Category: Covid-19 Vaccine

As the race for a safe and effective COVID-19 vaccine continues, three candidates have become frontrunners: one from Pfizer and BioNTech, another from Moderna, and another from AstraZeneca and Oxford University.

But each of these candidates has important differences, with widespread implications for their distribution and use. Take a look at Business Insider's chart below to compare.

Cost

AstraZeneca's vaccine is significantly cheaper than Moderna's and Pfizer's, AP reported. Unlike its two competitors, AstraZeneca is the only one of the three to pledge not to make a profit from the vaccine during the pandemic. Pfizer's vaccine clocks in at about $20 per dose, Moderna's at $15 to $25 a dose, and AstraZeneca's jab about $4, based on each company's contracts with the US government.

Read more: Pharmacies, doctor's offices and hospitals are gearing up to give coronavirus vaccines to millions of Americans. Here's how they're preparing and how much they stand to profit along the way.

Distribution

The potential success of the AstraZeneca vaccine is especially important for nations outside of the US and the UK. Of the three candidates, AstraZeneca is the only one to have already struck a deal with COVAX, a global initiative to distribute COVID-19 vaccines equitably, including to low-income nations, according to data from the Duke Global Health Innovation Center.

"The Oxford/AstraZeneca vaccine is really good news for the rest of the world," said Andrea Taylor, assistant director of programs at Duke Global Health Innovation Center, according to CNN.

COVAX has placed an order for 300 million doses from AstraZeneca. Meanwhile, Pfizer-BioNTech isn't part of the COVAX initiative, and Moderna is part of the COVAX project, but has not "quite aligned with them on how many doses and when those doses would be available," according to Axios.

Storage

Of the three, Pfizer's vaccine will be the most difficult to store and distribute. The vaccine must be kept at -94 degrees Fahrenheit for storage, and can be kept in a special dry ice case for up to 30 days, Pfizer says. To make matters more difficult, dry ice is already in high demand, according to WBUR.

Meanwhile, Moderna's vaccine can be kept in a standard freezer, at -4 degrees Fahrenheit long term, and can survive in a standard refrigerator for about a month. Of the three, AstraZeneca's vaccine candidate is the hardiest, since it's able to be refrigerated for up to 6 months, according to AstraZeneca.

Efficacy & Approval

While AstraZeneca's vaccine has obvious advantages, due to its cost and ease of distribution, the vaccine has also come under fire for concerns about the way it reported results from its trial. After announcing that its vaccine was 62% effective for a regimen of 2 full doses a month apart and 90% effective for a regimen of a half dose followed by a full dose, questions began to be raised about AstraZeneca's data and disclosures, according to The New York Times.

AstraZeneca's vaccine likely won't be authorized in the US until after shots from Pfizer and Moderna, because the company's late-stage trial is still ongoing here. Pfizer was the first of the three to file for FDA emergency use authorization, followed by Moderna. Pfizer's vaccine was approved for emergency use in the UKon Wednesday.

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How the top 3 COVID-19 vaccines compare, in one chart - Business Insider - Business Insider

The digital experience cant compare with watching the sun rise from a small boat. Still, we try hard to stay in touch, to support each other. Added to all we have shared for decades is now loss. Loss of physical closeness. Loss of freedoms. Loss of jobs, and even life. From our homes in San Francisco, Nashville, Atlanta, New Bedford and Philadelphia, we keep each other uplifted. We know we are all more fortunate than most, but we also know that we need each other to stay afloat.

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Why I tell my patients I will get the COVID-19 vaccine | Expert Opinion - The Philadelphia Inquirer

CHICAGO Illinois officials said they are prepared to launch the states COVID-19 vaccine distribution plan Monday, as Pfizers vaccine nears emergency use approval from the FDA.

We are likely to see hundreds of thousands of doses coming to Illinois during the month of December, Governor JB Pritzker said Monday.

According to the Illinois Department of Public Health, the state would receive an initial 109,000 doses of the vaccine as early as next week if it is approved.

The first allocation of the vaccine will go to the 50 counties with the highest numbers of death per capita. In the Chicago area that includes Cook, Lake, DuPage, Kane and Will counties.

Under phase one of the distribution plan, front-line health care workers and long-term care residents will be the first to be innoculated.

But the first shipment of 109,000 doses are a fraction of what the state needs. Illinois has more than 760,000 front-line health care workers and long-term care residents.

There are so many moving parts, and no matter what plan we put forth there are going to be holes poked in it and there is no perfect plan, IDPH Director Dr. Ngozi Ezike said.

Starting week two, residents of long term care facilities will receive the remaining 23,000 doses.

The FDA is also considering emergency use approval of Modernas COVID-19 vaccine, which Illinois can potentially have access to the week of Christmas if approved.

The first hospitals to receive vaccine doses include Northshore Highland Park Hospital, Loyola University Medical Center in Maywood, Christ Medical Center in Oak Lawn and Sherman Hospital in Elgin.

The City of Chicago will operate its own distribution plan with 23,000 initial doses of the vaccine.

Chicago remains under a stay-at-home advisory, which Mayor Lori Lightfoot said she believes is making a difference Sunday.

Were still nervously watching the numbers to see if theres going to be a post-Thanksgiving surge, Lightfoot said.

OHare Airport is playing a big role as well, as both United and American Airlines are transporting vaccines stored in ultra-cold freezer containers.

Lightfoot said first responders and essential workers will be vaccinated next in phase two of the distribution plan.

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Officials say theyre ready to distribute COVID-19 vaccine in Illinois if its approved this week - WGN TV Chicago

ELMIRA, N.Y. (WETM) A coronavirus vaccine is expected to arrive in New York on December 15th according to Gov. Andrew M. Cuomo.

