Herd Immunity May Not the Goal COVID Vaccination Should Pursue4
HSVG misson P.O. Box 206, Hagatna, GU 96932, USA
(April 14, 2021)Together Guam and Taiwan can make a difference in world healthTaiwanese are suffering from the Hualien train accident. Guam Governor Lou Leon Guerrero mentioned in her kind letter to Taiwanese President Tsai Ing-wen that Taiwan has relentlessly supported Guam’s COVID-19 response. Beyond sharing best practices, Taiwan’s utmost generosity and kindness during the global pandemic were also emphasized in the letter. A hearing for Resolution No. 53-36, which would provide legislative endorsement of Taiwan's bid for observer status at the World Health Organization’s 2021 annual assembly, highlighted the assistance that Taiwan provided throughout the pandemic. This included the procurement of 200,000 masks among other medical supplies, and help chartering flights to provide Guam residents off-island care during the health crisis. It also draws attention to education provided by Taiwanese physicians prior to the pandemic.The pandemic is obviously not over yet. After receiving lots of help from off-island, Guam is actually able to offer assistance back in the continuing fight against COVID-19 around the world. For example, Guam’s pretty nice vaccine rollout experience.When the first shipment of COVID-19 vaccine arrived on December 14 last year, Guam had 25 hospitalized COVID-19 patients. Two months later, although only 9.5% of Guam’s population has been fully vaccinated, the hospitalizations dropped to 5 and the island was moving to PCOR3, which allowed most businesses and activities to operate at moderate restrictions.After a considerable percentage of at-risk people got vaccinated, Guam decided to lower the vaccine age to 16 years old on March 22. At that time, the COVID-19 hospitalization has dropped again to only 1 patient at the hospital.Thus, combining Taiwan’s successful response before COVID-19 vaccines became available and Guam’s experience of COVID-19 vaccine rollouts, Guam and Taiwan could create a very comprehensive protocol helping many countries that are still being trapped in this public health crisis, for example, Philippines, Japan, Korea and many others in different regions.In addition to the pandemic, COVID-19 also reveals the importance of prevention and control of diabetes, heart disease and lung problems because these underlying health conditions increase people’s risk for severe COVID-19 illness and death. Learning from Taiwan’s experience in community health, Guam can not only improve its prevalence of diabetes and heart disease but also show its neighbors and the world a healthy life-changing model that would be extremely important in the post-pandemic era.The best platform to make all of these happen is the World Health Organization (WHO). Unfortunately, WHO has refused to grant Taiwan an observer status, which Taiwan used to own, at its annual assembly since 2017. Government of Guam can work together with the US Federal Government to support Taiwan to resume the observer status at the May 24 to June 1 World Health Assembly this year. It is absolutely a right thing to do.In our region, Guam should urge WHO’s Western Pacific Regional Office in the Philippines to immediately amend its improper approach that refused to contact or interact with Taiwan. As a result, Taiwan was unable to obtain information about the pandemic and related data issued by the office, and also unable to participate in meetings organized by the office. Many countries in the region therefore lost their opportunity to closely learn relevant public health practices from Taiwan. That is obviously a huge mistake the office really has to fix and Guam can urge them to do it right away. http://www.hsvg.org/hot_388518.html Together Guam and Taiwan can make a difference in world health 2021-04-14 2022-04-14
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(January 21, 2021)

Herd Immunity May Not the Goal COVID Vaccination Should Pursue

After COVID vaccines were finally available, some officials and experts started worrying about the percentage of people getting vaccinated. Their concerns are mainly related to herd immunity that most previous vaccination programs tried to achieve. However, COVID vaccination may need to pursue a different public health objective.

According to the University of Oxford Vaccine Knowledge Project, when a high percentage of the population is vaccinated, it is difficult for infectious diseases to spread, because there are not many people who can be infected. For example, if someone with measles is surrounded by people who are vaccinated against measles, the disease cannot easily be passed on to anyone, and it will quickly disappear. This is called herd immunity.

The governments that are distributing and administering COVID vaccines have to notice that herd immunity is not the only model to eradicate an pandemic. For example, the WHO (World Health Organization) was able to declare an end to the global 2009 influenza A (H1N1) pandemic on August 10, 2010, although, according to the report released by the US CDC (Center for Disease Control and Prevention), the overall vaccination coverage in the US was only 27%.

The novel influenza A (H1N1) virus was identified in April 2009. On September 15 that year, four vaccine manufacturers received approval from the US FDA (Food and Drug Administration) for use of the specific monovalent (H1N1) pdm09 vaccine in the prevention of influenza caused by the 2009 pandemic influenza A (H1N1) virus. Since the pandemic was associated with a threefold higher level of hospitalizations and deaths among people aged less than 65 compared with previous influenza seasons, the vaccination program prioritized five target groups – pregnant women, people who live with or provide care for infants younger than 6 months, health–care and emergency medical services personnel, children and young adults aged 6 months to 24 years, and people aged 25 to 64 years who have medical conditions that put them at higher risk for influenza–related complications.

The US CDC’s report showed that, from October 2009 through May 2010, there were 34.2% of people in the target groups getting vaccinated. Among people of non-target groups, the vaccination coverage for people aged 25 to 64 was 16.7% and for those aged over 65, 28.8%.

In fact, in the University of Oxford’s press release regarding its COVID vaccine’s emergency use authorization, they mentioned the Joint Committee on Vaccination and Immunisation (JCVI) will “publish its latest advice for the priority groups to receive this vaccine, with this announcement indicating that the JCVI has advised the priority should be to give as many people in at-risk groups their first dose, rather than providing the required two doses in as short a time as possible. The second dose completes the course and is important for longer term protection, and everyone will still receive their second dose within 12 weeks of their first, an approach the JCVI believes will maximise the benefits of this vaccine, ensuring at-risk people are able to get meaningful protection and ease the pressure on the UK National Health Service.” They did not address herd immunity.

Therefore, taking care of the at-risk people, once again, ought to be the main task after the COVID vaccines became available, instead of paying too much attention to the overall vaccination coverage rate and arguing with the anti-vaxxers. Once fewer at-risk people develop severe illness and hospitals are no longer overwhelmed, the whole world will see the light at the end of the tunnel.

The COVID vaccines’ effectiveness data supporting the emergency use authorization actually show that vaccines are significantly effective in preventing symptomatic COVID-19 disease and severe illness among the clinical trial participants. Every regulatory body also reminds that data are not available to make a determination about how long the vaccine will provide protection, nor is there evidence that the vaccine prevents transmission of the coronavirus from person to person. It implies the most relevant goal of COVID vaccination for now should be to protect at-risk groups from sickness, instead of pursuing herd immunity.

Since COVID’s highly contagious nature, it could be very difficult to achieve a containment goal and mitigation might be a better mindset to respond to the pandemic. Many countries had paid the price for inappropriate response strategies last year. Several conceptual errors are still keeping many governments trapped in this public health crisis. While COVID vaccines are finally available, governments of main countries really need to use vaccines as a powerful tool and do their best to convince and help at-risk people getting vaccination to bring the whole world to get through the pandemic as soon as possible.