Vaccine Challenges

To Members of the Baylor College of Medicine Community:

I am certainly glad we put 2020 behind us (thinly veiled sarcasm intended). What a year this has been so far. Today, I want to review our COVID-19 numbers, and spend some time discussing broad dynamics around vaccinations, building on my comments from last week.

Sadly, my review of our viral numbers in Houston can be brief, as it is almost identical to last week – all numbers are creeping steadily upward. Nationally, on Jan. 7 we achieved a new peak at a 4,011 deaths in a single day – about one death every 20 seconds. In the Houston metropolitan area, daily new cases are at an all-time high, averaging 3,661 new infections per day, compared to 373 in September and 2,366 at the peak of the July surge. Hospitalization rates and hospital census, which lag new cases, are approaching July surge peaks. We do not know when this will turn around, but it will be driven by our viral avoidance behaviors – please continue to mask, distance, avoid indoor aggregation, and stay away from others if you have symptoms.

Vaccines are our hope to end this, but the end seems far off, and many are rightly questioning the pace of vaccine administration. The logistical and operational challenges around getting hundreds of millions of doses of vaccine into arms are daunting, but will be overcome. A few opinions:

• We are not doing as badly as you might think. The New York Times has aggregated vaccine data from a variety of sources in an accessible format. Based on those data, as of Jan. 11, almost 25.5 million vaccine doses have been distributed nationwide, and close to 9 million doses administered, a usage rate of 35.3%. The administration rate of Texas is at 44%, above the national average. Texas has the highest administration rate of the top 15 most populous states. These numbers are probably slightly low, as there is a data-reporting lag. Good, but not good enough.
• We need to stabilize/clarify the national vaccine supply chain. The Houston region is currently in the middle of our fifth week of vaccinations. When you look at the allocation of first doses, all provider sites were allocated a total of 88,300 doses during the second week. This allotment has steadily decreased since that time, with an allocation of only 30,625 doses this week. Most of those being sent to three “vaccination hubs.” The variability of supply is not entirely in control of the state – they are allocating what they have been given. However, the choppy and unpredictable nature of the supply chain makes it very difficult for providers to build efficient distribution efforts. Predictable supply leads to consistent processes. Consistency promotes efficiency and reduce errors. Unpredictable supply leads to confusing messages to patients (For example: Sorry – we need to cancel your vaccination appointment because we have no vaccine. We will put you on a wait list, and here are some other resources you can try).
• Community health problems demand community driven solutions. New York City is different from Des Moines. Houston is different from Odessa. Variability of many local factors –population demographics and socioeconomic status, strength of medical and public health infrastructure and availability of public transportation to name a few – means part of our solution must be local. In the ideal world, regional civic leadership would come together, clarify the problem and propose solutions. How large is our total population, and how many need to be vaccinated to achieve herd immunity? By when? If we set a goal of herd immunity by the summer or fall, it is a relatively simple calculation to figure out how many people need to be vaccinated per day. Once the scope of the problem is defined, we can solve the equation. What are our vaccinating sites, and what is their daily capacity? Health systems and physicians will play a role – they have access to at-risk patients, and the patient trust to navigate vaccine hesitancy issues. Commercial pharmacies bring geographically dispersed sites of care with staff and infrastructure already designed to administer vaccinations. Health departments will play an important role, especially in reaching at-risk population enclaves – ethnic and socioeconomic groups that will have unique barriers to vaccination. Large hub sites will have a role administer high volumes of vaccine. The solution will be multifactorial.
• Avoid seeking villains or magical solutions. Like a Disney princess movie, our pandemic experience always seems to devolve into identifying a villain, or seeking a magical solution. Villains: Those cold-hearted executives want to keep their businesses open, and could not care less about the health of people. Those feckless healthcare providers want to shut down our economy indefinitely, and do not understand the impact they are having on the livelihoods of everyday working people. Magical Solutions: Masks, lockdowns, hydroxychloroquine, wide-spread testing, seasonal change in weather (the list goes on).

We have an opportunity to get this one final and critically important thing right. As we solve our vaccination problem, let us start by refusing to waste energy identifying villains. Throughout the pandemic, I have had the privilege of interacting with hundreds of people – academics; business and educational leaders; local, state and federal politicians from both sides of the political spectrum. I have not agreed with all the opinions I have heard expressed, but I can honestly say I have not met a single person – not a single one – who had ill intent, or who was not trying to do their best for people. Let us similarly avoid the temptation to gravitate towards magical solutions. There is no silver-bullet here. No one right answer. No perfect structure.

What is needed is not villainy nor magic, but collaboration and hard work. We have done many great things as a region, a state, and a nation, and I am confident we can rise to this challenge as well.

Stay well.

James T. McDeavitt, M.D.

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