- A recent viewpoint article in JAMA outlines the spread of the Delta variant and reflects upon what policymakers can do to reduce its impact.
- The authors explain that although vaccines may not stop cases from emerging, they can prevent severe outcomes from the disease.
- They suggest policymakers develop “middle-of-the-road” vaccine mandates to encourage more people to get vaccinated.
The recent surge in COVID-19 Delta variant cases in the United States is mostly affecting unvaccinated populations.
The authors of the new article point out that U.S. states with more than 70% of their population vaccinated report lower numbers of vaccine breakthrough cases, hospitalizations, and deaths from COVID-19.
Given the high transmission rate of the Delta variant, reaching herd immunity and interrupting transmission may need more than 85% of the population to develop an immune response to the novel coronavirus, either from vaccines or prior infection.
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One study found that fewer people than needed to reach herd immunity would “definitely” take the vaccine in the U.S. and United Kingdom. It also discovered that recent exposure to misinformation, even among those previously supporting vaccines, can create vaccine hesitancy.
Widespread misinformation and politicization of COVID-19 vaccines have led to a large vaccine supply alongside a low vaccine demand in the U.S. Encouraging more people to get vaccinated is crucial for controlling the COVID-19 pandemic.
In a recent opinion article, researchers from Emory University in Atlanta, GA, the University of Michigan in Ann Arbor, and Yale School of Medicine in New Haven, CT, outline the spread of the Delta variant, its impact, and how health officials might keep it at bay.
The article appears in JAMA.
The Delta situation
Health officials first identified the Delta variant in India in December 2020. Experts then detected it in the U.S. in March 2021. It gained the classification of “variant of concern” by the SARS-CoV-2 Interagency Group, set up by the Department of Health and Human Services.
The new paper’s authors explain that the Delta variant is estimated to be 60% more transmissible than the previous Alpha variant and less responsive to treatments and vaccines. Its high transmissibility also means it has more opportunity to mutate into other variants as it continues to spread.
“Viruses mutate. It’s what they do. But they need a host to replicate and mutate — they don’t just mutate on their own,” bioethicist L. Syd M Johnson, Ph.D., of SUNY Upstate Medical University in Syracuse, NY, who was not involved in the paper, told Medical News Today, “The only way to stop new and more dangerous mutations of SARS-CoV-2 from developing is to stop transmission and infection.”
“The only way to do that is to vaccinate people against the virus, so that even if they [contract the infection], their immune systems can attack the virus before it has a chance to mutate.”
Although COVID-19 vaccines may be less effective at preventing infection with the Delta variant than other variants, they still offer protection against severe cases of the disease requiring hospitalization.
Some countries are nevertheless developing different policy recommendations to control the further spread of SARS-CoV-2. Germany, France, and Israel, for example, have announced plans for a booster vaccine.
Meanwhile, the Food and Drug Administration (FDA) now also recommends booster vaccines for immunocompromised individuals at least 28 days after their second dose.
Although booster vaccines may be necessary for immunocompromised individuals, Johnson argues countries with low vaccine supplies should have priority before countries offer booster shots to those already protected from severe COVID-19 outcomes.
“The Delta variant first emerged in India — that wasn’t just bad luck. The population of India wasn’t protected by vaccines,” said Johnson, “It is shortsighted of wealthy countries to allow the rest of the world to remain unvaccinated when they could do a lot more to ensure access to vaccines […] When so much of the world remains unvaccinated, how can we justify providing additional shots to Americans?”
“We can’t save ourselves by sacrificing the lives of others. We endanger ourselves because we’re willing to sacrifice others. This is the simple lesson of COVID-19 and the one we can’t seem to learn. It applies to us as individuals, as societies, as nations. You can’t protect yourself by sacrificing others. United we stand, divided we fall,” she added.
Look to Iceland
Vaccine demand in the U.S. has picked up in recent weeks alongside a surge in Delta variant cases. As vaccines may require 5–6 weeks to achieve full protection, this small uptick is unlikely to stop the spread of the Delta variant in the short term.
Widespread vaccination nevertheless seems to be the best way to prevent severe cases of COVID-19. Iceland is a good example of this, where 84% of the population aged 12 years and older is fully vaccinated against COVID-19.
While the country has seen an uptick in COVID-19 Delta variant cases, no one has died from the virus since May. This shows that, even without herd immunity, high levels of vaccinations can at least prevent hospitalizations and deaths.
Vaccine mandates
To encourage more people to get vaccines, the authors of the recent paper recommend vaccine mandates. These are nothing new and are already in place for healthcare workers, members of the military, and school children. Vaccination requirements for school children in the U.S. started in the 1850s for smallpox and now include vaccines for other diseases, such as hepatitis B and rotavirus.
However, the authors say policymakers should follow a “middle-of-the-road” approach. If it is too easy to opt out, they may not be effective. However, if it is impossible to obtain an exemption, people may find loopholes and avoid the requirements altogether.
“As the immunization efforts move on from the mass vaccination model, physicians and other healthcare professionals will be vital to increasing vaccine acceptance,” wrote the researchers in their paper, “Several decades of research on vaccine acceptance and hesitancy identify clinicians as the most trusted source of vaccine information.”
“This remains true for COVID-19 vaccines. Fortunately, there has been increased focus on evidence-based approaches for healthcare professionals to communicate about vaccines with patients. Until recently, this evidence has not been translated into skills-based training, but this too is occurring,” they added.
“With so many Americans refusing to be vaccinated, I don’t see how higher rates of vaccination are possible without mandates,” Johnson told MNT, “There are some who think mandates involve coercing individuals to be vaccinated against their will. That’s false.”
“People will retain their right to refuse vaccines, but with mandates in place, their options to be involved in public and social life — the benefits of living in a society — will be restricted […] Access to cruise ships, airplanes, concerts, malls, and public events is not a right, and there have always been limits on that access. This will be one more limit. Individuals will still be free to choose to refuse,” she continued.
“Any mandate must allow exemptions for those individuals who, for medical reasons, cannot be safely vaccinated. And until the vaccines are approved for children under 12, they also have to be exempt. But the rest of us have a moral obligation to help protect those who cannot be vaccinated by surrounding them with a firewall of vaccinated, masked people,” she said.
In their article, the authors conclude that vaccines are the only way forward to preserve healthcare infrastructure and the economy and contain the pandemic.
However, getting more people vaccinated can only happen when everyone, including government officials, clinicians, public health practitioners, and members of the community, strongly support them.
“Protecting public health and the public good requires endorsing and honoring the social contract — it requires that we as individuals do our part to protect others, promote the common good and act justly, creating the many benefits we receive from being part of a society,” said Johnson.
“Vaccine refusers violate the social contract. They are free riders who want the benefits without any of the inconvenience or work. When you have too many free riders — which is what we’re seeing now — the benefits cannot be sustained, and it endangers everyone,” she explained.
“Most of us will never be in situations where we can save a life, let alone save the world,” she said “This is your chance to do both, and all you have to do is get vaccinated.”
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