Part 2 of 3 - too long for one post
‘The public is demanding it’
Oklahoma requires children entering school to be vaccinated for nine diseases, including measles, chickenpox and polio. Parents can apply for exemptions on medical, religious or personal grounds. Medical exemptions represent the smallest share of school exemptions in the state.
House Majority Floor Leader Jon Echols, R-Oklahoma City, anticipates the state Health Department would update the vaccination schedule for children to include COVID-19 once a safe and effective vaccine is available and the Legislature would approve it as long as parents could apply for the same exemptions.
“I think it would be widely used,” Echols said. “I would take it.”
But a general requirement to be vaccinated would not fly, Echols said. “There’s no chance of the Oklahoma Legislature passing a People’s Republic of China mandate,” he said.
Nationwide nearly half the states require young adults be vaccinated against meningococcal disease before heading to college, and 15 states also require the hepatitis B vaccine.
But unlike policies for children, few requirements exist for adult immunizations in the U.S. and little public health infrastructure supports mass vaccination of adults, according to the National Conference of State Legislatures.
Doctors and scientists say every vaccine has an adverse reaction rate. For the measles vaccine, it is one per 1 million people vaccinated, according to the World Health Organization. “But you save 40 to 50 people (per million) from dying,” Yen said.
The benefits of the eventual COVID-19 vaccine will “hugely outweigh the risks,” he said. “Coronavirus is way deadlier than measles.” Even if the death rate turns out to be only 1%, a vaccine given to 1 million people would save 10,000 lives, Yen said.
Scientists across the globe are fast-tracking development of a COVID-19 vaccine, with 118 candidate vaccines in the works, the World Health Organization reports. Of those, eight are in clinical or human trials and 100 are not yet being tested on humans.
It’s not clear when a safe and effective vaccine would be developed and available for distribution. Predictions have ranged from 12 or 18 months to at least a few years out, and residents in developed countries, or ones that originate a successful vaccine, could gain vaccine immunity first, while more impoverished countries wait.
The U.S. Food and Drug Administration is streamlining its processes for coronavirus vaccines and therapeutic treatments.
“The FDA is going to rush it through,” said William Hildebrand, a research professor at the University of Oklahoma College of Medicine who is among the many scientists worldwide working to create a vaccine. “The public is demanding it.”
Hildebrand’s team is looking at using the body’s protective T-cells to find and kill virus-infected cells, rather than developing a vaccine that helps the body produce antibodies. It’s a long shot, he said.
“Everybody’s odds are a little long (individually), but collectively our odds are pretty good,” Hildebrand said. “The odds are pretty good the scientific community is going to come up with something that will stop this virus.”
For a vaccine to stop the spread of an infectious disease, a sufficiently high number of people must be immune to the disease. That provides indirect protection, or herd immunity, to those who aren’t vaccinated or who have compromised immune systems and are at greater risk of catching an infection, including babies, older adults or people with certain medical conditions.
Herd immunity for each disease is based on how many additional cases each infected person will cause during their infectious period. One person with measles, for example, will infect 12 to 18 others, so, based on a complex calculation, 90% of the population needs to be vaccinated to ensure the disease does not spread.
In the case of COVID-19, the science shows an infected person will pass it along to about three others, meaning about 70% of the population will need to be vaccinated to reach herd immunity, said Gary Raskob, dean of the OU College of Public Health.
An analysis by the Journal of Infection in mid-March estimated that the percentage of a population that must be immune via vaccination or natural immunity to halt the spread of COVID-19 varies by country. In Kuwait, it’s less than 6%; in Japan, 33%; and in Spain, 81%. The percentages are based on R-naught values, the epidemiological number for the reproduction rate of the virus.
“The vaccine will be crucial,” Raskob said. “We have to get the public to understand the importance of vaccination.”
Public acceptance likely will be better than for the measles vaccine, he said. “Since measles was eradicated, many people have never seen a case of measles, even most physicians practicing today,” Raskob said.
Not so with COVID-19. People are reminded daily of the severe and fatal effects of the disease and many people have personal experience with it. People are likely to be waiting in line as production scales up once the FDA approves a vaccine, he said.
If there’s not enough vaccine to meet the initial demand, it would likely go first to health care workers and then the most vulnerable population, Raskob said. Hospitals and long-term care facilities will have the ability to require that employees be vaccinated over any personal objections, he said.
Oklahoma law currently requires hospital employees to provide documentation of immunity to measles, mumps, rubella and varicella. In addition, several hospitals have adopted the Oklahoma Hospital Association policy that supports mandatory employee influenza vaccinations as a condition of employment in hospitals.