In just two or three weeks, our Texas Medical Center hospitals will begin receiving the first shipments of the Pfizer-BioNTech vaccine. Intended initially for distribution to health care providers, the new vaccines could not arrive too soon. Texas has just surpassed more than one million confirmed COVID-19 cases, more than in any other state. If Texas were a nation we would rank 11th globally in between Colombia and Mexico, both of which have larger populations.
Our COVID-19 cases are accelerating the fastest in West Texas. The cities of El Paso and Lubbock lead all urban areas in the United States, but eventually cases will spread across Texas. At the current pace, according to the University of Washington model, an estimated 15,000 more Texans will lose their lives between now and Feb. 1 — just 10 days after the inauguration.
In the face of the strengthening pandemic, scientists all over the world, and including our team here in Houston, are closing in on vaccines. Millions of doses of the Pfizer-BioNTech vaccines are expected by the new year. However, no matter how innovative the technology, the vaccines won’t work if enough people don’t take them. We can’t let that happen.
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Which vaccine or not at all?
The question I am asked the most these days is, “Hey doc, which vaccine are you taking or waiting for?” My answer is “don’t wait.” In the beginning, these vaccines will be available in only limited quantities. I will take the first FDA-authorized vaccine offered to me (or my family) because they all more or less work in the same way. Every COVID-19 vaccine, including ours, induces immunity through virus neutralizing antibodies.
As we head into an awful winter and COVID-19 deaths mount, having those neutralizing antibodies in our system will keep most of us out of the hospital. Later, if it turns out the first vaccine we receive is not the best in terms of durability of protection or other factors we can potentially receive a boost, either with the same vaccine or one of the others.
Increasingly, however, we are learning that many Americans will refuse COVID-19 vaccines as they become more widely available in the early part of 2021. Surveys from well-established organizations indicate that up to one half of Americans have profound reservations about the Operation Warp Speed vaccines, expressing concerns that they were approved too quickly or before their safety and potential side effects were known.
Another study just released even finds that many health care professionals, especially nurses, may not accept COVID-19 vaccines, while the distrust of COVID-19 vaccines among the African American community is also very high.
These high rates of “vaccine hesitancy” or refusal partly reflects White House politicization of COVID-19 vaccines this year. Many Americans are concerned about what they are hearing in the media. They have genuine concerns and worry the process is being rushed. The extra speed is in the development of the vaccines not with the clinical trials. The testing for safety and effectiveness is being conducted with scientific rigor and integrity.
Apart from these genuine questions are underlying nefarious forces. The United States is home to some of the world’s greatest research universities and institutes, but our nation also hosts a vast and conspiracy-laden anti-vaccine movement.
In its current form, anti-vaccine sentiments accelerated about a year before the U.S. presidential election in 2016, initially in Southern California, before it amplified in Texas. New organizations formed under the banner of “health freedom” or “medical freedom” to protest traditional vaccine requirements in K-12 schools.
Ultimately, Texas became the epicenter of a well-funded and well-organized anti-vaccine effort linked to political extremism. Current estimates from the Texas Department of State Health Services find that more than 77,000 parents requested conscientious vaccine exemptions in 2019, a 60 percent increase from 2015. For 2019-20, 72,743 vaccine exemptions for school-aged children (in public and accredited private schools) were filed for non-medical reasons. The numbers do not include an unknown number of unvaccinated children among the estimated 350,000 home-schooled kids in our state.
The anti-vaccine movement has since expanded nationally. Robert F. Kennedy Jr. leads Children’s Health Defense, the largest and most far-reaching organization. Now anti-vaccine activities dominate the internet with more than 480 fake websites amplified on social media and e-commerce platforms.
I’m a major target because I wrote a book entitled “Vaccines Did Not Cause Rachel’s Autism” about my youngest daughter. RFK Jr. has publicly labeled me the “OG Villain” — I had to look that one up, it means “original gangster.” Things got even worse in 2020 when in response to COVID-19 the anti-vaccine movement expanded “health freedom” to include protests against masks and social distancing. Multiple news outlets further report how the protests extended to Western Europe this past summer, which in some cases were associated with QAnon and neo-Nazi groups. We definitely need our amazing Houston Holocaust Museum to delve into these matters.
