In recent weeks, some have been quick to criticize health policy decisions in the U.S. by pointing to decisions made in other countries. For example, the U.S. has a broad recommendation for the fall Covid-19 vaccine, while the U.K. has a more targeted policy
A number of years ago I spent time in a pediatric emergency room in a major medical center in a pretty large city. I discovered a lot about inequitable health care, and the damage it did to families, and to small lives. Completely changed my view of the US Healthcare system. When I hear people tell me we've no need for universal health care for all residents, I think back on those days, and the stark number of kids of poor families who would bring them in the midle of the night on a weekend, and tell us they hoped they weren't taking our time away from someone more important. We weren't allowed to ask but I suspect many were undocumented. We could ask about their employment, and most parents were each working two or more jobs with no benefits, and no regular healthcare for themselves or their kids. Nearly half of the patients I saw ended up in the hospital for care, and nearly, or perhaps more than half of those were direct ICU admits. Almost all of these kids could have avoided an ER visit and hospitalization if they had access to a good primary care doc (family practice or pediatrician) because most of their problems started as relatively simple, treatable illnesses. Simply, this affected my views and work forever (or at least for the last 40 years).
Watching our responses to COVID, and listening to the political narratives has been difficult. I'm particularly vexxed by our cultural decision that the pandemic is over, and some declarations in real time that we entered endemicity, something I was always taught was a lesson learned historically, and couldn't be seen in the moment. The result of this, and significant mis- and disinformation campaigns has been attacks on vaccines with proven efficacies, known public health practices including physical distancing and masking, isolation and quarantine, and even the existence of the threat itself. Another casualty has been the testing infrastructure. Never robust, and fraught with issues, some self-inflicted, some caused by loss of expertise and funding, we can no longer expect inexpensive access to quality testing with reportable results. There's a great place for home testing, although I'd be happier if we could standardize sample collection, and ecstatic if we could manage data collection of the majority of lateral-flow tests performed in a standardized and trackable database, but we lost the opportunity for that several years ago; initiating it now might be a good plan fo r future pandemics, but not for this one.
Most hospitals I'm familiar with no longer routinely test patients on admission and only test for ill-defined indications such as post-operative declines in oxygen saturation often secondary to atelectasis rather than viral disease. On the positive side, overall and excess mortality has declined, but we're still seeing too many virus-related deaths, but they're normalized socially in the public sphere. Our surveillance for new upticks in spread, likely by a new variant, will see a detection delay because there's a significant delta between wastewater detection and general upticks in human illness.
After a dismal booster uptake last year, I've little real hope we'll see a significant uptake this year despite indications from trials of good immune response to the current list of variants facing us.
We had a scare recently with BA.2.86, but we were lucky that it's less likely to actually infiltrate cells. We've learned a lot about how to diagnose and clinically approach this virus, but there remain a number of issues, especially in terms of long-COVID and the potential for immune system compromise that's arisen of late, or the fact that SARS-CoV-2 appears to be less an actor solely on the respiratory system than other systems, especially vascular. I fear we're a good mutation/substitution/deletion away from another big surge, because I'm not as confident as some that immunity derived from infection is as durable as they'd have us believe.
Great comment Gerry. Thank you. The normalizing of death and illness rooted mostly in political beliefs or world viewpoints is going to be a major topic in future history books covering this period.
It will not age well.
I watched a good friend of mine with serious complications from Lyme disease being ignored in ER because it was "all in her head". I took care of her for just over 18 months and gave her a place to stay so I knew otherwise. On visits where I accompanied her, staff treated her entirely differently in my presence. I'm not a doctor like you and thank you for your service, but I was exposed enough to the system here to know there are gaping flaws in it. Thankfully she is doing a little better now, but it has gone on for over 14 years for her and she is 1 of many of a forgotten demographic.
I'm originally from Ireland. The folks talking about how great our health system is here are those who do not need a public care system. They have the money to get the care they need. The only way their views on how healthcare serves others change, is if their circumstances change which is sad because at that point, they are just another statistic and part of the underserved. And their viewpoint doesn't matter at that point.
In my opinion, this pandemic has exposed a lot of the country's less than perfect underbelly.
