Our mission to improve business is fueled by readers like you. To gain unlimited access to our journalism, Sign up today.
The success of the massive COVID-19 American vaccination program now underway depends on people getting two doses separated by three to four weeks. But a recent study suggests that many people may not get their second injection, which is necessary to build maximum immunity.
The research, published Dec. 14, focused on a vaccine to prevent the viral skin condition known as shingles. It turned out that one in four Medicare patients had not received their second dose within six months of their first dose.
Recipients of the two COVID-19 vaccines currently approved for use are more likely to complete their vaccinations than those in the study, for reasons including a greater perceived health risk if they don’t. But the authors of the new study warn that many of the same barriers will work: not just patient negligence, but poverty, age and isolation.
A host of incomplete vaccinations could make it more difficult to stop the coronavirus and end the pandemic that is spiraling out of control in most states. It could also lead to more deaths and hospitalizations than would otherwise be the case.
To make matters worse, the study found that follow-up vaccination rates for the shingles were much lower for certain groups. Only 58% of Hispanic patients, 61% of Black patients and 69% of Asian patients received a second dose. Meanwhile, only 64% of the low-income patients and 66% of the disabled patients returned for their second dose.
“This clearly has some troubling implications for the COVID vaccine,” said Juliette Cubanski, one of the study authors and deputy director for Medicare policy at KFF, formerly the Kaiser Family Foundation. “These groups are among the hardest hit in terms of serious illness and death from COVID.”
There are important differences between Shingrix, the shingles vaccine and the coronavirus vaccines. Most clearly, while shingles can be extremely painful and even debilitating, it is rarely life-threatening. And with the coronavirus in the news every day, patients will be less likely to simply forget their second dose.
Another factor indicating higher second dose rates for the COVID vaccines is timing. Patients could wait up to six months for their second dose of Shingrix, but both COVID vaccines currently being administered – one from Moderna and one from Pfizer-BioNTech – require a second injection in three to four weeks. According to Cubanski, the longer Shingrix delay has made it possible for patients to miss their follow-up admission.
But other factors that prevent patients from getting their full course of Shingrix will still be in effect when it comes to the COVID vaccines.
One of these is the complex and often unpredictable payments that are inseparable from the U.S. healthcare system. The Shingrix vaccine required a cost of ownership for each dose, which Cubanski said may have discouraged some people from getting a second one. In contrast, the coronavirus vaccine is not expected to require payment from US recipients, even for the 29 million Americans without health insurance. But Cubanski is concerned that people may not realize they can be immunized at no cost.
“People’s concerns about having to pay for something out of pocket can be a problem, even when there are no actual costs,” she says. “They may not realize that the vaccine is actually free.”
Transportation will likely be an issue too. Disabled Americans, low-income Americans, or rural residents, in particular, may struggle to reach a vaccination site not once, but twice. Rural areas have some of America’s lowest flu vaccination rates – as much as 25% in some cases – in part because of distance.
Finally, Cubanski is concerned that some coronavirus vaccine recipients will be discouraged from taking their second dose after an adverse reaction to the first. Although the reactions are uncommon, both Pfizer and Moderna vaccines can cause mild muscle pain, fatigue, or a low fever.
“These side effects are a sign that the vaccine is working, and not a sign that you are infected with the virus and now have the disease,” Cubanski says. “That is an important message to convey.”
In fact, it is medically impossible for the Pfizer or Moderna vaccines to transmit the virus behind COVID-19. While some vaccines use attenuated versions of the virus they protect against, the new COVID vaccines use a new technique to activate immunity without using viral material.
Meanwhile, in the US, there is no system of any kind for ensuring that patients receive their second dose. That responsibility rests with the individual recipients and the different healthcare providers who administer the vaccine.
A major vaccination site is expected to be outpatient clinics, including Walgreens and CVS. Walgreens says it will use a variety of techniques to ensure follow-up doses, including scheduling an appointment for a second dose when the first is administered, and sending reminders to patients via email, email, and voice mail.
As with most aspects of the coronavirus pandemic, these challenges have consequences beyond the person who misses his or her second dose. Research data shows that a single dose of the Moderna or Pfizer vaccines provides significant protection against the coronavirus, but a second dose makes that protection much higher and likely to last longer. If enough people miss their second vaccination dose, it can take significantly longer to reach the population-wide immunity level needed to stop the virus’ circulation and end the pandemic.
Lake healthcare and Big Pharma coverage from The Washington City Times:
- The rollout of the COVID-19 vaccine is dangerously flawed. Science and data can solve it
- Powered by COVID-19, U.S. deaths will exceed 3 million in deadliest year on record
- Recipients of the COVID vaccine can still be contagious. When will we know for sure?
- COVID vaccine allergies are a cause for concern. Most Americans should still get their photos
- Pfizer, Trump, and Biden: A Twisted Triangle Complicating COVID-19’s Relief