Questions and concerns surface as COVID-19 vaccine nears approval

Even officials like Ingham County Health Officer Linda Vail have had moments where they’ve questioned the efficacy of a fast-tracked COVID-19 vaccine for residents in Greater Lansing.

Vail is a staunch believer in vaccination. She understands the science behind how they work and has been involved in the development of drugs (and the FDA approval process) as a former employee at Pfizer. Still, the rapid development of the vaccine has given her pause, she said.

Dr. Adenike Shoyinka, Ingham County’s chief medical officer, has also had her reservations about the vaccines as they were driven through clinical trials and testing. And her professional specialty is in infectious diseases, which for decades have been well controlled by vaccinations.

Then, last month, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and other leading health professionals threw support behind the vaccine trials.

“As soon as they came out strongly in support, and strongly supporting the efficacy, the safety, the process that this vaccine has gone through, I don’t have any concerns anymore,” Vail said.

Vail and Shoyinka, who have led Ingham County’s response to the pandemic, participated in a 37-minute video interview with City Pulse last week. 

Despite two vaccines — one produced by Pfizer and the other by Moderna — on the cusp of approval by the FDA, polling still shows that over half of Americans harbor some reluctance about the coronavirus vaccine, much like the original hesitations voiced by Vail and Shoyinka.

Trial data shows that each vaccine is at least 95% effective in preventing an infection with the virus. And even for those who contracted the virus after vaccination, the disease was less severe.

Those vaccines could begin being administered in Michigan as soon as Tuesday (Dec. 15), officials said.

And even as federal regulators prepared to approve the Pfizer vaccine for an emergency-use authorization this week, the country was still facing some of the largest spikes in COVID-19 cases and numbers of those hospitalized (and put on ventilators) since the pandemic began.

This week, Michigan confirmed 410,295 cases of COVID-19 and 10,138 deaths — including 16.629 cases in Greater Lansing and 219 deaths in Ingham, Clinton and Eaton counties.

Who’s first in line?

Last week, the federal Centers for Disease Control vaccine advisory board voted to provide the vaccine first and foremost to frontline medical workers. Residents and staff at long-term care facilities were next in line.

“Our first priority will be to keep our healthcare systems operating, and to protect those who are the most vulnerable,” according to the Michigan Department of Health and Human Services.

State officials still aren’t sure how many doses of the vaccine will be available in Michigan, but they already know it won’t cover everyone on the CDC’s priority list. A spokeswoman said the hope is to have vaccines for all staff at congregate care facilities — like group homes for those with disabilities and skilled nursing facilities — by January. At-risk populations will be prioritized.

With limited initial supplies, those first batches will go to frontline healthcare workers. Broad community availability is not expected until late spring 2021. That will delay a return to “normal,” state officials said, until 2022. Vail was optimistic for a return to “normal” in mid-2021.

Shoyinka disagreed; only time will tell. And public acceptance of the vaccine will be paramount.

“Let’s just say I’m trying to be realistic and optimistic at the same time,” Shoyinka added. “Again, like we said, we don’t know how well or how long this vaccine will induce immunity.”

The process requires two shots a month apart. Shoyinka suggested that “full immunity” won’t kick until the second dose. Even then, the duration of that immunity is uncertain, she said.

“Is this something that we’re going to have to take annually or biannually? We still don’t know,” Shoyinka added. “So yes. We still have a long way to go. I would say a minimum is a year.”

The distribution plan for the coronavirus vaccine is also different from the H1N1 vaccine in 2009. That vaccine was sent from the state to local health departments, and then to patients and long-term care facilities. This time around, the vaccine will be distributed directly to the long-term care facilities by the federal government through partner pharmacies, officials said.

Vail said the coronavirus vaccine also won’t be distributed in congregate settings like flu clinics.

“We still need to vaccinate people rapidly. We can’t bring people into rooms in large groups and cram them together in lines in order for us as a system to vaccinate them rapidly. So, in a sense, you do have to make sure that it gets out to a number of different places,” Vail added.

MDHHS identified 48 hospitals and 12 health departments with freezers frigid enough to keep the Pfizer vaccine stored at a required -94 degrees Fahrenheit. Home freezers are set at -4 degrees. At -94 degrees, a pint of ice cream would freeze hard enough to break a spoon.