Truly. If you spend 5 minutes looking at those graphs and don’t walk away shaking your head, you need to go back and spend 10 more minutes. The disconnect between idealizing the US as the “land of opportunity” while staggering amounts of poverty, homelessness, and chronic health conditions are all around us--AND ARE SOLVABLE--will continue until enough voters see the power of uniting above party lines and loyalty, for the common good. I think it’s happening but slowly, and 2024 is already on the horizon.
US is the land of opportunity, but in some ways careless of those less able or ambitious.
Makes for a great economic engine, but with stark differences based on abilities and educations. "Freedom" to be homeless on the street, or a mega-billionaire.
Absolutely spot-on. Excellent documentation of some of the myriad problems our healthcare system has evolved over time. And thanks for the OECD statistics. I need to put together a lecture on this topic, and you've raised points my notes didn't cover yet. I'd not considered the number of beds per capita, obviously a sign I needed more time on the topic, but your summary is very appropriate.
One more bit is that with everybody* in UK having an assigned gp, they have a relationship with an office that's going to be contacting them and offering vax as one of the targeted groups.
*Presumably there are some who falls through the cracks but in general
I believe that HCW shortage (for a myriad of reasons) will be affecting healthcare regardless of countries but there is underfunding at play too. Sadly, this deepens the healthcare inequities already in existence.
Thank you. That’s a brilliant explanation. Quite easy some to interpret the UK recommendations as “the vaccine is so dangerous for younger people that’s it been banned for those under 65”.
So clear. So accurate. So damning. I believe we can judge the intentions from the result. Our nation as a group does not want humane, compassionate, effective healthcare--in fact, it does not want health. My career in medicine has given me firsthand experiences which jibe really well with this column. As Bugs Bunny might say, our country is a moroon.
I agree with everything in the article. But I think the primary reason, the overwhelming reason, that the US and UK recommendations are different is because of funding. The UK health system was deciding who it would pay to vaccinate. And when you add up all the at risk people and the people they interact with (at home, in shops, etc.) they are actually paying for a lot of jabs. But not for everyone. The US CDC was deciding who would be allowed to get the vaccine, and whether other entities (mostly health insurers) would have to pick up the cost. But the people who decided for the US had no responsibility for the funding.
An excellent point, especially as it highlights how such a common well-understood word (“recommendation”) stands in for a host of real differences in goals, public policy, and state of healthcare. Thank you for that framework, it will stay with me.
I agree. I think this was the prime determinant regarding XBB boosters, and the estimation that only 25% of the US will end up getting it... or less. Cost crunching.
Casting a wide net won’t work for the sad 25% uptake rate anyway, right?
Great summary of the failings of our system notwithstanding. Maybe we should have a post about the failings AND successes of the US system compared to other major nations. We certainly do drive a lot of innovation, and as long as you have good insurance, the system doesn’t fail as often as for those without good insurance. And not providing a basic coverage safety net for every citizen is immoral IMO.
No, it's a system. It just not a health care system. It's an insurance company wealth care system. As such it's doing a great job of doing what it was designed to do. It just wasn't designed to actually make healthcare available to as many people as possible at the lowest cost.
Really helpful piece, but fyi, the ILF graph under the point about our terrible safety net and the US having zero paid sick leave doesn’t show sick leave; it’s about paid maternity leave (of which we also have zero, of course).
Guaranteed sick leave is also in short supply. In my last job, I had "leave", to be used as I saw fit. Before that, I'd had leave accrued at a rate similar to that last job, but solely for vacation. Sick leave was accrued in a different way and accounted for separately. And, so many part time jobs don't offer leave or insurance.
In some cases sick leave benefits can be extremely generous while creating perverse incentives that aren't consistent with the goal of containing infectious diseases. For instance, at my job I'm able to accrue up to 1500 hours, and up to 750 hours can be used towards my service credit when I retire.
New Zealand at 30+ is lowest after Austria and US/CAN.
After that 60-65+ is standard recommendation.
Considering that only 2.1% of the EU bothered with 3rd booster, I suspect only a handful will go for the 4th anyway. The public is treating CDC/PH like Catholics regard Vatican recommendations not to use birth control.
I personally think the recommendation to vaccinate everyone is good policy but unlikely to be supported by public opinion. I blame, and will for some time, the previous administration and their chosen CDC leader for many of the losses in public health respect we say. Recovering from that will take a long time.
