Jen Ezpeleta

Dr. Pissed Off: Vaccinations

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The who, what, when, where and why I’m pissed off about the vaccines

As word spreads of the pandemic worsening, nearly everyone on The Strand in Hermosa Beach is wearing a mask. Photo by JP Cordero

by Dr. Pissed off

Read to the end if you want to know why I am “pissed off.”

First, am I going to be vaccinated when offered? YES. 

Should you? Yes

Now, let me share some thoughts regarding the COVID-19 vaccines: 

We now have two and are anticipating more. This is a result of parallel efforts. Think Pfizer, Moderna, AstraZeneca, Johnson and Johnson. This is due to the federal government wisely investing dollars into vaccine development. However, nothing comes without conditions, which is why Pfizer, whose vaccine was the first to be authorized for use, did not accept federal support for vaccine development.

These vaccines have raced through the developmental stage to deployment in a thankfully record time. This is not solely a result of “Operation Warp Speed,” but rather as part of an effort that began more than a decade ago with the recognition of a biological (respiratory virus pandemic) threat, and basic science efforts to meet the perceived threat by the Bush administration.

“Which vaccine should I take?” As if there will be a choice for several months. We are currently in a time of inadequate supply of vaccines, of uncertain delivery and of urgent need to mitigate the pandemic. We will enter a time of oversupply. Oversupply may translate to choice. But when, who knows? 

Also, it is likely one vaccine will not fit all. Will one vaccine be the most effective in the elderly, the young, the pregnant, those with underlying medical conditions? Will the virus constantly mutate in a way, like influenza, that a yearly vaccination will be necessary. Or will it be like mumps and measles, where one vaccine is good for years? These questions cannot be answered during clinical trials but may be answered during widespread deployment. Think the flu vaccine and the difference in dosing and vaccine types for 65 and older, versus children. Time and experience will refine vaccine recommendations as to type, timing, dose. 

When will I get my vaccination?

 

Not sure, but hopefully soon. The first vaccinations are going to nursing home residents and their caretakers, frontline healthcare workers (still waiting for a precise definition of this one) and government officials (keep an eye on your TV). I suspect that the military is somewhere in this group. What do all these people have in common, besides high risk? They are easy to locate and thus vaccinate. What about everyone else? Would be nice to have a fully worked out plan, yesterday. I have no idea how the invitations to vaccinate will be delivered.

“What is the risk of getting vaccinated?”

The current vaccines are being deployed under Emergency Use Authorizations (EUAs), which means they have been deemed safe and effective based on clinical trials that involved tens of thousands of vaccinated people. We are now expanding that to millions, tens of millions and finally hundreds of millions domestically and internationally. Think making chocolate chip cookies for your family during the pandemic to acclaim, leading to making cookies for friends, again to acclaim, and now selling your cookies to anyone who wants them. What could go wrong? Who would have thought that one of your critical ingredients causes an allergic reaction in 0.1% of the population? (0.1% of 10 is 0.01 people; of 100 is 0.1 person; of 1,000 is 1 person; of 10,000 is 10 people and a mention in the local media; of 100,000 is 100 people and a visit from the Department of Public Health, you get the idea.) So, use math to inform your own thoughts about taking a vaccine where 30,000 to 40,000 people were involved in clinical trials and now the vaccine is going to the majority of the U.S.’s 330 million people, or the world’s 7.8 billion.

A comment on “us vs them,” by which I mean our family versus other families, our community versus other communities, our state versus other states, our country versus other countries, old versus young, blue versus red, nice versus mean, rich versus poor, employed versus unemployed in a time of limited resources. Let us start with the easiest in my opinion, which is restricting vaccine availability to the U.S. before the rest of the world by U.S. companies, or those vaccine producing companies that received federal funding. I will save the moral argument for another time — actually it is one I hope not to have to put in print, believing it to be obvious. 

Why I am “pissed off”

 

I am pissed off because we still do not know the full details of vaccine distribution. The CDC just came out Sunday with details regarding the hierarchy of vaccinations. Why has there not been a public dialogue? The pandemic began a year ago. The pattern of infection and at-risk populations have been known for months. That we were going to have a vaccine someday was a given. Why are we still waiting to find out when each of us will have a vaccination? Why don’t we know how we are going to be informed?

I am pissed off that vaccine delivery to “low lying fruit,” such as nursing home inhabitants and health care workers was publicized early and clearly. How are the rest going to be vaccinated? Will they be notified through their health insurance? What about the uninsured? Through work? What about the unemployed? Through voter registration? What about the unregistered? Through some governmental list? What about those not on the list? If we need to vaccinate 70 percent to 80 percent to reach “herd immunity” then that means of everyone, not just those who can be found on some list or registry. Did I miss the public discussion on this topic? The fact that so many have asked me these and many more questions means that I am not alone.

I am pissed off because we do not speak enough of essential versus essentially working people and although there is overlap between the two groups, they are not the same. Will we discriminate between those who are able to work at home versus those who cannot? Is age truly the way to define vaccine delivery after we have decided who is “essential?” I am not arguing with age as a criterion for vaccination and I do understand the age-related severity of the pandemic morbidity and mortality. I am just frustrated by the blunt instrument used by our officials to make decisions that do not always make sense to me. Maybe better put, that blunt instruments allow for the avoidance of making and explaining decisions.

I am really pissed off by what I perceive as a lack of public discourse and cohesion from our elected officials regarding the approach to the pandemic. I am appalled at the current administration’s handling of the worst public health disaster in my lifetime. The current situation regarding the pandemic is, in my view, an indictment against our approach as a country and as individuals. ER

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