The Ingham County Health Department is one of those capable of storing the vaccine. Health officials said they are finalizing contracts for dry ice to ship them out statewide.

Battling vaccine hesitancy

While the endorsement of leading health officials quelled any vaccine hesitancy for Shoyinka and Vail, the politics behind the virus — combined with a general sense of distrust of the government and vaccines — pose a significant hurdle for public health authorities to overcome.

Officials estimated that 70% to 80% of the U.S. population will need to be vaccinated in order to reach an immunity level to stop the coronavirus from spreading.

A Pew Research Center poll in May showed that 78% of respondents would take the vaccine. That rate declined by September with another poll showing that 49% would opt against the shot.

Those numbers are a little better in those between the ages of 50 and 80, according to another poll released last month by the University of Michigan, but those statistics also carried a huge caveat: Only 40% of Black participants and 51% of Hispanic participants said they would get a vaccine. And Black people have accounted for a disproportionate number of cases and deaths.

Those numbers don’t bode well for the forthcoming battle for public health, officials explained.

“You have people of color who have a long history of certainly not trusting anything that comes out that seems experimental after the Tuskegee experiment,” Vail said, referencing the infamous experiment where Black men weren’t told they had syphilis and had their disease left untreated.

“That has laid a path, rightfully so, of distrust in the Black community regarding lots of medicine and particularly anything that seems experimental,” Vail added. “This is not experimental, so we’re just going to have to work with a lot of that messaging in order to get past those barriers.”

State health officials, in the meantime, are crafting public messaging to address the hesitancy.

MDHHS spokeswoman Lynn Sutfin described an ongoing “multi-prong research study” on the attitudes of and behaviors of residents. As part of that study, state officials asked questions about vaccinations and reviewed national studies to understand the resistance to vaccines.

Just as Vail and Shoyinka relied on trusted sources for understanding and accepting the vaccine, they said they’ll need community partners to step up and serve in similar roles.

“We’re going to have to create a lot of messaging targeted to specific populations of specific people related to the specific issues that they have that are causing that hesitancy,” Vail said, noting that local faith-based institutions can help work with health officials on public perception —, ‘trust brokers’ within those different populations and use that as a method of gaining public trust.”

Vail said attitudes and pushback on pandemic responses from the government have also fed into a “distrust” of government in general. She used her powers as health officer to quarantine multiple buildings in East Lansing where people infected with COVID-19 were living and sharing common areas like kitchens, bathrooms and entertainment spaces — a rare move in Michigan.

A vaccine mandate?

Vail’s authority also allows her to mandate vaccinations, though that’s not in her plans, she said. Sutfin also said that mandatory vaccines aren’t part of state officials’ playbook on distribution. Vail said those mandates could only further erode trust between residents and health officials.

Still, Vail is expecting local healthcare systems and other businesses to use their authority as employers to create policies regarding vaccinations for their staff. Hospital systems routinely require certain vaccines for employees; they can likely require the same for the coronavirus.

Steve Japinga, vice president at the Lansing Regional Chamber of Commerce, said he will be working with the ReLaunch Lansing taskforce to develop policy recommendations.

“Regarding the mandate and how it’s going to look like, on whether an employer will mandate an employee to get a vaccination for COVID-19, we haven’t got to that point yet,” Japinga said of the ReLaunch Lansing effort. “But, of course, that’s going to be something that we’re going to be working on with the Ingham County Health Department, the state, and probably the feds to really get their guidance on how best to approach that subject.”

Costs and the economy

The vaccine may not cost much for local patients, but someone must float the bill. And state and local lawmakers are still busy figuring out how to pay for the vaccine and its pending distribution.

The federal government has already paid out billions to vaccine makers. In July, the U.S. Department of Health and Human Services and the Defense Department announced it had pre-paid Pfizer $1.95 billion for 100 million doses. In August, Moderna was awarded a $1.5 billion contract to deliver yet another 100 million doses of its own vaccine.

That’s on top of an additional $1 billion the feds gave Moderna to develop its vaccine. And if the U.S. government extends the contract, Moderna could collect another $8 billion in the first year.

Sutfin said the state of Michigan has already received $6.1 million for vaccine distribution from the federal government. Vail said she doesn’t know how those costs will translate to Ingham County residents. While the vaccine itself may be free, some providers may charge added fees.