Blame Redfield? He seemed reasonable - and I think the hindsight lens we now have, many of his early comments turned out to be correct ("“This virus is probably with us beyond this season, beyond this year, and I think eventually the virus will find a foothold and we will get community-based transmission.” - 2/13/20) [1]
Obviously, his claim that wearing masks could end the pandemic didn't age well, but he was always cautiously optimistic about the vaccine (compared to Trump who the media blasted for saying shortly before the election that the "vaccine will be here momentarily" - 10/5/20) [2]
I think the high vaccine uptake of the first 5 months after release falsifies the claim that previous admin had anything to do with current vaccine hesitancy. By May 2020 80% of elderly population had already got their 2nd shot [3], and even comparing total population the US was a leader compared to "doing it right" countries before summer of 2021 [4]
The reason why the Covid vaccine fell out of public opinion - and this is true for the entire world - is that it was overpromised and underdelivered. It was sold as something it wasn't, and it cost PH a massive amount of credibility. Fauci, Wallensky, Bourla, Bancel, etc - all said that the vaccine gave you immunity from Covid. (YLE among few vocal PH not on record making this claim). Suggesting it didn't prevent transmission was a cardinal sin and that wrong-think was actively censored on Twitter, Facebook, LinkedIn, and Google.
You can argue it was the "noble lie" as, if it was sold as Flu Shot, people wouldn't have taken it at such high levels, but the cost was credibility that will take a long time to earn back. Personally, I think the "Recommend for all" approach only widens that distrust and adds to the sentiment that the CDC recommendations carry little weight. (which invites a whole other set of downstream problems).
Bottom line, only 4% of 80+ year olds in the EU last year bothered with the 3rd booster. [5] I doubt that had anything to do with Redfield and Trump, and 100% due to false/misleading advertising.
Redfield was a lot of things but he was I’ll-suited for the job. The comment cited was one of the few where he assumed a leadership role. That said, leading CDC was a Dream Job for him culminating a career that’s been described various ways. I had no direct interactions, but my indirect interactions didn’t demonstrate great brilliance. And he came into the job with a mandate to oversee downsizing the organization, and didn’t object when the sole organization preparing for pandemic planning in the White House was scuttled.
Vaccine uptake early was pretty good, but mis/disinformation campaigns started taking their toll, and significant portions of mainstream media misrepresented things in a manner that was inexcusable. Sound bites from the likes of Fauci and Birx were the elements that oversold the vaccine. I was briefed late in 2020 that the vaccines in development would be a success if they reduced morbidity, hospitalization and death by 50%, with no mention of affecting transmission or protection from infection.
General masking has been demonstrated with varying efficacy for a long time and was one of the hallmarks of protecting against an airborne virus.
In the summer of 2021 we saw a significant increase in anti-vax propaganda which undoubtedly led to hesitancy, and the stories haven’t subsided. I was in the chorus of those trying to reduce the misconception regarding transmission, although for the ancestral strain there was supporting evidence. Subsequent immunity-evading clades removed even a hope for this, but when we attempted to discuss immune-evasion, we were also accused of changing our stories, even when we’d stated the original goals didn’t incorporate reduction of active infection or transmission at all.
There was undoubtedly a failure in communication that cost PH dearly, but I, for one, am used to presenting and providing factual data and not being accused of manufacturing information, something I was subjected to repeatedly both within my organization and publicly. The truth was, simply, clinically demonstrated data, which were never fact but were instead evidence available at the time, and subject to change based on discussions with real, live clinicians and reading a pretty significant number of preprints and peer-reviewed (if hastily!) articles critically to determine if I could even believe their data (note: My review of the hydroxychloroquine results from Raoult wasn’t favorable: the numbers appeared to perfect) required significantly more work than simply scanning an abstract and calling it good.
What we’ve seen has been incredible damage, as you note, to public health’s reputation overall, but that assault has been ongoing for decades, often on the basis of individuals’ rights claims, when the job of public health is to identify issues and recommend, and in some cases where the laws still support such, enforce measures to protect the public. In a number of cases, we’re reduced to trying to convince a public who’ve been told we’ve been misleading them, that any new data we share is real, and not shrill protestation.
YLE, and several others have done a very good job, but there are other voices out there who are loud and claim that, by virtue of their status should be allowed to vilify or deny evidence they disagree with. These are the people claiming the only reliable trial is a placebo-controlled randomized, double-blinded study, and they’ll question or deny all else... unless it supports their own concepts. These folks are the ones who are, today, causing significant harm, and are frankly abusing their positions to make themselves “stand out”. And they’ve convinced (confused?) a large enough group to be of concern.
