risk categories deserve more than yearly access considering the waning of efficacy and the seriousness for those at risk disabled and elderly.
7
Regulations.gov Comment from Humbert Chloe Posted by the Food and Drug Administration on Jun 5, 2024 The vaccines should not be restricted from people who want to get vaccinated as much as is scientifically beneficial. Research and funding should be based on what’s medically correct, not on pseudoscience wellness influencers promoting unfounded fears. We should not all be punished for the poor choices of people believing disinformation and various agencies that are unwilling or unable to promote vaccination effectively.
8
CDC ACIP public comment: Let them know you’re pro-vaccination – The CDC ACIP & FDA VRBPAC have members who think most of the public is anti-vax or don’t care to get boosted even though it’s a good idea. I’m not anti-vax & want to be heard so I submitted a comment. CHLOE HUMBERT SEP 07, 2023 In other words there are people at government agencies who might be anti-vax, or at least believe a majority of the public is anti-vax, and so the government appears to be catering to the anti-vax contingent by restricting vaccine development, frequency, and putting limits on who can get it, for reasons other than a scientific basis. Mike Osterholm was quoted in Stat News saying that public health is trying to “thread the needle” between people who want to be vaccinated and the anti-vaxxers who want nobody vaccinated. Trying to implement policy that’s halfway between Qanon and reality is not rational, and it’s costing people’s lives, because what the government recommends has direct impact on what a lot of healthcare providers do, what insurance covers, and what the public and even healthcare workers believe is real.
9
People’s CDC – Statement on FDA’s proposal for once a year COVID vaccination Published January 25, 2023 Public Comment by Rob Wallace, PhD, submitted to the FDA’s Vaccines and Related Biological Products Advisory Committee regarding the future vaccination regimens addressing COVID-19. The implications are twofold. Constraining vaccination to once a year would only further handcuff a public health response already limited by an abandonment of nonpharmaceutical interventions. At the clinical level, vaccination alone offers better protection but no guarantee against reinfection and Long COVID14,15. At the evolutionary level, models by Okamoto et al. show losing NPI likely selects for changes in SARS-2’s reproductive strategy and the emergence of vaccine-resistant strains16,17. In short, prevention, keeping people from getting infected in the first place, remains a critical contribution to preserving vaccine effectiveness. In the other direction, reducing the degrees of freedom we have in the types and scheduling of vaccine production only compounds the public health damage dropping NPI campaigns such as mask mandates and contact tracing produces18. Secondly, the rationale here behind simplifying the vaccine schedule is all wrong. It isn’t the present scheduling that keeps booster coverage at a little over 16% of eligible Americans19. It’s the insistence in declaring a still rapidly evolving pandemic over and ending all those programs that would have helped vaccination programs succeed. The success of federal pharmaceutical campaigns depends on the NPI campaigns going door-to-door that two administrations running dropped.
10
Public comment to CDC ACIP meeting. We need better vaccine promotion campaigns from our government. CHLOE HUMBERT JUN 28, 2024 Uptake for seniors is horribly low and it’s because there are people in their 80s who have not gotten the message, which was the responsibility of the CDC, this is what the public is paying this agency to do. This lack of vaccination campaign is a persistent failure and the anti-vax has been coming from inside the house. The scandalous news about the anti-vax campaign perpetrated by a DOD contractor on behalf of the government is a grotesque pinnacle of our nation’s unacceptable public health failures. This disinformation campaign is reported to have undermined vaccination and also masking and testing. It’s reported that the military psyops campaign was forbidden by law from targeting Americans, but in our world wide web world in a global pandemic, the idea of undermining public health abroad without harming Americans is ridiculous on its face. And harming innocent civilians abroad during a global health crisis is not itself defensible. CDC officials may think this is not the fault or responsibility of the CDC, but that is false. This is not “just some people online” and it’s not a game. Real people are counting on the CDC.
11
THE BIDEN PLAN TO COMBAT CORONAVIRUS (COVID-19) AND PREPARE FOR FUTURE GLOBAL HEALTH THREATS The American people deserve an urgent, robust, and professional response to the growing public health and economic crisis caused by the coronavirus (COVID-19) outbreak.
12
CDC – Morbidity and Mortality Weekly Report (MMWR) Use of an Additional Updated 2023–2024 COVID-19 Vaccine Dose for Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024 Weekly / April 25, 2024 Adults aged ≥65 years should receive an additional dose of the updated (2023–2024 Formula) COVID-19 vaccine to enhance their immunity and decrease the risk for severe COVID-19–associated illness.