Pfizer and Moderna are still pending approval by the Food and Drug Administration (FDA) and have submitted applications for an Emergency Use Authorization (EUA).

Questions are arising about if one gets a coronavirus vaccine, what would be the side effects of the vaccine, and would this ease tensions of people wanting to get the vaccine, but maybe too afraid.

Released statements from the studies from that vaccine trial have shown that most people are getting on a side effect of say injections site soreness so thats the most common side effect that theyre seeing. Other Side effects may include things like headache, fever, chills, and some ache in the joints and the muscles, said Dr. Justin Nistico, an Infectious Disease Physician at Arnot Health.

The Centers for Disease Control and Prevention (CDC) held a meeting on December 1st, confirming elderly residents of long care facilities and healthcare workers would be amongst the first to receive a vaccine.

There have been quite a few individuals that have reported things like their arm hurting after they got the injection. Sometimes what the typical treatments are would be giving medications that can lower your fever, and those medications are can be helpful if you get a fever from getting the vaccination, said Dr. Nistico.

Experts are predicting most people wont have access until late spring.

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What Will Be The Side Effects Of The COVID-19 Vaccine? Heres What Doctors Are Telling Us - WETM - MyTwinTiers.com

With more than 100 vaccines currently in various trial phases and some reaching the pre-approval stage or being authorized for emergency use, accurate science reporting has never been more important. Journalists play a vital role in informing the public on science, specifically vaccine, developments, in an unprecedented period of scientific publishing.

The situation is constantly evolving but there are some general guidelines that should be followed whenever possible.

Dont just report the topline

Read the full study or report before publishing an article about it. The findings in a studys summary may not be truly indicative of the full studys findings. Medical journals are reviewing and publishing reports faster than they normally would, so knowing how to read them critically is crucial to accurately reporting their findings.

Dont report based only on a press release. Always read the full study or research report.

Dont trust data automatically

Be aware of and willing to question stakeholders and data collection methodology. Request the raw data where possible and always include the details of the research methods in your reporting.

Use trusted and reliable sources

Reporting is only as good as its sources. Be sure to use expert and knowledgeable sources to inform your stories on COVID-19 and vaccines.

When reporting on a new vaccine or study, consult your countrys science media centre for expert evaluations of the latest developments.

State the source

When reporting on scientific studies, reports, case numbers and vaccines, name the source of the information to show credibility and allow readers to search for more information on the topic.

Define the terms

Although certain scientific words may be used frequently in reporting on COVID-19 and vaccines, it is important to define scientific terms in every article, or link to a glossary of terms that will allow the reader to educate themselves.

Use clear language

Most readers will not be familiar with scientific language. Some terms can be defined within the article but make an effort to frame explanations in simplified terms so that readers across all levels of comprehension will understand.

Explain the stage

Some research may show exciting results based only on a preliminary set of data. Check whether a report or study has been peer reviewed and make sure your writing states which stage it is in. Early-stage research should not be reported as equal to a peer-reviewed paper from a science journal.

Report the numbers

There are dozens of vaccines in various stages of development at any given time. When reporting on a vaccine or study, its important to specify the size, numbers tested, and time period of the trial.

Disclose the side effects

No vaccine in history has progressed through clinical trials and pre-approval as fast as the recent COVID-19 vaccines. Clearly stating the possible side effects of any given vaccine will help inform the public and ease their reservations as will reporting on any side effects experienced by participants in a vaccine trial.

Use appropriate imagery

Choice of illustration in articles about vaccines is important. Vaccines are not something to fear, so avoid such visuals as crying babies, anxious-looking patients and oversized needles. Ensure that illustrations represent all readers by showing a range of people working on, administering and receiving vaccines.

Dont forget demographics

Not every vaccine will be equally effective across all populations. When reporting on the efficacy of a vaccine in clinical trials, note the demographics of the participants in the trial. This information can usually be found in Table 1 of reported studies.

Remind everyone of the benefits of vaccines

Reporting on potentially effective COVID-19 vaccines is vital for informing those who already plan to be vaccinated, but with misinformation rife during the pandemic, dont forget to inform readers of the importance of all vaccines.

Tackle vaccine hesitancy by reporting facts and figures on vaccine efficacy in ending epidemics throughout history.

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Responsible media reporting on COVID-19 vaccines - World Health Organization

The man who is leading Operation Warp Speed said there is one thing that keeps him up at night: the possibility of making coronavirus vaccines available to people who then don't bother to get them.

"We get vaccines to the American people and they don't take them," Gen. Gus Perna told CBS "60 Minutes" of his worst nightmare in November. "Shame on us. 'Hey, I was already sick, I don't need it.' Shame on us. 'Hey, I don't believe in vaccines.' Shame on us."

Pfizer and Moderna have submitted requests to the U.S. Food and Drug Administration for emergency use authorization of their COVID-19 vaccines. The FDA is set to review Pfizer's request on Dec. 10 and Moderna's on Dec. 17. Both companies have announced vaccine efficacy rates of more than 90%.

The government's Operation Warp Speed has said there will be "shots in arms" within 24 hours of authorization.

But a Gallup Panel survey, which was conducted in late October before Pfizer and Moderna released results about the likely effectiveness of their vaccines, found that 58% of Americans would be willing to get a COVID-19 vaccine, a decrease from July, when 66% said they would.

Secretary of Health and Human Services Alex Azar pointed to the fact that the United Kingdom's regulatory agency recently approved the Pfizer vaccine.

"While the FDA completes its review, the approval of another independent regulatory body should give Americans additional confidence in the quality of such a vaccine," Azar said Wednesday.