I feel you give too much of a pass to this administration.
It was the Biden Administration who pushed Fauci's (incorrect) "dead ends for transmission" claims [1]
It was Biden who was "losing patience" with the unvaccinated because he believed they were the ones spreading it [2] (imagine a president "losing patience" with people who don't want to take statins).
It was the Biden administration who pressured social media platforms to censor claims the vaccination didn't stop transmission [3] - I would have never heard of Alex Berenson if he wasn't famously banned from Twitter for saying (correctly) the vaccine doesn't stop transmission. [4]
It was Biden administration which mandated companies to fire unvaccinated employees (including doctors and nurses) [5] which were at no risk to their peers even when his head of CDC was finally acknowledging the vaccine doesn't stop transmission [6].
This is why there is an erosion in public health. The people feel like they got bullshitted and are embarrassed they engaged in such behavior. The apathy towards shot #5 is bipartisan - a fraction of the population will bother.
Michael, I think you summed it up really well. I personally know a lot of people who have had the vaccines who ended up getting Covid anyway. For a lot of them, that was when they were just done with getting the shots. I think that to many people, it is pretty pointless. (Not saying I agree with it, but I do empathize.)
Nice spreadsheet. I wonder if US and Canada, which are large countries in terms of size, have lower natural immunity vs other countries where people are more apt to live in apartments and take public transportation?
I love this article for so many reasons -- the clear and concise articulation of so many elements of the ecosystem in which we live (and how and why decisions are made as a result) and a general primer on why context matters. Thank you!
Considering that currently 88% of hospitalization and death is occurring with at risk population, there is a need to really target them in messaging. As for the rest, durable immunity still seems to be working well. I also think the HCW will/should be targeted.
Additionally, for reasons that are unfounded, PCP seems to be slow in using antivirals like Paxlovid and Remdesivir. Both show 90% reduction used within the first 5 and 10 days respectively. Remdesivir seems to be getting harder to obtain. So, what's up with the FDA and VV116?
Of course, I've some things heard/seen/read, "its mild", "let's wait and see", "rebound" and "take when your temp is 102". When you test positive, this is when you need this in high risk populations. Psst, SARS-CoV-2 is biphasic and 2nd stage inflammatory response (so called rebound) is the natural history of COVID-19. This happens WITH or WITHOUT antivirals. We should be targeting this message!
Valuable point about Covid's biphasic response (what other viruses induce this kind of response? Usually it seems it's one acute response varying in severity and duration - though some have late effects). On the question of healthcare workers getting vaccinated-what's our current evidence on how well that protects *others?* Intuitively if it reduces viral load (if infected) it should, but....
One of the most concise and honestly damning pieces I have seen written about the US Health care system compared to other 1st world nations.
A number of years ago I spent time in a pediatric emergency room in a major medical center in a pretty large city. I discovered a lot about inequitable health care, and the damage it did to families, and to small lives. Completely changed my view of the US Healthcare system. When I hear people tell me we've no need for universal health care for all residents, I think back on those days, and the stark number of kids of poor families who would bring them in the midle of the night on a weekend, and tell us they hoped they weren't taking our time away from someone more important. We weren't allowed to ask but I suspect many were undocumented. We could ask about their employment, and most parents were each working two or more jobs with no benefits, and no regular healthcare for themselves or their kids. Nearly half of the patients I saw ended up in the hospital for care, and nearly, or perhaps more than half of those were direct ICU admits. Almost all of these kids could have avoided an ER visit and hospitalization if they had access to a good primary care doc (family practice or pediatrician) because most of their problems started as relatively simple, treatable illnesses. Simply, this affected my views and work forever (or at least for the last 40 years).
Watching our responses to COVID, and listening to the political narratives has been difficult. I'm particularly vexxed by our cultural decision that the pandemic is over, and some declarations in real time that we entered endemicity, something I was always taught was a lesson learned historically, and couldn't be seen in the moment. The result of this, and significant mis- and disinformation campaigns has been attacks on vaccines with proven efficacies, known public health practices including physical distancing and masking, isolation and quarantine, and even the existence of the threat itself. Another casualty has been the testing infrastructure. Never robust, and fraught with issues, some self-inflicted, some caused by loss of expertise and funding, we can no longer expect inexpensive access to quality testing with reportable results. There's a great place for home testing, although I'd be happier if we could standardize sample collection, and ecstatic if we could manage data collection of the majority of lateral-flow tests performed in a standardized and trackable database, but we lost the opportunity for that several years ago; initiating it now might be a good plan fo r future pandemics, but not for this one.
