With the first doses of the COVID-19 vaccine potentially arriving for Michigan’s frontline workers in a matter of weeks and the general public possibly accessing the vaccine by spring, public health experts across the state are beginning to see a light at the end of this long tunnel. The days of a virus that has killed almost 270,000 Americans — more than 9,000 in Michigan — could be numbered.
“There is an end to this pandemic, and we’ll be in a much better place next spring and certainly by next summer,” Dr. Joneigh Khaldun, Michigan’s chief medical executive, said in an interview last week with Michigan Advance. “But we have to double down right now and do our very best to prevent the spread of the disease.”
In light of recent encouraging news about efficacy rates from drug manufacturers — Moderna and Pfizer, the latter of which Khaldun said could be distributing vaccine doses to Michigan health care workers as soon as mid-December — the “best” that the chief medical executive cites centers around a weary public holding guard against COVID-19.
The vaccines are, indeed, coming, as is an end to the pandemic, at least in the way we know it now — but, Khaldun said, people must continue to avoid large gatherings, like holiday parties, wear masks and wash hands.
This, the chief medical executive emphasized, is particularly crucial at a time when COVID-19 cases, hospitalizations and deaths had been climbing in Michigan and stressing an already fractured health care infrastructure in which Khaldun said “many hospitals are at or near capacity.”
Like Gov. Gretchen Whitmer, Khaldun said she was “concerned” about big gatherings during Thanksgiving last week, as well as other upcoming events for Christmas and New Year’s Eve.
Last week, Khaldun said that Michigan was in “an exponential growth phase in the state,” citing cases, hospitalizations and deaths that have been on the rise.”
Those numbers have declined over the past seven days, Khaldun said during a press conference on Tuesday, although she said she remains concerned about the impact Thanksgiving and holiday gatherings could have on that trend. Khaldun said the statewide case rate “has been declining for the past week,” as has the test positivity rate.
“We are cautiously optimistic,” Khaldun said Tuesday. “Based on what we are seeing, more people started doing the right thing towards the beginning of November. That means wearing masks, not gathering and maintaining six feet of distance from others.”
Still, throughout the state, hospitals — from small, rural facilities to major metropolitan ones — have been sinking under the weight of COVID-19 cases, hospitalizations and deaths. In Michigan, 9,324 people have died from COVID-19, and there have been a total of 366,242 cases. Intensive care units across the state are flooded with patients, and already traumatized and deeply fatigued health care workers are faced with staffing shortages and continued concerns over a lack of personal protective equipment.
According to data posted by the DHHS on Nov. 30, six Michigan hospitals are at 100% capacity, and a total of 20 hospitals are operating at 90% capacity or higher.
As of late November, Michigan had the fourth-highest number of COVID-19 deaths in the country, the fifth highest number of cases, the sixth-highest number of COVID-19 patients in intensive care units, and the seventh-highest hospitalization rate, according to the data from the Michigan Department of Health and Human Services (MDHHS). In response to intensive care units across the state bursting at the seams as the rate of people hospitalized with the coronavirus in Michigan doubled every two weeks, hospital leaders recently pleaded with the public to wear masks and social distance.
“Across the entire state, we’re seeing outbreaks associated with gatherings, weddings, funerals, sports teams, places of employment — the general theme is people gathering and people not wearing masks while gathering,” Khaldun said in her interview with Michigan Advance.
All of this leaves health officials who said they are, of course, grateful a vaccine is coming, but, especially with the winter holidays on the horizon, need the public to follow what their state’s health leaders are telling them: keep social distancing, keep wearing masks, keep washing hands. It’s a mantra repeated time and again, in large part, because health experts said some people are not heeding these messages. Millions of Americans, for example, traveled for Thanksgiving, ignoring the U.S. Centers for Disease Control and Prevention’s advice not to do so in order to mitigate the virus that has been spreading like a wildfire across the country.
“It’s been a very hard year, especially for those in direct caregiver positions,” said Ruthanne Sudderth, the vice president of public affairs and communications for the Michigan Health and Hospital Association. “The vaccine news we’re seeing is starting to be a little bit of a light at the end of the tunnel, but we have long months ahead. What we really need if people want to show their support for health care workers is to adhere to the [DHHS] orders and not go to large … gatherings. We need people to wear a mask and social distance.”
“We don’t want to be in a situation where, come Christmastime, people are going into the hospital instead of sitting around the tree with their family,” Sudderth continued.
