[This is Part IV of a four-part series about COVID vaccines, starting with Part I].
We have three vaccines that appear to be effective and safe. To date, the public discourse has been about getting to a vaccine. The results are impressive, brilliant, even Olympic.
The remaining work is not glamorous. The people involved aren’t inventing new science or commanding nature to obey their orders. They have more in common with your neighbors, teacher Debra Smith and carpenter Tony Jones, than with esteemed personalities such as Dr. Debra Birx and Dr. Tony Fauci. There won’t be daily televised briefings about delivering 27 doses to your doctor and 113 to your pharmacy. Success will not be reported; any stumble will be the subject of nightly news for months. But the job will get done in the Western World.
There are people who will refuse to be vaccinated. That won’t matter much until we’ve sorted through those who want to be vaccinated. Different people will have different ideas about who should get the first vaccines. PharmDs will follow a practitioner’s orders, or health department edicts. Practitioners are likely to make their own decisions based on individual patients.
There’s great news. The scientists have finally decided to follow the science. Data have always shown that young children aren’t immune to COVID19, they just experience much milder symptoms, rarely need hospitalizations and almost never die. And, children under eight are rarely contagious. Dr. Fauci announced that there was no reason to keep elementary schools closed, and little reason to close middle schools and high schools. Teachers will be at risk from one another, but largely not at all from students. Masks, social distancing and frequent hand-washing should suffice.
This will free up parents to get a sanity break, otherwise known as going to work. Data appear to show that children of elementary school age are being deprived of socializing and developing interpersonal skills, and that all K-12 students are on average falling significantly behind in mathematics and reading. According to a JAMA (Journal of the American Medical Association) Pediatrics study of 135,000 patients, seven percent of K-12 students were infected, and hospitalization rates were about 1.9%, concentrated in children with compromised immune systems. Case fatality rate is near zero.
Yes, a few children get sick and some actually die. That is tragic. So is using those statistics to justify closing down schools, increasing childhood suicidal ideation and driving more people into poverty.
Other good news: The US Army, the world’s best logistics organization, has been planning, building capability and testing distribution throughout the U.S. Several other militaries are likely to be doing the same, including Australia, Japan, the UK, Germany, Netherlands, Denmark and a few others.
Should vaccines be mandatory? For practitioners and caregivers, I’ll agree, so long as the individual has a choice of vaccines and timing, and an opportunity to explain her reluctance. Not only should they go first, but others who work in hospitals, clinics and physicians’ offices should be vaccinated quickly if they have contact with patients or with samples.
Some populations will be difficult to reach in the Western World. Most of Alaska and Canada is largely empty. A few cases, such as Falkland Islands/Malvinas, are difficult to reach in stormy weather. Archipelagos with hundreds of inhabited islands will be a tough slog,
In most of the world, expensive super-cooling freezers do not exist, therefore PFZ is unlikely to be used. Freezers to -4 Fahrenheit are much more common, but are not universal even in relatively prosperous India. ATZ is likely to be the best choice.
My wife (69) and I (72) prefer not to use ATZ, since it uses a common cold virus to deliver the vaccine against another common cold virus. It was learned in the 1990s that communal sleeping arrangements, such as barracks for soldiers, are breeding grounds for adenovirus. The older one is, the more likely it is that existing antibodies will kill the carrier virus before it can penetrate a cell. Men are much more likely to have adenovirus antibodies than women.
WARNING: All statements hereafter are personal opinion.
Both sub-Saharan Africa and South America are special cases. Ports are few and quite inefficient compared to the West. Transport via rail or truck can be perilous, with home-grown guerillas and pillaging warlords preventing deliveries. Central Asia is largely screwed. In Africa, I expect Egypt, Morocco, coastal Nigeria and South Africa to do well. In South America I expect Argentina, Brazil and Chile to do relatively well, at least in major cities.
If you have ever flown commercially, you have heard the safety briefing: Put on your own oxygen mask first before taking care of your children. The kids will survive 15-20 seconds without oxygen, but if their parent dies, they probably won’t survive. The West is the only hope for the rest of the world, because that is where the critical resources are. It is blatantly unfair, but the West has to save itself first, then focus on saving the rest of the world.
There is at least one other vaccine available, probably several, from China. There is an agreement in place with Ali Baba’s Cainiao logistics subsidiary and Ethiopian Airways to ship vaccine to African and Middle Eastern countries, including cold-chain shipping. Given an option, I will elect Western quality control over that of China, but that may be simple bias. I have no reason to believe that a vaccine from China will be harmful.
A gentle reminder: I am not an expert in anything relating to vaccines or their logistics. I know more than most about vaccines, healthcare, logistics, conflict zones, policies of national governments and another dozen fields that touch on getting a vaccine from concept to syringe. I have no doubt some of what I have written will be proved wrong; nevertheless, it is offered in good faith. Please be patient and be kind to one another. In that way, everyone contributes.
