Silver Bullet June 11 - Vaccine incentives, US vaccine giveaway, heart inflammation concerns
A weekly update on all things COVID-19. News, public health guidance, trends, breakthroughs, and thousands of scientific papers distilled down to what you need to know right now.
Vaccine incentive programs are taking off everywhere, over the objections of critics
Covid vaccine lotteries and cash incentives are becoming wildly popular, but critics say they’re a blunt instrument with some potential downsides
The Ohio Department of Public Health reported that more than 2.7 million adults entered its first weekly Vax-a-Million drawing for a one million dollar prize, and more than 100,000 teens entered for a college scholarship. The first winners were announced Wednesday, while entries remain open for next week’s lottery, the second out of five. The entry process is simple: get your shot, then fill out an online form.
New York, Maryland, Colorado, and Oregon have announced plans for their own lotteries. Under New York’s “Vax and Scratch” program, people who get vaccinated at one of the state’s mass vaccination sites from May 24-28 will receive a free scratch of ticket for the $5,000,000 Mega Multiplier lottery, normally valued at $20. Maryland recently rolled out its $2 million VaxCash promotion, a series of 40 statewide drawings for $40,000. Everyone who is vaccinated is automatically enrolled. Colorado and Oregon residents are also automatically entered in their states’ respective lotteries when they receive a vaccination. Colorado will be giving away five $1 million prizes, and Oregon will hold a single lottery for prizes ranging from $10,000 to $1 million on June 27.
Similarly, some states are offering direct cash incentives. For example, under New Jersey’s “shot and a beer” program, any state resident who gets their first vaccine dose in the month of May can get a free beer at a participating brewery. Maryland is offering a direct $100 payment to state employees who receive the vaccine. And in West Virginia, 16-35 year-old residents will get a $100 savings bond for getting vaccinated.
Some businesses, particularly restaurants, are jumping on the bandwagon, as well. Krispy Kreme was one of the first, offering a free doughnut per day to customers who present their vaccination card. White Castle is offering a free dessert to its vaccinated customers. And, if you’re vaccinated, you can get a free side of fries at Shake Shack. Companies offering financial incentives for vaccinations include Aldi, Kroger, McDonald’s, and Trader Joe’s—generally in the form of store credit or paid time off for employees.
While increasingly popular, vaccine incentive programs have been hotly controversial from the outset. Krispy Kreme’s announcement drew swift condemnation on social media for everything from discrimination against the unvaccinated to irresponsible distribution of unhealthy food.
Meanwhile, Ohio legislators immediately got busy trying to cancel Vax-a-Million. Ohio State Rep. Jena Powell, known in the state as an opponent of vaccines generally, has sponsored a bill that would prevent the state from operating any vaccine lottery.
“The vaccine lottery is a frivolous use of taxpayer dollars,” Powell tweeted. And it’s not just Republicans opposing the lottery. Vax-a-Million drew fire from the other side of the aisle, as well. Speaking to the Cincinnati Enquirer, Ohio House Minority Leader Emilia Strong Sykes called it a “grave misuse of money that could be going to respond to this ongoing crisis.” Read more at Flux…
US vaccination drive accelerates
The Biden administration is pulling out all the stops to get 70% of American adults vaccinated by July 4. At the beginning of June, 52% of adults were fully vaccinated, and 63% had received at least one shot, Biden noted in a speech he gave in early June. Efforts to boost those percentages will include extended hours at vaccination sites, and pharmacies that stay open 24 hours every Friday night. Some national daycare chains and hundreds of local YMCAs will be offering free drop-in child care for anyone needing a vaccine, and Uber and Lyft will continue to offer free rides to and from vaccination sites. A new “Shots at the Shop” initiative will connect black and brown communities with vaccine information and appointment booking through barbers and hairstylists. And volunteers across the country will be knocking on doors to encourage people to get vaccinated. The administration is also continuing to encourage incentives like lotteries, free baseball tickets, free beers, etc, and is offering tax credits to employers who offer time off for vaccinations. There’s also a new HHS website that offers guidance for those who want to volunteer during the “Month of Action.”
Earlier this month, the Biden administration has promised to donate 80 million doses of COVID vaccine to Africa, Latin America, and Asia by the end of June. About 19 million will go to COVAX, an initiative surging vaccines to developing countries. Six million are earmarked for South and Central America, 7 million for Asia, and 5 million for Africa. The doses will come from US supplies of Pfizer, Moderna, and Johnson and Johnson vaccines. Another 60 million doses of AstraZeneca vaccine will also be donated abroad upon authorization by the FDA.
And on Thursday, President Biden announced that the US will donate 500 million new Pfizer vaccines to 92 low- and lower middle-income countries. The vaccines will begin shipping in August, with a planned 200 million delivered by the end of the year, and another 300 million in the first half of 2022.
Teen hospitalizations crept upward
Rates of hospitalization for COVID-19 have increased among teens between 12 and 17 between March and April, says the CDC. The rate of hospitalization was 0.6 per 100,000 in March, but rose to 1.3 per 100,000 in April. The analysis included 204 adolescents. One third of those hospitalizations required admission to the ICU, and 5% required mechanical ventilation. There were no deaths. Teens were not eligible for COVID-19 vaccines during that time period. The hospitalization rate for teens was still much lower than that of adults, but the agency highlighted the increase as concerning and called for more vaccination of people in that age group.