Health officials get it, Khaldun said: People are tired; they want to see their family and friends. They want to feel some levity in a deeply draining year. But, she said, this year has to be different.
“If you really must gather, please do pay attention to having no more than two households and 10 people together,” Khaldun said. “Be vigilant if you do that: wear the masks over your mouth and nose. You should be washing your hands frequently and have hand sanitizer available for everyone. Try to see if people can be outdoors. We have to be creative.”
Hang on, officials said. This holiday season will be hard. But next year is slated to be a different story. The vaccines are on their way, and by this time next year, it’s likely you won’t have to worry about the health risks of traveling for the holidays or filling your table with family and friends, said Dr. Abram Wagner, a research assistant professor of epidemiology at the University of Michigan.
“I think people can make plans for next fall to do large gatherings,” Wagner said. “Those plans may be canceled, but I think it’s something you can look forward to. We have … vaccine candidates which seem good.”
Who gets vaccines first
So far, Pfizer and Moderna have announced promising vaccine efficacy results from clinical trials. AstraZeneca and the University of Oxford did as well, though their results have come into question. And health experts emphasized in interviews with Michigan Advance that other vaccines are being pursued and could be brought to market.
The pharmaceutical giant Pfizer, which is manufacturing its vaccine in Kalamazoo, and its partner, Germany’s Biopharmaceutical New Technologies, last month reported a 95% efficacy rate. Moderna, a Massachusetts-based biotech upstart that has never before brought a vaccine to market, said its vaccine is 94.1% effective.
AstraZeneca, a British-based drugmaker, and the University of Oxford announced last Monday that its vaccine ranged from 62% to 90% effective, depending on how the doses were administered. However, following that original report, scientists have called into question whether those numbers will hold up under additional testing after AstraZeneca admitted it made a mistake in the vaccine dosage taken by some of the clinical study’s participants.
All three of these companies still need to receive approval from the U.S. Food and Drug Administration (FDA) before being able to distribute doses. Each of the company’s vaccines would require people to take two doses of them in order for them to work.
Pfizer is likely to be the first to provide its vaccine in Michigan, according to Khaldun. The company last month asked the FDA for emergency approval of its vaccine, and the federal agency is expected to take approximately three weeks to decide whether or not to give Pfizer the go-ahead. On Monday, Nov. 30, Moderna also applied for emergency FDA approval of its vaccine.
“We are very hopeful about the vaccine progress that’s been made,” Khaldun said. “We expect that Pfizer’s vaccine could be available as early as mid-December. In the very beginning, there will be limited doses; we don’t know how many are coming to Michigan, and we’ll be working to target some of our frontline workers [to receive the first doses].”
“When it comes to the general public, it really depends what happens at the federal level, but we’ll hopefully ramp up our ability to vaccinate many more people by spring,” Khaldun continued.
In mid-December, Pfizer is expected to distribute about 6.4 million vaccine doses in the United States, U.S. Secretary of Health and Human Services Alex Azar told the New York Times.
Combined, Pfizer and Moderna are slated to provide 45 million doses by January — enough to vaccinate 22.5 million Americans. With the drug companies backed by billions of dollars in federal money, U.S. health officials have said they expect them to be able to manufacture hundreds of millions of doses by next spring. AstraZeneca said it would likely have four million doses available in Britain by the end of the year and at least 300 million doses for global distribution by the end of March.
A draft plan from the Michigan DHHS said health care workers in the state will be the first to receive the vaccine; after that, local health departments will be responsible for distributing it to their most vulnerable populations, including individuals older than 65, first responders, people with underlying chronic health conditions, and those who live or work in long-term care facilities, prisons or jails, homeless shelters, and other group settings.
Phase two of Michigan’s vaccine plan would include distributing doses to essential workers at grocery stores and food distribution centers; the general public would be eligible to receive the vaccine during phase three. Hospitals, health clinics, pharmacies, and medical offices are expected to have the vaccine to administer to patients.
All of which is to say: The vaccine is coming, and that’s good news, but health experts cautioned there are still plenty of questions about the vaccines and their rollouts to the public.
Wagner said health care workers in Michigan have been told vaccines for them are likely coming within weeks, but, as Khaldun said, how many doses will arrive remains up in the air.
And Dr. Andrea Amalfitano — a vaccine expert, dean of Michigan State University’s College of Osteopathic Medicine, and a professor of pediatrics, microbiology and molecular genetics at MSU — explained that while it’s promising news about the vaccines’ efficacy rates, those rates are based on “highly controlled clinical trial situations in which tens of thousands of people were vaccinated.” Once the vaccine is brought to the general public, he explained, those numbers could change.
