What are they? What do they say about vaccination, public health, and the mortality of older adults? A new perspective to the problem of vaccination and the differential risks of disease

What are they? We spent a lot of time on the need for vaccine because of the fact that there is no simple solution for older people who are vulnerable to disease (also known as the vulnerabilities of age). But clearer communication — from public health officials to politicians and the media — about differential risk could nevertheless help, emphasizing not just that more shots are good but that different groups probably need different approaches, and that even with up-to-date vaccination and bivalent boosting, infection represents a considerable threat to older adults.

As a country, we prefer to not see the deaths that occur everyday as a sort of background noise, or even a kind of faded wallpaper. We don’t have to comprehend who’s dying or why because we don’t want to think about the fact that at a rough pace of around 100,000 deaths a year, Covid-19 is the third leading cause of death in the US. This is normal, but we don’t really track the ups and downs of cancer or heart disease.

Vaccination Safety and the Fencesitters: The Case of Anthony Fauci in the NIAID Director during the 1981-19-19 Pandemic

Although before the pandemic most US parents took their children to be vaccinated against multiple diseases to comply with school mandates, Salmon estimates that between one-third and one-quarter had serious concerns about the safety and necessity of these routine childhood vaccinations. “It’s the fence-sitters, the people who could be pushed over the edge, that worry me,” he says. This issue has become more pertinent in the current situation. For example, several reports have described cases of inflammation of the heart tissue — a condition called myocarditis — among adolescent boys receiving multiple shots of the mRNA vaccines3.

This month, Anthony Fauci will step down as director of the US National Institute of Allergy and Infectious Diseases (NIAID) after more than 38 years in the post and 54 years at its parent organization, the US National Institutes of Health (NIH). He has led the institute under seven US presidents and overseen its research and response to the HIV/AIDS epidemic, the Ebola outbreak that began in 2014 and the COVID-19 pandemic. The 81-year-old physician-scientist became a household name during the pandemic, during which he was revered as a trusted source of advice by some and disparaged by others, including former US president Donald Trump, who saw his advice as inconsistent and overbearing. On 11 December, he was attacked on Twitter by Elon Musk, who took over the social-media platform in October. Fauci talked to Nature about Musk and the problems he caused.

One of the most important is in the area of HIV. In 1981, when we first became aware of the cases of HIV, [it was] a mysterious disease of unknown etiology that was killing virtually everybody who was infected. It was one of the darkest periods of my or anybody’s professional career in infectious diseases. We went from a bleak time where we didn’t know what was killing the majority of young gay men to seeing a diagnostic test and then a series of drugs that had completely transformed the lives of people with HIV. We have created highly effective prevention methods with pre-exposure prophylaxis that will bring the level of virus to below detectable levels so people who are infections do not transmit it to anyone else.

One of the most exciting aspects of infectious-disease research is a vaccine for HIV. We’ve made spectacular advances in the development of therapies, both for treatment and prevention of disease. But the one thing that’s eluded us up to now has been a safe and effective vaccine. That is one of the things we look forward to. There is a chance that you can have a cure for HIV in which there will be no further therapy in order to have suppression or elimination of the virus. We have not reached that point yet, but that is an aspirational goal.

Yes, we do. You do it by doing it. It’s not that difficult to incorporate a discipline of social sciences into the discipline of the hard sciences of developing vaccines. It is very disturbing that, in our country, we have 68% of the total population vaccinated with the primary vaccine for COVID. Of those, only half have received a single boost. And importantly, [despite] the availability of an effective BA.4/5 bivalent updated booster, only 13% of the eligible population has received it. That is very disturbing and embarrassing that we have a low enthusiasm for getting a life-saving vaccine.

Source: https://www.nature.com/articles/d41586-022-04432-7

COVID-19 has left a lasting legacy on mental health: what can we learn from the UK, Israel, South Africa and other countries?

Another aspect that has been brought to the fore by COVID-19 is the importance of mental health, and paying attention to the stresses that [the pandemic] has put on society: not only on health-care workers, doctors and nurses, but also on the general population, including children. They have been shaped by missing school, as well as the stress of not having their parents around, and also the disruption of the normal flow of their childhood. All of that has had a major negative impact on mental health.

That is not possible to answer. If there are countries or groups that are not transparent, that’s a big hindrance to the global public-health effort. And I would hope that all the countries of the world come to a realization that we’ve got to be completely cooperative, collaborative and transparent in everything we do, because there’s no such thing as a pandemic, particularly of an infectious disease spread by the respiratory route, that’s going to stay in one country. We saw that very painfully with how COVID spread throughout the world and has already resulted in close to seven million deaths, and that’s probably a gross underestimate.

It’s hard to give a fair answer when you have aviruses like this, and you are going to die. But the global community, including the United States, certainly could have done better. The one success story has been the rapid development and deployment of vaccines. The public-health response has not been successful. Take this country as an example. Over the decades, we have let our public-health system atrophy Not getting information accessible in real time, not replacing people who leave and not keeping equipment up to date are all ways in which this has been done. We’ve had to go to other countries to get real-time information: the UK, Israel, South Africa. The CDC requires the states to participate in the response in contrast with the system of reporting where the states do not have to. That really has got to change.