Most hospitals I'm familiar with no longer routinely test patients on admission and only test for ill-defined indications such as post-operative declines in oxygen saturation often secondary to atelectasis rather than viral disease. On the positive side, overall and excess mortality has declined, but we're still seeing too many virus-related deaths, but they're normalized socially in the public sphere. Our surveillance for new upticks in spread, likely by a new variant, will see a detection delay because there's a significant delta between wastewater detection and general upticks in human illness.
After a dismal booster uptake last year, I've little real hope we'll see a significant uptake this year despite indications from trials of good immune response to the current list of variants facing us.
We had a scare recently with BA.2.86, but we were lucky that it's less likely to actually infiltrate cells. We've learned a lot about how to diagnose and clinically approach this virus, but there remain a number of issues, especially in terms of long-COVID and the potential for immune system compromise that's arisen of late, or the fact that SARS-CoV-2 appears to be less an actor solely on the respiratory system than other systems, especially vascular. I fear we're a good mutation/substitution/deletion away from another big surge, because I'm not as confident as some that immunity derived from infection is as durable as they'd have us believe.
Great comment Gerry. Thank you. The normalizing of death and illness rooted mostly in political beliefs or world viewpoints is going to be a major topic in future history books covering this period.
It will not age well.
I watched a good friend of mine with serious complications from Lyme disease being ignored in ER because it was "all in her head". I took care of her for just over 18 months and gave her a place to stay so I knew otherwise. On visits where I accompanied her, staff treated her entirely differently in my presence. I'm not a doctor like you and thank you for your service, but I was exposed enough to the system here to know there are gaping flaws in it. Thankfully she is doing a little better now, but it has gone on for over 14 years for her and she is 1 of many of a forgotten demographic.
I'm originally from Ireland. The folks talking about how great our health system is here are those who do not need a public care system. They have the money to get the care they need. The only way their views on how healthcare serves others change, is if their circumstances change which is sad because at that point, they are just another statistic and part of the underserved. And their viewpoint doesn't matter at that point.
In my opinion, this pandemic has exposed a lot of the country's less than perfect underbelly.
In the US, you can have it all if you have the financial means. The culture of the "Marlboro Man" permeates most of US society.
Not if DeSantis has his way
Truly. If you spend 5 minutes looking at those graphs and don’t walk away shaking your head, you need to go back and spend 10 more minutes. The disconnect between idealizing the US as the “land of opportunity” while staggering amounts of poverty, homelessness, and chronic health conditions are all around us--AND ARE SOLVABLE--will continue until enough voters see the power of uniting above party lines and loyalty, for the common good. I think it’s happening but slowly, and 2024 is already on the horizon.
US is the land of opportunity, but in some ways careless of those less able or ambitious.
Makes for a great economic engine, but with stark differences based on abilities and educations. "Freedom" to be homeless on the street, or a mega-billionaire.
Absolutely spot-on. Excellent documentation of some of the myriad problems our healthcare system has evolved over time. And thanks for the OECD statistics. I need to put together a lecture on this topic, and you've raised points my notes didn't cover yet. I'd not considered the number of beds per capita, obviously a sign I needed more time on the topic, but your summary is very appropriate.
Thank you.
One more bit is that with everybody* in UK having an assigned gp, they have a relationship with an office that's going to be contacting them and offering vax as one of the targeted groups.
*Presumably there are some who falls through the cracks but in general
One would hope, but they're also likely overburdened and understaffed, which means there's likely to be a number who fall through the cracks.
I believe that HCW shortage (for a myriad of reasons) will be affecting healthcare regardless of countries but there is underfunding at play too. Sadly, this deepens the healthcare inequities already in existence.
More likely there's an automated mail out based on already captured categories, but your point stands in general.
Thank you. That’s a brilliant explanation. Quite easy some to interpret the UK recommendations as “the vaccine is so dangerous for younger people that’s it been banned for those under 65”.