Overdoses spiked during the pandemic
Drug overdose deaths increased by 42% during 2020, according to a review of data from the National EMS Information System published in JAMA Psychiatry. The hardest hit groups were African American (+50.3%) and Latino (+49.7%). The study authors say the increase is part of an overall trend in recent years of increasing overdoses due to trafficking of illicitly manufactured fentanyls. Although the COVID-19 pandemic has exacerbated existing trends, the study highlights economic disparities, structural racism, and US drug policy as other contributors to the rise in drug deaths.
CDC says heart inflammation may be related to mRNA vaccines
The CDC says it has received 275 reports of heart inflammation among 16-24 year olds following a second dose of Pfizer or Moderna’s COVID-19 vaccine. There would normally be between 10 and 102 cases of myocarditis over that time period in that population. The issue came up at a meeting of the CDC’s Vaccines and Related Biological Products Advisory Committee meeting, which was held to discuss the safety of COVID-19 vaccines in children 6 months and older. The condition has been found an average of 3-5 days after the second dose of vaccine. However, it remains extremely rare and it is not yet clear whether it is truly related to the vaccine. (Via CNBC)
Study reveals strong vaccine-induced T cell immunity
Pfizer and BioNTech’s COVID-19 vaccine, BNT162b2, is known to have 95% efficacy in preventing symptomatic disease. A new publication in Nature from BioNTech updates the state of knowledge about how the vaccine protects from disease with evidence that in addition to stimulating the production of antibodies against the virus, it also produces a strong T cell response, specifically CD8 and CD4 T cells. CD4 T cells help to recognize cells infected by a virus, and trigger production of antibodies. CD8 T cells, known as cytotoxic or “killer” T cells attack infected cells directly. CD8 T cells can move very quickly to stop a virus. They can recognize cells infected by influenza in 1.5 hours. They also form a memory, so that they can respond to the same threat later. This is a potentially powerful form of immunity induced by the vaccine that is not measured by conventional antibody tests.
Re-rethinking convalescent plasma
Convalescent plasma was one of the earliest treatments used for COVID-19, going back to the Wuhan days. However, a couple of large clinical trials in 2020 showed no benefit, and use of convalescent plasma declined. A new study in eLife finds that it may have been a mistake for hospitals to abandon convalescent plasma. Their analysis shows that while use of convalescent plasma declined in late 2020, patient mortality increased, with a strong statistical correlation between the two trends. The model suggests that about 29,000 deaths could have been prevented with sustained use of plasma. And overall, the model estimated that convalescent plasma saved around 95,000 lives, even though its use was always fairly limited.
Targeting zombie cells
Cellular senescence is a process where the normal cell cycle becomes arrested due to stress. It is a known mechanism of aging. In a young person, these damaged “zombie cells” are cleared by the immune system. But with aging, they accumulate and contribute to inflammation and diseases of aging like stiffer arteries and arthritis. A new study in Science links senescent cells with mortality from COVID-19. Researchers infected elderly mice with a virus similar to SARS-CoV-2, and found that when they subsequently treated the mice with drugs that target senescent cells, there was reduced mortality, reduced cellular senescence, reduced inflammation, and increased antibodies against the virus. This suggests that cellular senescence is a contributor to COVID-19 mortality (not a surprise since there’s a tight correlation between increased age and mortality), and that treatment with this new class of senolytic drugs could be effective for reducing mortality in humans.
Other science news
FDA clears controversial Alzheimer’s drug
The FDA has approved a controversial Alzheimer’s disease therapy under its accelerated approval pathway. The drug, aducanumab, turned in a poor performance in two Phase III studies, EMERGE and ENGAGE, and those trials were terminated following a futility analysis by drug developer Biogen in March 2019. Subsequently, Biogen reviewed some previously unavailable data and determined there was some benefit for preventing cognitive decline in the EMERGE trial, but not in ENGAGE. In spite of a 10-0 recommendation against approval by the FDA’s Peripheral and Central Nervous System Drugs Advisory Committee, the agency went ahead and approved the drug. One member of the advisory committee subsequently resigned in protest. Meanwhile, Biogen continues the search for a justification for the drug in its Phase IIIb EMBARK trial, re-dosing Alzheimer’s patients who were previously enrolled in halted trials of aducanumab. From Dr. Patrizia Cavazzoni, Director, FDA Center for Drug Evaluation and Research:
“We ultimately decided to use the Accelerated Approval pathway—a pathway intended to provide earlier access to potentially valuable therapies for patients with serious diseases where there is an unmet need, and where there is an expectation of clinical benefit despite some residual uncertainty regarding that benefit. In determining that the application met the requirements for Accelerated Approval, the Agency concluded that the benefits of Aduhelm for patients with Alzheimer’s disease outweighed the risks of the therapy.”
Cannabis may not be safe during pregnancy
A study in Zebrafish finds that cannabis exposure in the early stages of development can lead to a significant drop in neural activity later. Although cannabis is widely believed to have many health benefits, medical research has not yet caught up with its growing popularity, and there are few studies of potential harms during fetal development. The period of exposure in the zebrafish—10 hours—corresponds to about a week of exposure during the earliest stages of pregnancy, about three weeks after fertilization. At that stage, many expectant mothers are not yet aware that they are pregnant. The researchers tested both THC and CBD and found both compounds negatively affected later neural activity.