The miracle of science has exceeded, even the most ambitious expectations, in delivering highly efficacious vaccines utilizing both traditional and exciting new technologies. Vaccines give the world a hope to exorcise the curse of COVID-19.
A large scale Israeli data using Pfizer vaccine, released on Jan. 31, affirmed the original trial results with 95 percent efficacy in infection prevention and a very significant hospitalization reduction.
In the U.S., Moderna and Pfizer are expected to deliver 10 million dosages a week. The Johnson & Johnson vaccine will likely join the mix soon, expanding supply even further.
Piling repositories, however, won’t contain the pandemic. Only mass vaccination will put the pandemic out. Every vaccinated human being becomes part of the solution.
A risk calculator that determines the demographics most at risk from the ravages of COVID-19 and those deemed essential, reasonably need to be at the head of the line. Roughly 25 percent of the population is age 16 and under. They are currently not on the vaccination list.
COVID-19 infection seems to lend durable immunity. There is substantial evidence across the world that risk of repeat infection is very rare (less than 1 percent in a British study of more than 6,000 participants). For now, those with previous infections should be at the end of the line.
Taking kids 16 and under and those with prior infections off the immediate vaccination list, the number needed to vaccinate drops down to 230 million nationally (using the same math, roughly 600,000 for Kern County).
A fast-spreading virus has accorded numerous opportunities for mutations. Several mutations (British/South African/Brazilian/Californian) seem to lend the virus as more contagious and virulent. There is a disconcerting observation of vaccine resistance (South African variant).
We need to accelerate vaccination to stay ahead of potential adverse mutations that may compel us to go back to the drawing board and start all over again. In the sage words of Yogi Berra, “it’s getting late early.”
We have a good handle on the demand, supplies thankfully are expanding and now we need to solve the riddle of vaccination itself. It appears that limited supplies, special storage requirements of the Pfizer vaccine and fragility of mRNA-based biologics compelled decision makers to establish stringent rules regarding “vaccination clinics.” Somewhat complex algorithms for tiered vaccination and the threat of punitive measures to health care providers for any deviation from subscribed guidelines paradoxically resulted in vaccine wastage. Both the wasted vaccine and vaccine idly adorning the freezer shelfs are counterintuitive to the stated goal of expedited vaccination.
The solution in this case is simple — a solution supported by existing infrastructure of doctor-patient relationship and corner pharmacies. Bureaucratic intrusiveness through “designated vaccine centers” is an unnecessary impediment. To create new charts for patients in “vaccine clinics” is redundant and wasteful. To have elderly, infirm and anxious people wait for hours in lines around sports stadiums is an avoidable drama.
Release the vaccine to doctors and pharmacies. Relationships there are underpinned by trust and familiarity. Patient records already exist. Compliance to guidelines should be encouraged, but thrust of vaccination has to be vaccination. We should resist the temptation to overthink. Sometimes the solution is inside the box.
Dr. Brij Bhambi specializes in cardiac and vascular intervention, nuclear cardiology, consultative and general cardiology and holds board certification in interventional cardiology, cardiovascular disease and internal medicine. He is a chief medical officer at Bakersfield Heart Hospital.