Dr. Jetelina’s compilation of information here is a huge public service that I hope will be widely read and considered. Add to this that, in a cross country comparison, we in the US pay a whole lot more than other countries for this miserable state of affairs. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
It is so demoralizing, we pay a lot more for worse care.
So clear. So accurate. So damning. I believe we can judge the intentions from the result. Our nation as a group does not want humane, compassionate, effective healthcare--in fact, it does not want health. My career in medicine has given me firsthand experiences which jibe really well with this column. As Bugs Bunny might say, our country is a moroon.
I agree with everything in the article. But I think the primary reason, the overwhelming reason, that the US and UK recommendations are different is because of funding. The UK health system was deciding who it would pay to vaccinate. And when you add up all the at risk people and the people they interact with (at home, in shops, etc.) they are actually paying for a lot of jabs. But not for everyone. The US CDC was deciding who would be allowed to get the vaccine, and whether other entities (mostly health insurers) would have to pick up the cost. But the people who decided for the US had no responsibility for the funding.
An excellent point, especially as it highlights how such a common well-understood word (“recommendation”) stands in for a host of real differences in goals, public policy, and state of healthcare. Thank you for that framework, it will stay with me.
I agree. I think this was the prime determinant regarding XBB boosters, and the estimation that only 25% of the US will end up getting it... or less. Cost crunching.
Casting a wide net won’t work for the sad 25% uptake rate anyway, right?
Great summary of the failings of our system notwithstanding. Maybe we should have a post about the failings AND successes of the US system compared to other major nations. We certainly do drive a lot of innovation, and as long as you have good insurance, the system doesn’t fail as often as for those without good insurance. And not providing a basic coverage safety net for every citizen is immoral IMO.
Not only "subpar", but also not a "system".
No, it's a system. It just not a health care system. It's an insurance company wealth care system. As such it's doing a great job of doing what it was designed to do. It just wasn't designed to actually make healthcare available to as many people as possible at the lowest cost.
Bravo! You nailed it.
Really helpful piece, but fyi, the ILF graph under the point about our terrible safety net and the US having zero paid sick leave doesn’t show sick leave; it’s about paid maternity leave (of which we also have zero, of course).
Guaranteed sick leave is also in short supply. In my last job, I had "leave", to be used as I saw fit. Before that, I'd had leave accrued at a rate similar to that last job, but solely for vacation. Sick leave was accrued in a different way and accounted for separately. And, so many part time jobs don't offer leave or insurance.
In some cases sick leave benefits can be extremely generous while creating perverse incentives that aren't consistent with the goal of containing infectious diseases. For instance, at my job I'm able to accrue up to 1500 hours, and up to 750 hours can be used towards my service credit when I retire.
Well written assembly of data that I wish more of the US public understood - for this conversation and many others in healthcare.
(Cross post of my comment on Dr Paul Offits Substack from yesterday who argued for targeted protection)
I put together a spreadsheet tracking recommendations by country here:
https://docs.google.com/spreadsheets/d/1oJusZ0yAve1cCCSS5MGjp1XYjNc7qJffqJsz7ARlnLg/edit?usp=sharing
US, Canada outliers at 6 mo+
Austria at 12+ is outlier in EU.
New Zealand at 30+ is lowest after Austria and US/CAN.
After that 60-65+ is standard recommendation.
Considering that only 2.1% of the EU bothered with 3rd booster, I suspect only a handful will go for the 4th anyway. The public is treating CDC/PH like Catholics regard Vatican recommendations not to use birth control.
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-vaccination-strategies-march-2023.pdf
I personally think the recommendation to vaccinate everyone is good policy but unlikely to be supported by public opinion. I blame, and will for some time, the previous administration and their chosen CDC leader for many of the losses in public health respect we say. Recovering from that will take a long time.
Appreciate the spreadsheet.
