Two senior FDA officials, including Dr. Robert Califf, the agency head, recently published a journal article entitled, "Is Vaccination Approaching a Dangerous Tipping Point?" They make a compelling case that we are facing a crisis:
Despite the care taken in the development and deployment of vaccines and their clear and compelling benefit of saving individual lives and improving population health outcomes, an increasing number of people in the US are now declining vaccination for a variety of reasons, ranging from safety concerns to religious beliefs.
Vaccination is a pillar of disease prevention. The CDC estimates that, worldwide, between 2021 and 2030, more than 50 million deaths will have been prevented through immunization.
The U.S. cannot afford widespread rejection of vaccines, but Dr. Califf's proposed remedy is weak, essentially shifting the responsibility for educating the public "to all those directly interacting with individuals in a health care setting, ranging from front office staff to retail pharmacists to primary care physicians."
Healthcare providers cannot do it alone. Government officials, especially at the top of the food chain, need to be part of the solution.
For a start, Dr. Califf should meet with White House Chief of Staff Jeff Zients, whose previous job was White House coronavirus response coordinator, grab him by the lapels, and give him a proper tongue-lashing. The White House has been letting senior healthcare officials get away with murder. Literally. The CDC Director, NIH Director, U.S. Surgeon General, HHS Secretary and Assistant Secretary for Health – and Califf, himself, for that matter – have been invisible. For all the public knows, they could have entered the Federal Witness Protection Program and, with new identities, be flipping burgers in Cheyenne, Wyoming.
How bad is the current situation?
COVID is a case in point. During the week from Dec 24-Dec 30, COVID hospitalizations were up 20.4% week-over-week, with almost 35,000 hospitalizations that week. COVID deaths were up 12.5% from the previous week. And the curves were clearly trending upward, with the full impacts of holiday super-spreader events not yet evident.
Another worrisome trend is the concentration of SARS-CoV-2, the virus that causes COVID, in wastewater, which is an early predictor of future infections. Leaving aside the predictive value of wastewater analysis, it can also be used to estimate the number of infections in real-time. According to infectious disease modeler J.P. Weiland, the U.S. was experiencing more than 1.5 million cases of COVID daily (and trending upwards) as of December 31. We are undoubtedly over 2 million COVID infections per day by now.
Yet, only 19% of eligible Americans have gotten the most recent COVID vaccine booster, and masking is almost non-existent even in high-risk situations such as airports, airplanes, trains, theaters, and other places where people congregate indoors in large numbers. An opportunity lost was President Biden's January 8 campaign speech at a Charleston, SC, church. The pews were completely full but there was not a mask in sight. Had Biden's staff required the attendees to wear masks, that would have sent a message.
Vaccine rejection is being found increasingly in pediatric patients, which has led to measles outbreaks in the unvaccinated as herd immunity has been breached. There is even what veterinarians have dubbed "canine vaccine hesitancy." An article published last year in the journal Vaccine found that "a large minority of dog owners consider vaccines administered to dogs to be unsafe (37%), ineffective (22%), and/or unnecessary (30%)," and that a majority of dog owners (53%) hold one or more of those opinions.
What can be done?
We need a multi-pronged public education campaign with participation from politicians and celebrities of all stripes. Think of a widely distributed Public Service Announcement video (including during the Super Bowl) that shows President Biden and Donald Trump getting RSV vaccinations and Taylor Swift and Oprah Winfrey getting a COVID booster.
We can and must do better.
Henry I. Miller, a physician and molecular biologist, is the Glenn Swogger Distinguished Fellow at the American Council on Science and Health. He was previously the director of the FDA's Office of Biotechnology.