As COVID-19 cases continue to climb across the country—with some states seeing vertical rises—public health experts are once again emphatically imploring Americans to get the highly effective, safe COVID-19 vaccines that are readily available.

Despite an oversupply of vaccine doses, only about 49 percent of the country is fully vaccinated overall—and many states and areas have lower vaccination coverage still. Meanwhile, the hyper-transmissible delta coronavirus variant continues to blaze through unvaccinated communities. It now accounts for 83 percent of sequenced cases nationwide.

While cases are rising overall, they’re growing fastest in places with low vaccination rates. Louisiana, for instance, only has about 36 percent of its population fully vaccinated, and it is seeing one of the steepest rises. Daily new case counts now rival those seen in the winter surge. But about one in every five new cases in the country is in Florida. The state’s top hot spot is the area around Jacksonville, which has the highest rates of infection in the state. That area includes Baker county, which has only 20 percent of its population vaccinated. Arkansas, Missouri, Nevada, and Mississippi are also seeing sharp rises—all with relatively low vaccination coverage.

“We are yet at another pivotal moment in this pandemic, with cases rising again and some hospitals reaching their capacity,” Rochelle Walensky, director of the Centers for Disease Control and Prevention, said in a White House press briefing Thursday. “We need to come together as one nation, unified in our resolve to protect the health of ourselves, our children, our community, our country, and our future, with the tools we have available.”

Efficacy and breakthroughs

In the press briefing, Walensky and Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, reiterated all the reasons that everyone should get vaccinated and also tried to tamp down concern over so-called “breakthrough” infections.

“These vaccines are some of the most effective that we have in modern medicine,” Walensky said, referencing the high efficacy rates of the three vaccines available in the US. The two mRNA vaccines (Pfizer/BioNTech and Moderna’s vaccines) had efficacy rates above 90 percent in clinical trials. The Johnson & Johnson vaccine efficacy was a bit lower—72 percent in the US—but is still quite high.

Note, those numbers are very high, but not 100 percent, Fauci cautioned. “Infections after vaccination are expected,” he said, adding, “no vaccine is 100 percent effective.”

The primary goal of vaccines is to protect against severe disease and death—which all three vaccines do very well, even against the delta variant, Fauci emphasized. In a real-world study of people who had been vaccinated with the Pfizer/BioNTech vaccine, for instance, the full two doses were 96 percent effective at preventing hospitalization from infections with the delta variant. Similarly, the AstraZeneca vaccine—which is very similar in design to the Johnson & Johnson vaccine—was 92 percent effective against hospitalization from delta. In addition, preliminary laboratory studies have shown that all three vaccines can prompt neutralizing antibodies and durable cellular defenses that can thwart the delta variant and other concerning variants. Currently, 97 percent of people hospitalized with COVID-19 are unvaccinated, as are 99.5 percent of those dying of COVID-19.

Still, some vaccinated people will get infected after reaching a fully vaccinated state—that is, two weeks after getting either the second dose of an mRNA vaccine or the one dose of the Johnson & Johnson vaccine. Typically, these breakthrough infections have no symptoms or have relatively mild symptoms. It’s worth noting—as a piece published in Slate did yesterday—that relatively mild infections aren’t necessarily harmless; they can be quite unpleasant. But being laid out at home for a few days, feeling crummy with a fever and chills, is significantly better than a stay in the hospital while needing oxygen, or worse—landing in the intensive care unit, being on a ventilator, or even dying.

“Even though we are seeing infections after vaccination… the effectiveness against severe disease is still substantial,” Fauci said, “which is yet again another argument which all of us say continually: Get vaccinated.”

Booster confusion

In a back-and-forth with reporters, Fauci also shot down unwarranted concern that the Johnson & Johnson vaccine was not effective against the delta variant. The concern was largely driven by an article this week in The New York Times that focused on unpublished data looking only at antibody levels. The study (which has not been peer-reviewed) claimed that the Johnson & Johnson vaccine prompted lower levels of neutralizing antibodies against the delta variant, compared with neutralizing antibodies levels against other versions of the virus. The New York Times declared that the data suggests that the millions of people who received the one-and-done Johnson & Johnson shot now need a booster shot.