13
CDC Newsroom – Older Adults Now Able to Receive Additional Dose of Updated COVID-19 Vaccine Media Statement For Immediate Release: Wednesday, February 28, 2024 Today, CDC Director Mandy Cohen endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation for adults ages 65 years and older to receive an additional updated 2023-2024 COVID-19 vaccine dose. The recommendation acknowledges the increased risk of severe disease from COVID-19 in older adults, along with the currently available data on vaccine effectiveness. Previous CDC recommendations ensured that people who are immunocompromised are already eligible for additional doses of the COVID-19 vaccine.
14
CDC – COVID-19 – COVID-19 Vaccines for People Who Are Moderately or Severely Immunocompromised Updated Mar. 8, 2024 Talk to your healthcare provider about getting additional doses of updated 2023-2024 COVID-19 vaccine if you are moderately or severely immunocompromised. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html
15
Advisory Committee on Immunization Practices (ACIP) Day 2 – Centers for Disease Control and Prevention (CDC) July 27, 2024 Carol Hayes, CNM, MN, MPH, FACNM: I just want to kind of bring y’all back for one second, somebody here said earlier, a couple people said that they were a little bit surprised that healthcare professionals are not recommending the vaccine. And I will tell you that a number of people that I’ve spoken to, healthcare professionals, the public in general, do not understand how much this virus has mutated, and that if we’re not giving the current vaccine, you’re not protected. And we have to just keep saying that over and over and over again: You need this year’s vaccine to be protected against this year’s strain of the virus.
16
Advisory Committee on Immunization Practices (ACIP) Day 2 – Centers for Disease Control and Prevention (CDC) July 27, 2024 Dr. Denise Jamieson MD MPH: I was really struck with the low proportion of healthcare providers that recommended and given what we know about influenza and other vaccines and the critical role that healthcare providers play in recommending vaccines um I wondered what we did know about healthcare provider attitudes and what some of the barriers may be and as an aside it worries me that if it were not a universal recommendation that the role of the health care provider in identifying and appropriately counseling those with risk um would that would be become even more problematic.
17
CDC – Respiratory Illness – Vaccination Trends The percent of the population reporting receipt of the updated 2023-24 COVID-19 vaccine is 14.1% (95% confidence interval: 13.4-14.9) for children and 22.6% (22.1-23.0) for adults 18+, including 42.1% (40.8-43.3) among adults age 65+.
18
CDC – COVID-19 – People with Certain Medical Conditions – Updated Apr. 15, 2024 A person with any of the medical conditions listed below is more likely to get very sick with COVID-19. If you have one of these conditions, talk with your healthcare provider about how best to protect yourself from severe illness from COVID-19. The list below does not include all possible conditions that put you at higher risk of severe illness from COVID-19. If you have questions about a condition not included on this list, talk to your healthcare provider about how best to manage your condition and protect yourself from COVID-19. If you have symptoms consistent with COVID-19 and you are aged 50 years or older OR are at high risk of getting very sick, you may be eligible for treatment. Contact your healthcare provider and start treatment within the first 5-7 days after you first develop symptoms.
19
CDC – COVID-19 – Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals – Updated Apr. 12, 2024 Age is the strongest risk factor for severe COVID-19 outcomes. Patients with one or multiple of certain underlying medical conditions are also at higher risk.(1–3) Additionally, being unvaccinated or not being up to date on COVID-19 vaccinations also increases the risk of severe COVID-19 outcomes. […] Studies have shown that COVID-19 does not affect all population groups equally. Three important factors are age, race, and ethnicity. […] Risk of severe outcomes is increased in people of all ages with certain underlying medical conditions and in people who are 50 years and older, with risk increasing substantially at ages >65 years […] This cross-sectional study of 540,667 adults hospitalized with COVID-19 included both inpatients and hospital-based outpatients with laboratory-diagnosed COVID-19 from March 1, 2020, through March 31, 2021. The database included reports from 592 acute care hospitals in the United States. The study was designed to examine risk factors associated with severe outcomes of COVID-19 including admission to an ICU or stepdown unit, invasive mechanical ventilation, and death. Main Findings: Certain underlying medical conditions were associated with an increased risk for severe COVID-19 illness in adults. Having multiple conditions was also associated with severe COVID-19 illness. Obesity, diabetes with complications, and anxiety and fear-related disorders had the strongest association with death.