Meanwhile, Facebook announced Wednesday it would take steps to combat misinformation about COVID-19 vaccines in order to keep users safe and informed. "For example, we will remove false claims that COVID-19 vaccines contain microchips, or anything else that isn't on the official vaccine ingredient list," Head of Health Kang-Xing Jin wrote in a statement. "We will also remove conspiracy theories about COVID-19 vaccines that we know today are false: like specific populations are being used without their consent to test the vaccine's safety."

The Centers for Disease Control and Prevention (CDC) also announced a new strategy to "educate and promote vaccination," a CDC spokesperson told ABC News. In the vein of "I Voted" stickers, the agency plans to give health providers a template for buttons and stickers people can wear to declare they have been "vaccinated for COVID-19."

As of Thursday, there were more than 14 million confirmed coronavirus cases and 275,000 deaths from COVID-19 in the United States.

A subject receives a shot in the first-stage safety study clinical trial of a potential vaccine by Moderna for COVID-19, the disease caused by the new coronavirus, at the Kaiser Permanente Washington Health Research Institute in Seattle, March 16, 2020.

ABC News spoke to three experts about the American public's confidence in getting the vaccine and what they think needs to be done to ensure people get vaccinated once it's available to them.

Dr. Susan Bailey, president of the American Medical Association: We have been in this pandemic for less than a year, and development of COVID-19 vaccines has been on an accelerated timeline. And it's natural for people to be suspicious of things they don't know about.

Jessica Malaty Rivera, M.S., infectious disease researcher and science communication lead at the COVID Tracking Project: The science community has been bracing itself for hesitancy for many months. It's an epidemic of misinformation. From the beginning, we had a lot of bad actors creating misinformation about the vaccine and conspiracy theories.

Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention: The biggest hurdle we have to overcome is the concern that the systems we have to make sure that vaccines are appropriately tested for safety and effectiveness have been politicized. Politics has interfered with science and public health too many times during this pandemic. That has led to a deep erosion of trust -- particularly in communities of color that have been hit hardest by this virus.

Malaty Rivera: We are seeing people in health care-adjacent roles express their distrust. I don't think they realize the ripple effect that can have. Their biases and misinformation can impact everyone. It's a matter of making sure of making these people in positions of leadership and leadership in science don't discredit the process that we look for.What should make them come around is the data. The only thing that should be informing the process -- its all about the safety and efficacy of the data.

Besser: As a pediatrician, I have long relied on the recommendations of FDA and CDC to ensure my patients are properly vaccinated. The FDA and CDC have established independent advisory commissions -- which include some of the world's leading medical and public health experts -- to ensure that science and public health informs recommendations on which vaccines should be approved and which populations should receive them. I trust those institutions. If they're free to operate with complete transparency and without political pressure, I will have full confidence recommending approved vaccines to my patients and getting vaccinated myself.

Trucks are loaded at a factory of multinational pharmaceutical company Pfizer, in Puurs, Belgium, Dec. 3, 2020.

Bailey: It's a catchy title, and my concern about this has been that it has the potential to imply that speed has been more important than safety or efficacy. But that couldn't be further from the truth.

Malaty Rivera: People think the vaccine was rushed -- it wasn't rushed. It was an incredible collaborative process on a global level, fully financed, no red tape, no bureaucracy, and we had a running start. We had been researching coronaviruses since SARS, and we hit the ground running.

The idea of"warp speed" makes people think they are cutting corners. That is the opposite of what has happened. Safety has not been compromised in this process.

Besser: It is true that the follow-up period in these vaccine trials has been short. For some people, that will make them uncomfortable. That is why it is imperative that the FDA's advisory committee -- a vital part of this process -- be given the time and space needed for its medical and public health experts to do a thorough evaluation of the data being submitted. If they approve these vaccines for emergency use, they must ensure that there is continued follow-up of study participants so that any longer-term side effects are detected.

Besser: The CDC has some of the world's leading scientists and public health experts. If we let them lead and then follow their guidance and recommendations without political interference, I believe we can clear the way for improved trust in the process and any approved vaccines. The science that informs our pandemic response is not controversial. Vaccines are a stunning and effective advancement in the history of human health.

Bailey: I think it's an all-hands-on-deck project. We need culturally appropriate education for different parts of our population. We need positive messaging that is honest and transparent.

Malaty Rivera: I feel confident that we can get close to 70% to get the vaccine. One thing that is encouraging is that we were hoping for 50% efficacy -- we are seeing that its potentially 90% effective. That changes the game. It gives people more confidence it will work for them.

Bailey: There is a desire amongst health care workers in actually seeing the data about the vaccine trials. Up until now, we have seen press releases and news reports that have been encouraging, and we want to see the data ourselves. And that is coming very quickly. The public will have access to the data that the FDA has, and we will be able to review that. I'm confident that once we see the data, that confidence will soar.

A refrigerated truck drives out of the Pfizer Manufacturing plant in Puurs, Belgium, on Dec. 3, 2020.

Besser: We are currently experiencing the worst moments of this pandemic: Cases are soaring, Congress is deadlocked over providing much-needed aid and respiratory viruses like COVID-19 tend to thrive during the colder winter months. The expected vaccines will not quickly change the trajectory of this pandemic -- for most Americans, a vaccine is at least several months away. What we do now will determine whether tens of thousands of Americans live long enough to get vaccinated. I am encouraged that the incoming administration is assembling a team of experts that values science and will follow a public health roadmap to getting the virus under control and our economy back on track. But it is incumbent on each of us to wear masks, socially distance and wash hands -- even after a vaccine is approved.

Malaty Rivera: It's not impossible, but it's going to require an enormous investment. We are going to need as big of a communications campaign as well.We can't distribute massive amount of vaccines without also having the proper communication about them that goes along with it. It's going to require a large amount of investment from the federal government to ensure that people are getting the right messaging. There also needs to be investment and involvement from the community level. There is a lot of distrust about the vaccine from communities of color. To rebuild that trust is going to involve community leaders.