The Good, the Bad, and the Ugly: What do you think about public service and public health? How do you respond to misinformation and how to stop it?

I don’t pay attention and I don’t feel I need to respond. I don’t write on social media. I don’t have a social media account. I don’t bother with a lot of the stuff because it is just a cesspool of misinformation.

Of course it is at risk. I often have federal agents with me. That kind of stirs up a lot of hate in people that have no idea why they dislike someone, and that is because someone like that is on social media.

I would encourage them not to be deterred, because the satisfaction and the degree of contribution you can make to society by getting into public service and public health is immeasurable. It is truly extraordinary. It takes the bad stuff and makes it better. Attacks on public-health officials are unfortunate. The accomplishments you can make in the field are wonderful. And it certainly supersedes all that other stuff.

The impact of COVID-19 on vaccine use during the first year of the pandemic: a study by Omer, Omer and Omer

The first year of the Pandemic had a hit on children’s vaccinations. A team of mathematicians combed through data from various sources to estimate how many vaccine missed in 2020 will be caused by COVID-19. Some parts of Africa and Asia saw by far the sharpest drop in rates, but high-income countries in other regions also experienced dips at the start of the pandemic.

The risks of allowing these infections to flourish are clear. Between April and October there was a huge Measles outbreak in Zimbabwe, which claimed the lives of more than 750 children. And poliovirus has recently re-emerged in the United States after decades of successful elimination, prompting a state of emergency in New York.

There were many targeted vaccine campaigns for children that were stopped due to the phrenology. A study conducted by the WHO found that by May 2020, almost all the vaccine campaigns were either delayed or canceled.

It was just weeks ago that the organization declared COVID-19 to be a pandemic. O’Brien said that it shut things down. This absolute plummet in April, May and June of 2020 is compared to how many doses were given in the same month the previous year.

Much of this early impact was directly attributable to the strong measures taken to contain the spread of the SARS-CoV-2 virus, with many jurisdictions limiting travel, closing schools and restricting access to non-urgent medical care. Health-care providers couldn’t always provide all of the care they needed. Resources and expertise were diverted from health care sectors, including immunization systems. Even when there were no formal impediments to scheduling a visit to a health-care provider, social and psychological factors came into play that further undermined timely vaccination. The fear of even having contact with the health-care services was created by carbon dioxide.

The extent to which concerns about COVID-19 shots are fuelling hesitancy around other vaccines remains unclear. Some who study vaccine use are worried about it. It will be awhile until we have the data, but I would not be surprised to see a lot of drops in vaccine use. Omer’s research is already picking up some early indications of reduced uptake for the tetanus, diphtheria and pertussis vaccine among people in the United States who are pregnant. Even though these findings are preliminary, he is worried that they are just the tip of a larger problem.

The chance that this distrust will spread globally is still present. According to an anthropologist at the London School of Hygiene and Tropical Medicine, there is a globally coordinated network of people who are against vaccinations on social networks. The vaccine hesitancy is most prevalent in wealthier communities that have the time and money to research information on the internet. “TikTok is one of the more dangerous platforms that I have seen,” she says. A lot of these things are happening there. The conversation in poor communities is driven by radio, religious leaders, and poster campaigns.

The erosion of confidence in once-trusted authorities is part of the problem. But this can arise for a range of reasons — from bad-faith political arguments in Western nations to the long delay in providing COVID-19 vaccines to the world’s poorest countries. Africa might have lost a lot of trust from the global health community. We have failed them, and that is not going to be forgotten.

The day of December 9, 2022, when Gabe Marcotti and I were wrapping up a Zoom call, remember how my friend Gabriele was trying to reach me

It was the end of the workday on Friday, Dec. 9, 2022. I was wrapping up a Zoom call when my phone started to vibrate with calls, text messages and emails. Gabriele Marcotti, an ESPN journalist, was trying to reach me from Qatar, where he was covering the World Cup alongside my husband, Grant Wahl.

Gabriele’s an old friend. He was at a wedding over 20 years ago. He told me on the phone that Grant collapsed in the stadium press box at the end of the Argentina-Netherlands match. He was told that bystanders had begun cardiopulmonary defibrilation on Grant. I gasped, barely forming the words to ask, “Did he have a pulse?” Gabriele didn’t know. Grant was taken to a hospital by ambulance. It wasn’t until over an hour later that I tracked down a doctor in the emergency department for an update. Grant had passed away.

I knew that disinformation purveyors would blame Grant’s death on Covid vaccines, and I knew what tactics they would use to do so. I also knew that debunking what these people believe head-on in public risks giving them the attention they crave and invites further trolling. I have dealt with many similar situations as an infectious disease specialist and epidemiologist or while serving on the Covid Advisory Board. This was my Grant, and I needed to know what had happened to him. I knew I had to share it with the rest of the world.