There also could be logistical hurdles in connecting the public with the vaccines, Amalfitano said.
“What I’ll be watching for is once these vaccines get approved, you’ll hear what type of inventory they already have and how they’ll be distributed,” Amalfitano said, noting that one significant barrier to distribution is the fact that the Pfizer vaccine has to be stored at negative 70 degrees Celsius, or minus 94 degrees Fahrenheit.
“There’s still a ways to go before we can say we’re going back to normal,” Amalfitano said. “… It will take time. Even with a vaccine getting approved, you’ve got to scale up the doses. You have to manufacture them.”
Wagner, a University of Michigan epidemiologist who researches “vaccine hesitancy,” too said the vaccine distribution will be a slow process, and one that must include health officials paying special attention to connecting the public with the vaccine — logistically, but also with messaging that hammers home the importance of eradicating COVID-19 and promotes the safety of the drugs.
“What we should be doing as public health professionals is being able to first off make sure the system in place for regulatory approval of vaccines is good and fair and will allow the scientific process to come through, and I do believe that’s the case,” Wagner said. “The other thing is we need to convey to individuals that the vaccines are safe and effective.”
Health experts said they’re thrilled how quickly the vaccines have appeared on the scene — it’s the fastest the world has ever seen a vaccine — and emphasized they are safe. But, that safety doesn’t mean there aren’t potential unwanted side effects that people will have to deal with.
“You could have an efficacious vaccine, but it could turn out you’ll be inducing all kinds of side effects,” Amalfitano said. “As you start moving from tens of thousands of people receiving the vaccine to hundreds of thousands, you’ll monitor those people for side effects. You might come up with this may not be the best way to go.”
Pfizer, Moderna and AstraZeneca so far have reported minimal side effects for their vaccines; patients experienced side effects common for vaccinations, including muscle aches, low-grade fevers, fatigue, and headaches.
What if people won’t take it?
For Wagner, one of the biggest challenges in eradicating COVID-19 is ensuring that the overwhelming majority of the population, in the United States and worldwide, will take the vaccine.
“I think the problem will be [that] we in the United States are not doing so great at distributing vaccines,” Wagner said. “Influenza [vaccine] distribution is at 50 to 60% for adults; we want it to be higher for COVID-19. We need to decide as a society if we want to eliminate COVID-19, or is it going to be something that’s endemic and at low levels in the background, and we accept that, just like there are periodic outbreaks of measles throughout the world and in the United States.”
There are a number of factors that play into whether or not people will get the vaccine, Wagner said, including how serious someone perceives COVID-19 to be and whether they themselves have gotten very ill or know someone who has.
Health experts too have cautioned about the impact that the anti-vaccination movement and vaccine misinformation could have on COVID-19 vaccinations. A Pew Research Center poll in September reported 51% of Americans would take a COVID-19 vaccine, down from 72% in May. This hesitancy, or outright refusal, to take the vaccine is being propelled by a dangerous anti-vaccination movement rooted in misinformation spread online, according to a May 2020 paper published by Neil Johnson, a physicist at George Washington University who studies online extremism, and a team of researchers.
“Distrust in scientific expertise is dangerous,” the paper states. “Opposition to vaccination with a future vaccine against SARS-CoV-2, the causal agent of COVID-19, for example, could amplify outbreaks, as happened for measles in 2019. Home remedies and falsehoods are shared widely on the internet, as well as dismissals of expert advice.”
The percentage of Americans who said they’d get the vaccine has increased since September, with 58% of Americans reporting they would get the COVID-19 vaccine, according to an October Gallup poll conducted before the vaccine efficacy announcements from Pfizer and Moderna.
As the country struggles with another wave of cases and deaths, with some experts saying the nation could see a total death toll of close to 500,000 people by March, health officials are hoping the magnitude of the pandemic will sink in for most Americans and propel them to take the vaccine.
Part of making sure people are taking COVID-19 seriously and getting the vaccine comes down to whether or not someone has seen a serious case of the disease — whether personally, through a family member or friend, or in the media, Wagner said. If they have, he said they’re much more likely to support getting the vaccine. This, Wagner explained, should help to inform public health messaging around the vaccine: statistics do not sink in for many people, but personal stories about individuals who have suffered do.
“That personal experience matters,” Wagner said. “As the vaccine gets rolled out, it will be important to refamiliarize people with the faces of the disease, the faces of people who have died from the disease.”