Bailey: I think the experts that are working on this -- the current people in the FDA, and individuals that are on the Biden-Harris COVID team are more than up to the challenge. They are accomplished professionals who know how to do this. It's also important to remember that most of the work that is being done is by career scientists, by the FDA and CDC who don't come and go with administrations. They have dedicated themselves to the health of our country. We need to understand that this process has not been politicized at all. We continue to hold our leaders accountable for providing honest information.

These interviews have been edited for clarity and brevity.

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Health experts on COVID-19 vaccine: Americans have a lot of distrust - ABC News

Experts say side effects from the COVID-19 vaccine range from soreness to fatigue. USA TODAY

Americans will likely experience at least one side effect from the COVID-19 vaccine, but doctors say thats normal and you should still get vaccinated.

In Modernas Phase 3 trials, the company said the most common side effects were fatigue, muscle soreness and aches, joint pain and headache, plus pain, redness or swelling at the injection site.

More than half of Modernas study participants had side effects from the vaccine in Phase 1 trials, according to a preliminary report published in July in the New England Journal of Medicine.

In Pfizer/BioNTech Phase 3 trials, the probability of fatigue or headaches was 3.8% and 2%, respectively.

Experts say well know more details about who is more likely to experience what side effects when the U.S. Food and Drug Administration finishes reviewing the Phase 3 trial data for both vaccines and releases that information to the public. The earliest that could happen is Dec. 10.

Physicians emphasize that theside effects are not just normal but also a sign that thebody is reacting properly to the vaccine.

Dr. Melanie Swift, an occupational medicine physician helping lead the COVID-19 vaccination plan at the Mayo Clinic, said its important to educate Americans about a vaccine'sside effects or it may deter people from getting a second dose as needed.

Just because youre sore doesnt mean that (the vaccine) didnt work or wasnt effective. It just means that your body responded the way its supposed to, she said. Its important to take both doses, or that first dose was all for nothing.

In Dr. Fauci's words: Why Americans shouldn't fear avaccine authorized by the FDA

Coronavirus vaccine Q&A: When can you get it? Will you have to take it every year?

Though companies and agencies tend to interchange the terms side effects and adverse effects," experts warn that "adverse events" are a very different experience.

Side effects are common and dont disrupt daily life. Adverse events are more unanticipated effects of a drug. Some adverse events from other vaccines reported over the decades includerare neurological events or vaccine-induced immune enhancement, said Dr. Len Horovitz, pulmonary specialist at Lenox Hill Hospital.

But while 10% to 15% of patients who get the flu vaccine experience side effects, Swift said adverse events likely occur in under .1% of patients.

Adverse events are rarer events. Side effects are common, self-limited and benign, Horovitz said. Most side effects can be treated with a Tylenol, he said.

For example, if you work out at the gym and leave feeling sore, that's a common and expected side effect, Swift said. But if you leave the gym and get pink eye, that's a reportable adverse event. And if enough people get pink eye, then there's a problem with the gym.

Is this ethical?Continuing COVID-19 vaccine trials may put some volunteers at unnecessary risk

If someone is going to have a bad reaction to a vaccine, it is likely to occur in the first six weeks after vaccination, according to medical experts. But experts still dont know the long-term effects of the COVID-19 vaccines and wont know until after the trials are completed and researchers monitor participants in the real world for years after.

Drug and Safety Monitoring Boards for both Pfizer and Moderna reported no serious safety concerns for their vaccines. If there was an adverse event, Swift said, the board would have likely halted the trial.

Thathappened to Johnson & Johnson in October when its large-scale COVID-19 vaccine trial was paused after an unexplained illness in a volunteer. Another trial, run by AstraZeneca, was halted Sept. 8 after a participant in the U.K. was diagnosed with a neurological condition, believed to be transverse myelitis.

Both trials resumed after regulators found no evidence the vaccines caused the volunteersto fall ill.

We have an extremely high standard for safety and adverse events, Swift said, adding thatModerna and Pfizer probably would not have been able to submit their vaccines for FDA authorization if an adverse event were reported during trials.

The Advisory Committee on Immunization Practices voted healthcare workers and residents of long-term care facilities should receive the vaccine first. USA TODAY

The U.S. Centers for Disease Control and Prevention has national monitoring systems in place to track reportable adverse events from vaccines. However, the agency added another layer of safety monitoring for the COVID-19 vaccine: V-SAFE.

Its a new smartphone-based, post-vaccination health checker for essential workers who receive the vaccine. For those who enroll, the program will use texting messaging and web surveys to check in with people for health problems aftervaccination.

The CDC said it plans to enroll up to 20 million people during the first few months of the program. Text messages and emails will be sent daily for the first week after vaccination and then weekly for six weeks.

The agency will not only ask about side effects and possible adverse eventsbut also will ask about coronavirus infection to better understand effectiveness and how long vaccine protection may last.

Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

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Side effects from the COVID-19 vaccine means 'your body responded the way it's supposed to,' experts say - USA TODAY

Rural counties have some of the lowest flu vaccination rates. Thats a serious problem for the COVID vaccine rollout.

Americas poor track record vaccinating people against the flu spells trouble for the coming effort to immunize the nation against COVID-19, experts say, particularly in rural areas where the virus is raging out of control.

A USA TODAY analysis of flu vaccine rates among Medicare participants shows that rural counties from West Texas to northern Nebraska to the Upper Peninsula of Michigan had some of the countrys lowest vaccination rates in 2017, the most recent year with data. Its a pattern that holds true across America. The more rural the county, the lower flu vaccination rates tended to be.

