HIV and ID Observations

A Joyful Easter, 1900. New York Public Library.

Big announcement this week from CDC, saying that people who have been fully vaccinated for COVID-19 can safely travel.

Of course many didn’t need this permission, as data increasingly show the vaccines not only powerfully protect you, but protect others. But having official endorsement from our cautious federal health agency surely means the data are especially strong.

For the record, it’s worth highlighting two recent bits of extremely good news on the vaccine front:

1. The Pfizer vaccine continued to provide high-level protection at least 6 months after immunization. Over 90% effective in preventing any symptomatic disease, and 100% in preventing severe disease. Why is this important? The clinical trial started during the summer of 2020, which means these data take us through the winter surge in cases that occurred globally. Furthermore, the vaccine was just as effective in South Africa, where the more transmissible B.1.351 variant is highly prevalent.
2. Prospectively collected data from the CDC show that people who received the mRNA vaccines were 90% less likely to get infected. The study included nearly 4000 front-line workers who were tested regularly by RT-PCR, even without symptoms, and confirms similar data collected in the United Kingdom and Israel, also with large sample sizes. Here’s why these data are important — fewer people with infection means fewer who can infect somebody else:

Amazing prospective @CDC data reinforcing that these vaccines prevent disease *and* infection — and hence reduce the risk of transmission.

Remember, fewer people with infection means fewer who can infect somebody else. 

Let's get vaccinated ASAP! https://t.co/k9wl9Tsrmp

— Paul Sax (@PaulSaxMD) March 29, 2021

Many (including me) have always thought that it would be highly unusual if these powerfully effective vaccines failed to reduce transmission risk — now we have multiple lines of evidence that indeed they do. It may not be 100% — nothing is — but it’s a lot. To quote Dr. Neil Stone, “it takes a special kind of pessimist to believe that Covid vaccines won’t significantly reduce transmission of virus.”

We don’t want to be that kind of pessimist.

Why should we stress the highly favorable nature of the vaccine effectiveness data, both for personal health and the health of others? This will help many of those who are on the fence about whether to get vaccinated make the right decision — which is emphatically to get a COVID-19 vaccine. This will become increasingly important when supply of the vaccines exceeds the demand, and any adult will be eligible for immunization.

But what if this isn’t enough? Should we proceed with vaccine mandates in certain settings? Especially in high-risk transmission jobs, such as healthcare, where vaccination will both protect our patients and make the work environment safer for others working in the same setting?

As noted in this excellent concise review entitled “Should healthcare institutions mandate SARS-CoV-2 vaccination for staff?”, the question raises several challenging ethical questions. The piece covers the pros and cons, ultimately concluding that “mandates may be ethically permissible in select circumstances.” It also notes that from a practical perspective today, the current “emergency use authorization” of the vaccines makes them technically still experimental, hence a mandatory immunization is “legally and ethically problematic.”

I would argue, however, that with the pandemic still very much ongoing — COVID-19 cases are up substantially over the past few weeks — individual company policies can strongly encourage vaccination by making it the ticket to greater on-the-job benefits, flexibility, and freedom.

A carrot, not a stick.

An example? Here’s what Major League Baseball did, in a move this ID doctor and rabid baseball fan 100% supports:

Major League Baseball is getting back to normal. Players can now travel with their families. They can go to restaurants. They can play cards and move around on planes and buses. They can use whirlpools and saunas in the clubhouse. And they no longer are required to wear a mask on the bench or in the bullpen. However, teams are first required to have at least 85% of their players and staff fully vaccinated … Plus, these new protocols only apply to those who have been fully vaccinated.

In other words, if you and enough of your teammates agree to get vaccinated, here’s what you get in return — freedom! It’s analogous to CDC saying that fully vaccinated people can safely travel.

Despite the increase in cases, the pathway out of the pandemic looks brighter all the time. And it’s these amazing vaccines that will lead us there.

Spread the word.