But experts were quick to push back. They noted that vaccines don’t prompt antibodies alone—they also elicit other critical cellular immune defenses to protect from infection and disease. Moreover, there is no clear level of neutralizing antibodies at which point a person is deemed unprotected. Lastly, other data has suggested that immune responses after the Johnson & Johnson vaccine are robust and sustained. In short, the study wasn’t looking at vaccine efficacy, and the data does not suggest the need for boosters.

In the press briefing Thursday, Fauci called the Johnson & Johnson vaccine “a very effective vaccine.”

“There is no reason to believe right now that people who have taken the J&J vaccine are in need of a booster dose of any sort,” he said. “There are no data to indicate that that is the case.”

The Times has since significantly altered the original story and its headline, though the paper did not note any of those changes. The headline no longer calls the vaccine “ineffective”; instead, the headline says it “may be less effective.” The top of the story has also been amended to note that the unpublished data may not reflect vaccine efficacy.

Vaccination push

In an effort to boost vaccination in the US, Fauci and Walensky reiterated Thursday that the totality of data so far suggests that the vaccines at hand are safe and highly effective against the pandemic coronavirus, even the delta variant. In terms of safety, the vaccines do often produce mild, short-lived side effects, such as pain around the injection site and possibly a day or so of feeling under the weather. But serious side effects are exceedingly rare. Though some unvaccinated people have said they are concerned about unidentified long-term side effects, historical data on vaccination indicates that if any side effects are going to arise, they tend to do so within six weeks of vaccination. Thus it’s unlikely that new side effects are suddenly going to become apparent.

Though breakthrough cases are always a concern with any vaccine, vaccinated people can continue to follow some health measures such as mask-wearing and avoiding crowds if they want to be cautious. Taking extra precautions may be worth considering for people in areas with low vaccination rates and high transmission amid the spread of the delta variant, Walensky added.

“If you are not vaccinated, please take the delta variant seriously,” Walensky pleaded. “This virus has no incentive to let up, and it remains in search of the next vulnerable person to infect. Please consider getting vaccinated, and take precautions until you do.”

For those who have recovered from COVID-19, Walensky noted that the CDC “strongly recommends” that they too get vaccinated. “It gives you longer-lasting and more robust protection with the breadth and depth of coverage needed to conquer the variants currently circulating in this country,” she said.

And Walensky urged those still hesitant to get vaccinated to closely examine what is behind their hesitation. “If you still have questions about the vaccines, we welcome them,” she said. “My request to you is this: Ask your questions. Talk to your healthcare provider. Talk to your pharmacist. Talk to your friends and neighbors who have gotten vaccinated and get your questions answered so that you feel comfortable and informed in making this critical decision.”

The point connects with another made recently in a heartbreaking article out of Alabama, in which a doctor working in a Birmingham hospital described caring for her unvaccinated COVID-19 patients on their death beds. The piece was moving for several reasons, including a heartbreaking description of how misinformation has plagued this pandemic. The article quoted a doctor as saying:

I try to be very non-judgmental when I’m getting a new COVID patient that’s unvaccinated, but I really just started asking them, “Why haven’t you gotten the vaccine?” And I’ll just ask it point-blank, in the least judgmental way possible. And most of them, they’re very honest, they give me answers. “I talked to this person, I saw this thing on Facebook, I got this email, I saw this on the news,” you know, these are all the reasons that I didn’t get vaccinated.

And the one question that I always ask them is, did you make an appointment with your primary care doctor and ask them for their opinion on whether or not you should receive the vaccine? And so far, nobody has answered yes to that question.

A recent poll by the American Medical Association found that more than 96 percent of practicing doctors have been fully vaccinated against COVID-19. And of those remaining, 45 percent said they plan to get vaccinated.

https://arstechnica.com/?p=1782437