Data for the analysis came from the County Health Rankings project and the Index of Relative Rurality, a metric that ranks counties based on population size, density, remoteness, and built-up area. The analysis identified 604 counties where fewer than a third of Medicare participants received flu vaccines, 580 of which were predominantly rural.

These places were home to more than 13 million people and were spread across the nation; all but nine states had at least one low-vaccination county.

At the extreme, there were 215 counties where fewer than 1 in 4 residents on Medicare were vaccinated.

We don't have the convenience of jumping into a Walgreens, CVS or Walmart and getting our flu shot. Our nearest Walgreens and Walmart are 30 miles away, said Dr. Jennifer Bacani McKenney, a family physician and the Wilson County Health Officer in Fredonia, Kansas, explaining some of the barriers in rural areas that exist in addition to vaccine hesitancy and distrust.

Due to financial, storage and staffing issues, she said, "none of the providers in our county and many private clinics across the state do not provide in-clinic vaccinations, so the patient is required to make an additional appointment to get vaccines at a health department."

Of course, people who opt out of the flu vaccine might seek it for the coronavirus because the pandemic has killed more people than the annual flu. At the same time, people who previously took the flu vaccine might not get their shots for COVID-19 because the pandemic has intensified Americans skepticism of science and drug regulators.

But flu vaccination rates can at least provide clues to how rural America will respond to the arrival of the COVID-19 vaccine. Data on flu vaccination among Medicare enrollees -- primary elderly Americans -- provide a detailed geographic window into how the COVID-19 vaccine will be accepted by that key at-risk group, said Dr. Randy Hubach, an associate professor of rural health and director of the Sexual Health Research Lab at Oklahoma State University. I think its an accurate contextual representation of what we can probably expect with the COVID vaccine.

The potential consequences for rural America can be seen in flu data. Historic data from the U.S. Centers for Disease Control and Prevention Wonder database show that the flu virus tends to kill at higher rates in more rural counties.

Experts say if COVID-19 vaccination follows the same pattern as the flu, the flow of people between these communities and the rest of the country will put both city dwellers and rural residents at risk.

Flu vaccination has largely skipped much of rural America because, in part, its harder for people in remote communities to get to pharmacies, clinics or hospitals offering vaccines. Theres also a long-standing distrust in the medical system in these areas. Yet getting the COVID vaccine to these areas will be key to tamping down a virus thats ravaged rural communities, experts said.

Ensuring vaccine coverage of rural communities is an essential part of the strategy to protect rural communities from COVID-19, Dr. Thomas Tsai, a surgeon and health policy researcher at Harvard's T.H. Chan School of Public Health, said in an email.

Researchers dont know how much of the U.S. population will need to be protected to stop the spread of COVID-19. Estimates range from 50% to as high as 90% of the population to achieve a threshold epidemiologists describe as herd immunity.

Reaching that threshold will be a struggle, if the flu vaccine is any indication. Only half the country gets vaccinated for the flu, on average, and surveys show a growing number of people intend to refuse a COVID-19 vaccine. Achieving a much higher vaccination rate with the COVID-19 vaccine will be the difference between a coronavirus thats endemic and actively circulating and a coronavirus thats all but wiped out, a goal the nation has attained with the smallpox, mumps and diphtheria viruses.

How you are going to move that needle from 50% up to 75% really becomes the question, said Dr. Hubach.

More: When could the first COVID-19 vaccines be given in the US?

And the prickly problem of vaccine uptake is one that health officials need to figure out quickly. With two COVID vaccine candidates expected to receive emergency use authorization from the U.S. Food and Drug Administration later this month, federal and state health officials are finalizing vaccine distribution plans to immunize the front-line health care workers and nursing home residents that comprise the so-called Phase 1a group, the Americans who will first receive the vaccine against the coronavirus.

That wave of immunizations is expected to occur before the end of the year. Dr. Mancef Slaoui, the chief science advisor to Operation Warp Speed, recently said he expected the first Americans to be vaccinated within two days of the FDAs authorization. Dr. Nancy Messionier, director of CDCs National Center for Immunization and Respiratory Diseases, said last week that everyone in phase 1a should expect their first dose within three weeks of a vaccine being authorized.

The rollout thereafter should proceed quickly. On a Dec. 2 Operation Warp Speed call with reporters, Dr. Slaoui said he expected that 20 million people would receive either the Pfizer or Moderna vaccine in December, followed by 30 million people in January and 50 million people in February, pending FDA authorization. In early 2021, vaccinations will proceed beyond front-line health care workers and nursing home residents to essential workers followed by adults with high-risk medical conditions and people aged 65 and older.

But getting vaccines to essential workers and seniors, especially in rural areas, will be an ongoing challenge given the historically low vaccination rates, which researchers sometimes refer to as 'uptake, in rural counties. The reason for low vaccine uptake? A variety of factors including long-standing systemic health and social inequities as well as a distrust of medical providers, says Dr. Hubach.

Dr. McKenney in Kansas is seeing vaccine distrust play out both in private clinic visits and in public town hall discussions about the coronavirus.

I hear people saying theyre hesitant to take this vaccine, said McKenney. Theyre nervous. They dont want to be the first ones. It goes along with the rural mentality of being suspicious of the government and science.

More: Kentucky legislator pre-files bill prohibiting colleges from mandating vaccines

That worries McKenney because of how hard communities in Kansas and across the Plains have been hit by COVID-19 in recent months.

The numbers that were seeing right now in our communities actually makes me kind of terrified about whats going to happen before we ever start vaccinating, she said. Whats going to happen in the next month or two months?

Yet despite that damage, people arent changing their behaviors. Even with those high numbers of cases and deaths, its still not hitting home for people, said McKenney. Theyre saying, Only 1 percent die. Its not a big deal.