Blame Redfield? He seemed reasonable - and I think the hindsight lens we now have, many of his early comments turned out to be correct ("“This virus is probably with us beyond this season, beyond this year, and I think eventually the virus will find a foothold and we will get community-based transmission.” - 2/13/20) [1]
Obviously, his claim that wearing masks could end the pandemic didn't age well, but he was always cautiously optimistic about the vaccine (compared to Trump who the media blasted for saying shortly before the election that the "vaccine will be here momentarily" - 10/5/20) [2]
I think the high vaccine uptake of the first 5 months after release falsifies the claim that previous admin had anything to do with current vaccine hesitancy. By May 2020 80% of elderly population had already got their 2nd shot [3], and even comparing total population the US was a leader compared to "doing it right" countries before summer of 2021 [4]
The reason why the Covid vaccine fell out of public opinion - and this is true for the entire world - is that it was overpromised and underdelivered. It was sold as something it wasn't, and it cost PH a massive amount of credibility. Fauci, Wallensky, Bourla, Bancel, etc - all said that the vaccine gave you immunity from Covid. (YLE among few vocal PH not on record making this claim). Suggesting it didn't prevent transmission was a cardinal sin and that wrong-think was actively censored on Twitter, Facebook, LinkedIn, and Google.
You can argue it was the "noble lie" as, if it was sold as Flu Shot, people wouldn't have taken it at such high levels, but the cost was credibility that will take a long time to earn back. Personally, I think the "Recommend for all" approach only widens that distrust and adds to the sentiment that the CDC recommendations carry little weight. (which invites a whole other set of downstream problems).
Bottom line, only 4% of 80+ year olds in the EU last year bothered with the 3rd booster. [5] I doubt that had anything to do with Redfield and Trump, and 100% due to false/misleading advertising.
_____________________
[1] https://www.cnn.com/2020/02/13/health/coronavirus-cdc-robert-redfield-gupta-intv/index.html
[2] https://www.technologyreview.com/2020/10/19/1010646/campaign-stop-covid-19-vaccine-trump-election-day/
[3] https://www.cdc.gov/mmwr/volumes/70/wr/mm7025e1.htm#T1_down
[4] https://imgur.com/a/GE2IhKI
(To recreate set Metric to "people fully vaccinated", Check "Relative to population", choose your countries)
https://ourworldindata.org/covid-vaccinations
[5] Fascinating report from ECDC
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-vaccination-strategies-march-2023.pdf
Redfield was a lot of things but he was I’ll-suited for the job. The comment cited was one of the few where he assumed a leadership role. That said, leading CDC was a Dream Job for him culminating a career that’s been described various ways. I had no direct interactions, but my indirect interactions didn’t demonstrate great brilliance. And he came into the job with a mandate to oversee downsizing the organization, and didn’t object when the sole organization preparing for pandemic planning in the White House was scuttled.
Vaccine uptake early was pretty good, but mis/disinformation campaigns started taking their toll, and significant portions of mainstream media misrepresented things in a manner that was inexcusable. Sound bites from the likes of Fauci and Birx were the elements that oversold the vaccine. I was briefed late in 2020 that the vaccines in development would be a success if they reduced morbidity, hospitalization and death by 50%, with no mention of affecting transmission or protection from infection.
General masking has been demonstrated with varying efficacy for a long time and was one of the hallmarks of protecting against an airborne virus.
In the summer of 2021 we saw a significant increase in anti-vax propaganda which undoubtedly led to hesitancy, and the stories haven’t subsided. I was in the chorus of those trying to reduce the misconception regarding transmission, although for the ancestral strain there was supporting evidence. Subsequent immunity-evading clades removed even a hope for this, but when we attempted to discuss immune-evasion, we were also accused of changing our stories, even when we’d stated the original goals didn’t incorporate reduction of active infection or transmission at all.
There was undoubtedly a failure in communication that cost PH dearly, but I, for one, am used to presenting and providing factual data and not being accused of manufacturing information, something I was subjected to repeatedly both within my organization and publicly. The truth was, simply, clinically demonstrated data, which were never fact but were instead evidence available at the time, and subject to change based on discussions with real, live clinicians and reading a pretty significant number of preprints and peer-reviewed (if hastily!) articles critically to determine if I could even believe their data (note: My review of the hydroxychloroquine results from Raoult wasn’t favorable: the numbers appeared to perfect) required significantly more work than simply scanning an abstract and calling it good.
What we’ve seen has been incredible damage, as you note, to public health’s reputation overall, but that assault has been ongoing for decades, often on the basis of individuals’ rights claims, when the job of public health is to identify issues and recommend, and in some cases where the laws still support such, enforce measures to protect the public. In a number of cases, we’re reduced to trying to convince a public who’ve been told we’ve been misleading them, that any new data we share is real, and not shrill protestation.