Texas vaccine education
Anti-vaccine and anti-science groups and activities should not dominate Texas. Our state is built on true greatness that includes our extraordinary university systems: University of Texas, Texas A&M, Texas Tech, University of Houston, Texas State University, Texas Southern University, and of course Baylor, Rice and the Texas Medical Center, in addition to dedicated advocacy groups like The Immunization Partnership and Immunize Texas. Texas Children’s Hospital and Baylor College of Medicine are scientific powerhouses where I have the privilege to work.
Through our Texas Children’s Center for Vaccine Development I co-head with Dr. Maria Elena Bottazzi, our scientists developed a new COVID-19 vaccine whose cost will be low enough for use across low-and-middle-income countries, so everyone has access, not just the United States and Europe.
Through a collaboration with Biological E (BioE) and Dynavax, our vaccine is now undergoing clinical testing in India and the production of 1.2 billion doses. We hope this non-exclusive arrangement with private companies will be replicated in other countries as well. Simultaneously, I’m doing all I can to save lives in the United States by communicating the urgency of preventing needless deaths that result when large numbers of the sick cause surges on our hospitals and intensive care units.
Death rates skyrocket when nurses, doctors and other hospital ICU staff become exhausted and overwhelmed. This occurred last spring in New York and Southern Europe, and it is why we might lose so many Americans, including Texans, by early February. Saving lives means implementing measures to maximize social distancing and face masks in order to slow hospital admissions.
We won’t need such measures for too much longer. There is good news ahead, as our first COVID-19 vaccines become available in the United States. The first two from Pfizer and Moderna rely on a new mRNA technology, followed by two adenovirus-vectored vaccines from AstraZeneca-Oxford and Johnson & Johnson. We hope that our Baylor and Texas Children’s vaccine will also become available next summer, initially in India and later globally including the United States.
But our successes are being undermined by powerful anti-science forces linked to extremism. Now they threaten the health and security of Texans. Last year measles returned to Texas and the United States, and now COVID-19 will soon rank as one of the single largest killers in our state.
There is an urgency to prevent the deaths and save the lives of 15,000 Texans. The message is simple: If we halt the surges on our ICUs and hospitals, practice social distancing and wear masks, then many fewer will die. We then lead everyone through to the other side, get them vaccinated beginning in a few weeks, and allow them to live.
As we start vaccinating Texans, we will need unprecedented levels of public communication. I can already see on social media and other platforms how the anti-vaccine and anti-science forces are gathering to fight us. Ultimately, health freedom is a meaningless slogan designed to divide and intimidate. Also, watch out for the absurd conspiracy theories involving Anthony Fauci, Bill Gates or even me, typically combined with some odd combination of fretting over 5G networks or implanting microchips.
The Operation Warp Speed vaccines have been tested to the highest possible standards for efficacy and safety. The clinical trials include testing each vaccine on 30,000 to 60,000 individuals in order to pick up even rare safety events. Right now, the Food and Drug Administration is carefully scrutinizing the data from these trials to begin releasing vaccines under emergency-use authorization, beginning with the Pfizer-BioNTech vaccine, followed by others. The information received so far indicates they are highly protective and will save the life of you and loved ones. They work in older and minority populations.
As we vaccinate the U.S. population against COVID-19, our nation will be in a much better place. By spring or summer at the latest, a significant percentage of our adult population will be protected against this awful illness. America is built on a tradition of science and innovation. It helped us achieve victory in World War II, send humans to the moon, win the Cold War, and one day soon, I hope, conquer AIDS. Science and vaccines will also get us past COVID-19.
Hotez MD PhD is Professor of Pediatrics and Molecular Virology & Microbiology and Dean of the National School of Tropical Medicine at Baylor College of Medicine. His forthcoming book is entitled, “Preventing the Next Pandemic: Vaccine Diplomacy in a Time of Anti-Science.”
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