Rural counties in the Dakotas, Kansas, Montana and Mississippi have seen some of the highest COVID surges with over 300 deaths per 100,000 people. Influenza and other respiratory diseases have also hit many of those same counties hard in the past, though at much lower levels around 25 deaths per 100,000 on average, according to CDC data from 2018.

Maria Harvey and her sister Ashley Makridakis protest mandatory flu vaccinations outside the Massachusetts Statehouse on Aug. 30 in Boston. Public health authorities say flu shots are very important this year to avoid overburdening the health system amid the coronavirus pandemic.(Photo: Nancy Lane/Boston Herald via AP)

Rural residents who opt out of vaccination are far from monolithic in their reasons.

Lynn Ogren said she routinely passes on the flu shot and all other vaccines in Jerauld County, South Dakota, where just over one in five residents was immunized in 2017. The 69-year-old retired rancher and substitute teacher said she instead takes dietary supplements and minds a strict diet to keep in good health. She wont be getting vaccinated for COVID-19 either, she said.

I dont put anything foreign into my body that I dont need to, Ogren said. Ive never been vaccinated for the flu, and I dont get vaccinated for anything.

Jerauld County residents have died of COVID-19 at a rate of more than 640 per 100,000 residents, one of the highest rates in the country.

Health experts warn that if a population doesnt attain herd immunity, places that havent been immunized will continue to see surges in cases and deaths from the virus known by the scientific name SARS-CoV-2. But achieving herd immunity will be a serious challenge in countries like the United States where vaccine hesitancy is widespread. The consequence is a coronavirus that returns seasonally, guaranteeing continued suffering.

California Gov. Gavin Newsom gets a flu shot during a news conference Monday in Rancho Cordova, Calif.(Photo: California Governors Office via AP)

What happens if countries do not reach high vaccine coverage levels? First, SARS-CoV-2 will become endemic but at a low level with peaks in winter and troughs in summer in the northern hemisphere, wrote the authors of a letter published last month in The Lancet journal pointing out challenges to herd immunity.

Dr. Roy Anderson, one of the authors and a professor in the School of Public Health at Imperial College London, said in an interview that the virus will continue to circulate if herd immunity isnt reached. Rural areas will not be spared.

The virus will remain endemic, but cities will be major reservoirs seeding rural regions, said Dr. Anderson, who was adamant that the virus would likely not ever go away. It will be endemic and seasonal.

Dr. Krutika Kuppalli, an assistant professor in the division of infectious disease at the Medical University of South Carolina, is also concerned.

Do I think its going to become endemic? said Kuppalli. Yeah, I do. When we have millions and millions of cases, it seems like its going to become endemic. My hope is we get enough people to take up the vaccine.

Despite rural counties historically low rates of vaccine uptake, Hubach sees an opportunity to better communicate with those communities about the COVID-19 vaccine. Tapping faith leaders and community outreach workers that have an understanding of local context and climate is going to be very important. How do you have them say, Vaccination is one thing we can do for the common good?, he said.

More: Side effects from the COVID-19 vaccine means 'your body responded the way it's supposed to,' experts say

In addition to tailoring public health messages to specific communities in rural counties, relying on the patient-doctor bond is an important way to build trust in the COVID-19 vaccine and boost vaccination rates, says Dr. Brian Chow, a physician and principal investigator on AstraZenecas COVID vaccine trial at Tufts Medical Center in Boston. Many rural communities have been historically marginalized and denied health care or worse, Chow explained. Promoting COVID vaccination needs to surmount distrust in medical care.

The majority of people will get vaccinated through their doctors office, said Chow. Leveraging those relationships will be key. A strong recommendation from their primary care provider really influences whether or not people accept a vaccine.

Aleszu Bajak is on Twitter at @aleszubajak or can be emailed at abajak@usatoday.com

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What vaccination rates in rural America tell us about the advent of COVID vaccines - USA TODAY

Rural counties have some of the lowest flu vaccination rates. Thats a serious problem for the COVID vaccine rollout.

Americas poor track record vaccinating people against the flu spells trouble for the coming effort to immunize the nation against COVID-19, experts say, particularly in rural areas where the virus is raging out of control.

A USA TODAY analysis of flu vaccine rates among Medicare participants shows that rural counties from West Texas to northern Nebraska to the Upper Peninsula of Michigan had some of the countrys lowest vaccination rates in 2017, the most recent year with data. Its a pattern that holds true across America. The more rural the county, the lower flu vaccination rates tended to be.

Data for the analysis came from the County Health Rankings project and the Index of Relative Rurality, a metric that ranks counties based on population size, density, remoteness, and built-up area. The analysis identified 604 counties where fewer than a third of Medicare participants received flu vaccines, 580 of which were predominantly rural.

These places were home to more than 13 million people and were spread across the nation; all but nine states had at least one low-vaccination county.

At the extreme, there were 215 counties where fewer than 1 in 4 residents on Medicare were vaccinated.

We don't have the convenience of jumping into a Walgreens, CVS or Walmart and getting our flu shot. Our nearest Walgreens and Walmart are 30 miles away, said Dr. Jennifer Bacani McKenney, a family physician and the Wilson County Health Officer in Fredonia, Kansas, explaining some of the barriers in rural areas that exist in addition to vaccine hesitancy and distrust.

Due to financial, storage and staffing issues, she said, "none of the providers in our county and many private clinics across the state do not provide in-clinic vaccinations, so the patient is required to make an additional appointment to get vaccines at a health department."

Of course, people who opt out of the flu vaccine might seek it for the coronavirus because the pandemic has killed more people than the annual flu. At the same time, people who previously took the flu vaccine might not get their shots for COVID-19 because the pandemic has intensified Americans skepticism of science and drug regulators.