YLE, and several others have done a very good job, but there are other voices out there who are loud and claim that, by virtue of their status should be allowed to vilify or deny evidence they disagree with. These are the people claiming the only reliable trial is a placebo-controlled randomized, double-blinded study, and they’ll question or deny all else... unless it supports their own concepts. These folks are the ones who are, today, causing significant harm, and are frankly abusing their positions to make themselves “stand out”. And they’ve convinced (confused?) a large enough group to be of concern.
I feel you give too much of a pass to this administration.
It was the Biden Administration who pushed Fauci's (incorrect) "dead ends for transmission" claims [1]
It was Biden who was "losing patience" with the unvaccinated because he believed they were the ones spreading it [2] (imagine a president "losing patience" with people who don't want to take statins).
It was the Biden administration who pressured social media platforms to censor claims the vaccination didn't stop transmission [3] - I would have never heard of Alex Berenson if he wasn't famously banned from Twitter for saying (correctly) the vaccine doesn't stop transmission. [4]
It was Biden administration which mandated companies to fire unvaccinated employees (including doctors and nurses) [5] which were at no risk to their peers even when his head of CDC was finally acknowledging the vaccine doesn't stop transmission [6].
This is why there is an erosion in public health. The people feel like they got bullshitted and are embarrassed they engaged in such behavior. The apathy towards shot #5 is bipartisan - a fraction of the population will bother.
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[1] https://thehill.com/homenews/sunday-talk-shows/553773-fauci-vaccinated-people-become-dead-ends-for-the-coronavirus/
[2] https://www.cnn.com/videos/politics/2021/09/09/biden-message-unvaccinated-americans-patience-sot-lead-vpx.cnn
[3] https://www.usatoday.com/story/money/2023/09/08/biden-administration-coerced-facebook-court-rules/70800723007/
[4] https://www.foxnews.com/media/white-house-asked-twitter-why-alex-berenson-wasnt-banned-from-platform-lawsuit-reveals
[5] https://www.nytimes.com/2022/01/15/us/healthcare-workers-vaccine-mandate.html
[6] Earliest I can find concession from Walensky that vaccines don't stop transmission is 8/5/2021
https://twitter.com/cnnsitroom/status/1423422301882748929
Michael, I think you summed it up really well. I personally know a lot of people who have had the vaccines who ended up getting Covid anyway. For a lot of them, that was when they were just done with getting the shots. I think that to many people, it is pretty pointless. (Not saying I agree with it, but I do empathize.)
It was Biden who said “Covid is over.”
Nice spreadsheet. I wonder if US and Canada, which are large countries in terms of size, have lower natural immunity vs other countries where people are more apt to live in apartments and take public transportation?
I love this article for so many reasons -- the clear and concise articulation of so many elements of the ecosystem in which we live (and how and why decisions are made as a result) and a general primer on why context matters. Thank you!
Considering that currently 88% of hospitalization and death is occurring with at risk population, there is a need to really target them in messaging. As for the rest, durable immunity still seems to be working well. I also think the HCW will/should be targeted.
Additionally, for reasons that are unfounded, PCP seems to be slow in using antivirals like Paxlovid and Remdesivir. Both show 90% reduction used within the first 5 and 10 days respectively. Remdesivir seems to be getting harder to obtain. So, what's up with the FDA and VV116?
https://pubmed.ncbi.nlm.nih.gov/36577095/
Of course, I've some things heard/seen/read, "its mild", "let's wait and see", "rebound" and "take when your temp is 102". When you test positive, this is when you need this in high risk populations. Psst, SARS-CoV-2 is biphasic and 2nd stage inflammatory response (so called rebound) is the natural history of COVID-19. This happens WITH or WITHOUT antivirals. We should be targeting this message!
OK,rant over...
Valuable point about Covid's biphasic response (what other viruses induce this kind of response? Usually it seems it's one acute response varying in severity and duration - though some have late effects). On the question of healthcare workers getting vaccinated-what's our current evidence on how well that protects *others?* Intuitively if it reduces viral load (if infected) it should, but....
Quite a few infectious diseases but protecting others? I am more concern about their health.
Incredible explanation and sure wish this post would get "out" and "about"! Thank you very much.
Outstanding. Depressing, but valuable information.
To be fair, we should criticize health policy not for COVID but for all those other reasons as to why our country's healthcare is behind.
Some of have done so and continue, but we also are working to try to improve it.
This is a stark, and discouraging, analysis of what we “kind of knew.” Thanks.