But flu vaccination rates can at least provide clues to how rural America will respond to the arrival of the COVID-19 vaccine. Data on flu vaccination among Medicare enrollees -- primary elderly Americans -- provide a detailed geographic window into how the COVID-19 vaccine will be accepted by that key at-risk group, said Dr. Randy Hubach, an associate professor of rural health and director of the Sexual Health Research Lab at Oklahoma State University. I think its an accurate contextual representation of what we can probably expect with the COVID vaccine.

The potential consequences for rural America can be seen in flu data. Historic data from the U.S. Centers for Disease Control and Prevention Wonder database show that the flu virus tends to kill at higher rates in more rural counties.

Experts say if COVID-19 vaccination follows the same pattern as the flu, the flow of people between these communities and the rest of the country will put both city dwellers and rural residents at risk.

Flu vaccination has largely skipped much of rural America because, in part, its harder for people in remote communities to get to pharmacies, clinics or hospitals offering vaccines. Theres also a long-standing distrust in the medical system in these areas. Yet getting the COVID vaccine to these areas will be key to tamping down a virus thats ravaged rural communities, experts said.

Ensuring vaccine coverage of rural communities is an essential part of the strategy to protect rural communities from COVID-19, Dr. Thomas Tsai, a surgeon and health policy researcher at Harvard's T.H. Chan School of Public Health, said in an email.

Researchers dont know how much of the U.S. population will need to be protected to stop the spread of COVID-19. Estimates range from 50% to as high as 90% of the population to achieve a threshold epidemiologists describe as herd immunity.

Reaching that threshold will be a struggle, if the flu vaccine is any indication. Only half the country gets vaccinated for the flu, on average, and surveys show a growing number of people intend to refuse a COVID-19 vaccine. Achieving a much higher vaccination rate with the COVID-19 vaccine will be the difference between a coronavirus thats endemic and actively circulating and a coronavirus thats all but wiped out, a goal the nation has attained with the smallpox, mumps and diphtheria viruses.

How you are going to move that needle from 50% up to 75% really becomes the question, said Dr. Hubach.

More: When could the first COVID-19 vaccines be given in the US?

And the prickly problem of vaccine uptake is one that health officials need to figure out quickly. With two COVID vaccine candidates expected to receive emergency use authorization from the U.S. Food and Drug Administration later this month, federal and state health officials are finalizing vaccine distribution plans to immunize the front-line health care workers and nursing home residents that comprise the so-called Phase 1a group, the Americans who will first receive the vaccine against the coronavirus.

That wave of immunizations is expected to occur before the end of the year. Dr. Mancef Slaoui, the chief science advisor to Operation Warp Speed, recently said he expected the first Americans to be vaccinated within two days of the FDAs authorization. Dr. Nancy Messionier, director of CDCs National Center for Immunization and Respiratory Diseases, said last week that everyone in phase 1a should expect their first dose within three weeks of a vaccine being authorized.

The rollout thereafter should proceed quickly. On a Dec. 2 Operation Warp Speed call with reporters, Dr. Slaoui said he expected that 20 million people would receive either the Pfizer or Moderna vaccine in December, followed by 30 million people in January and 50 million people in February, pending FDA authorization. In early 2021, vaccinations will proceed beyond front-line health care workers and nursing home residents to essential workers followed by adults with high-risk medical conditions and people aged 65 and older.

But getting vaccines to essential workers and seniors, especially in rural areas, will be an ongoing challenge given the historically low vaccination rates, which researchers sometimes refer to as 'uptake, in rural counties. The reason for low vaccine uptake? A variety of factors including long-standing systemic health and social inequities as well as a distrust of medical providers, says Dr. Hubach.

Dr. McKenney in Kansas is seeing vaccine distrust play out both in private clinic visits and in public town hall discussions about the coronavirus.

I hear people saying theyre hesitant to take this vaccine, said McKenney. Theyre nervous. They dont want to be the first ones. It goes along with the rural mentality of being suspicious of the government and science.

More: Kentucky legislator pre-files bill prohibiting colleges from mandating vaccines

That worries McKenney because of how hard communities in Kansas and across the Plains have been hit by COVID-19 in recent months.

The numbers that were seeing right now in our communities actually makes me kind of terrified about whats going to happen before we ever start vaccinating, she said. Whats going to happen in the next month or two months?

Yet despite that damage, people arent changing their behaviors. Even with those high numbers of cases and deaths, its still not hitting home for people, said McKenney. Theyre saying, Only 1 percent die. Its not a big deal.

Rural counties in the Dakotas, Kansas, Montana and Mississippi have seen some of the highest COVID surges with over 300 deaths per 100,000 people. Influenza and other respiratory diseases have also hit many of those same counties hard in the past, though at much lower levels around 25 deaths per 100,000 on average, according to CDC data from 2018.

Maria Harvey and her sister Ashley Makridakis protest mandatory flu vaccinations outside the Massachusetts Statehouse on Aug. 30 in Boston. Public health authorities say flu shots are very important this year to avoid overburdening the health system amid the coronavirus pandemic.(Photo: Nancy Lane/Boston Herald via AP)

Rural residents who opt out of vaccination are far from monolithic in their reasons.

Lynn Ogren said she routinely passes on the flu shot and all other vaccines in Jerauld County, South Dakota, where just over one in five residents was immunized in 2017. The 69-year-old retired rancher and substitute teacher said she instead takes dietary supplements and minds a strict diet to keep in good health. She wont be getting vaccinated for COVID-19 either, she said.

I dont put anything foreign into my body that I dont need to, Ogren said. Ive never been vaccinated for the flu, and I dont get vaccinated for anything.

Jerauld County residents have died of COVID-19 at a rate of more than 640 per 100,000 residents, one of the highest rates in the country.

Health experts warn that if a population doesnt attain herd immunity, places that havent been immunized will continue to see surges in cases and deaths from the virus known by the scientific name SARS-CoV-2. But achieving herd immunity will be a serious challenge in countries like the United States where vaccine hesitancy is widespread. The consequence is a coronavirus that returns seasonally, guaranteeing continued suffering.

California Gov. Gavin Newsom gets a flu shot during a news conference Monday in Rancho Cordova, Calif.(Photo: California Governors Office via AP)

What happens if countries do not reach high vaccine coverage levels? First, SARS-CoV-2 will become endemic but at a low level with peaks in winter and troughs in summer in the northern hemisphere, wrote the authors of a letter published last month in The Lancet journal pointing out challenges to herd immunity.

Dr. Roy Anderson, one of the authors and a professor in the School of Public Health at Imperial College London, said in an interview that the virus will continue to circulate if herd immunity isnt reached. Rural areas will not be spared.

The virus will remain endemic, but cities will be major reservoirs seeding rural regions, said Dr. Anderson, who was adamant that the virus would likely not ever go away. It will be endemic and seasonal.

Dr. Krutika Kuppalli, an assistant professor in the division of infectious disease at the Medical University of South Carolina, is also concerned.

Do I think its going to become endemic? said Kuppalli. Yeah, I do. When we have millions and millions of cases, it seems like its going to become endemic. My hope is we get enough people to take up the vaccine.

Despite rural counties historically low rates of vaccine uptake, Hubach sees an opportunity to better communicate with those communities about the COVID-19 vaccine. Tapping faith leaders and community outreach workers that have an understanding of local context and climate is going to be very important. How do you have them say, Vaccination is one thing we can do for the common good?, he said.

More: Side effects from the COVID-19 vaccine means 'your body responded the way it's supposed to,' experts say

In addition to tailoring public health messages to specific communities in rural counties, relying on the patient-doctor bond is an important way to build trust in the COVID-19 vaccine and boost vaccination rates, says Dr. Brian Chow, a physician and principal investigator on AstraZenecas COVID vaccine trial at Tufts Medical Center in Boston. Many rural communities have been historically marginalized and denied health care or worse, Chow explained. Promoting COVID vaccination needs to surmount distrust in medical care.

The majority of people will get vaccinated through their doctors office, said Chow. Leveraging those relationships will be key. A strong recommendation from their primary care provider really influences whether or not people accept a vaccine.

Aleszu Bajak is on Twitter at @aleszubajak or can be emailed at abajak@usatoday.com

Read or Share this story: https://www.usatoday.com/story/news/health/2020/12/06/flu-vaccine-rates-rural-covid-19-vaccine/3832618001/

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What vaccination rates in rural America tell us about the advent of COVID vaccines - USA TODAY

"This really couldn't be coming at a more needed time, the current state of the pandemic in the United States is really out of control."

BOISE, Idaho The Idaho Department of Health and Welfare anticipates receiving and distributing the Pfizer COVID-19 by mid-December, first to healthcare providers then to people living and working in long-term care facilities.

About 6.4 million doses of the vaccine will be available nationwide, but Idaho will only receive a sliver of that 13,650.

However, medical staffs at both Saint Alphonsus and St. Luke's say they've been waiting for the vaccine rollout and are ready for it.

"This really couldn't be coming at a more needed time, the current state of the pandemic in the United States is really out of control," St. Lukes Chief Medical Officer Dr. Jim Souza said.

During an internal meeting, St. Luke's staff discussed what the rollout would look like.

"The way we are deciding, or prioritizing people is really, where do you work, not so much what is your role so a great example would be, I think all of us would consider a covid until or if you work in the emergency room, that you are in a high-risk clinical area," Dr. Laura McGeorge said.

The doses will arrive in weekly shipments and won't just be a single shot.

"These vaccines have a prime, a first shot, and a booster, that's designed to really solidify the immune response to give us much longer-lasting immunity than natural infection," said Dr. Sky Blue, an infectious disease specialist.

Saint Alphonsus has a similar rollout plan based on prioritizing employees who have the highest exposure risk in the hospital.

"We have people that have been working hard, we have a certain number that are out on quarantine, and if we have any more of that it's going to be challenging for us to care for the people that need care so it's important to get those folks as immune as possible so that they can care for the general public as we start working on getting the public vaccinated as well," Dr. Patrice Burgess, the executive director for Saint Alphonsus, said.

But many are skeptical of the vaccine because of how quickly it was developed.

"I know some people just say well why don't we just get infected and get it over with well a certain percentage of people aren't going to do well with the infection and people that do have the infection, we've seen cases around the world where people get infected again and the vaccine seems to have a stronger immune response, so the more people we can get vaccinated, the less community spread we will have," Dr. Burgess said.

Although there is still a fair number of unknowns about the vaccine, medical experts said what they do know is promising.

"These vaccines, as far as their effectiveness, is very exciting, we don't see this very often a lot of our vaccines are 60, 70, 80 percent effective, these are 94 and 95 percent effective, so once we get enough people vaccinated, it's going to be a very exciting development," Dr. Burgess said.

"When we are talking about unknowns which there are and im not going to gloss over that, but we know the knows about what this natural infection does so when we compare tose, at the frontlines of being exposed and those of the community who are at severe risk of disease and death, those risks vastly overshadow the unknown risks that we are talking about in the one in a million vaccinated individuals here," Dr. Blue said.

The COVID-19 vaccine is will a couple of weeks away from being shipped to hospitals.

Both doctors said this bit of good news does not mean people can start to relax their social distancing and mask-wearing as the vaccine is still a ways away until its available to the general public.

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How Saint Alphonsus and St. Luke's plan on distributing the COVID-19 vaccine to healthcare workers - KTVB.com