RIO DE JANEIRO, BRAZIL – Vaccines currently are the primary strategy to combat Covid-19 around the world. For instance, the narrative related to the ongoing surge of new cases in the United States (US) is argued to be driven by areas with low vaccination rates.
A similar narrative has also been observed in Germany and the United Kingdom. At the same time, Israel hailed for its fast and high vaccination rates, has also seen a substantial resurgence in Covid-19 cases.
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S V Subramanian from the Harvard Center for Population and Development Studies, Cambridge, MA, USA and Akhil Kumar from the Indian Institute of Science investigated in a recent study the relationship between the percentage of the fully vaccinated population and new Covid-19 cases across 68 countries and 2947 counties in the US.
FINDINGS
At the country level, there appears to be no discernable relationship between the percentage of the population fully vaccinated and new Covid-19 cases in the last seven days. The trend line suggests a marginally positive association such that countries with a higher percentage of the population fully vaccinated have higher Covid-19 cases per 1 million people.
Notably, with over 60% of their population fully vaccinated, Israel had the highest Covid-19 cases per 1 million people in the last seven days. The lack of a meaningful association between the percentage of the population fully vaccinated and new Covid-19 cases are further exemplified, for instance, by comparison of Iceland and Portugal.
Both countries have over 75% of their population fully vaccinated. They have more Covid-19 cases per 1 million people than countries like Vietnam and South Africa, with around 10% of their population fully vaccinated.
Across the US counties, the median new Covid-19 cases per 100,000 people in the last seven days are similar, mainly across the categories of percent population fully vaccinated.
Notably, there is also substantial county variation in new Covid-19 cases within categories of percentage population fully vaccinated. There also appears to be no significant signaling of COVID-19 cases decreasing with higher percentages of the people fully vaccinated.
Of the top 5 counties that have the highest percentage of the population fully vaccinated (99.9–84.3%), the US Centers for Disease Control and Prevention (CDC) identifies 4 of them as “High” Transmission counties.
Chattahoochee (Georgia), McKinley (New Mexico), and Arecibo (Puerto Rico) counties have above 90% of their population fully vaccinated, with all three being classified as “High” transmission.
Conversely, of the 57 counties that have been classified as “low” transmission counties by the CDC, 26.3% (15) have a percentage of the population fully vaccinated below 20%.
Since complete immunity from the vaccine is believed to take about two weeks after the second dose, the researchers conducted sensitivity analyses by using a 1-month lag on the percentage of the population fully vaccinated for countries and US counties.
The above findings of no discernable association between Covid-19 cases and levels of fully vaccinated were also observed when we considered a 1-month lag on the levels of fully vaccinated.
The researchers note that the Covid-19 case data is of confirmed cases, which is a function of both supplies (e.g., variation in testing capacities or reporting practices) and demand-side (e.g., variation in people’s decision on when to get tested) factors.
INTERPRETATION
The sole reliance on vaccination as a primary strategy to mitigate Covid-19 and its adverse consequences needs to be re-examined, especially considering the Delta (B.1.617.2) variant and the likelihood of future variants. Other pharmacological and non pharmacological interventions may need to be put in place alongside increasing vaccination rates.
Such course correction, especially regarding the policy narrative, becomes paramount with emerging scientific evidence on the actual-world effectiveness of the vaccines.
For instance, in a report released from the Ministry of Health in Israel, the effectiveness of 2 doses of the BNT162b2 (Pfizer-BioNTech) vaccine against preventing Covid-19 infection was reported to be 39%, substantially lower than the trial efficacy of 96%.
It is also emerging that immunity derived from the Pfizer-BioNTech vaccine may not be as strong as immunity acquired through recovery from the Covid-19 virus.
A substantial decline in immunity from mRNA vaccines 6-months post-immunization has also been reported [9]. Even though vaccinations offer protection to individuals against severe hospitalization and death, the CDC reported an increase from 0.01 to 9% and 0 to 15.1% (between January to May 2021) in the rates of hospitalizations and deaths, respectively, amongst the fully vaccinated.
In summary, even as efforts should be made to encourage populations to get vaccinated, it should be done so with humility and respect. Stigmatizing people can do more harm than good.
Notably, other non-pharmacological prevention efforts (e.g., the importance of essential public health hygiene with regards to maintaining safe distance or handwashing, promoting better frequent and cheaper forms of testing) needs to be renewed to strike the balance of learning to live with Covid-19 in the same manner we continue to live a 100 years later with various seasonal alterations of the 1918 Influenza virus.
METHODS
They used Covid-19 data provided by the Our World in Data for cross-country analysis, available as of September 3, 2021, and included 68 countries that met the following criteria: had second dose vaccine data available; had Covid-19 case data available; had population data available; and the last update of data was within three days before or on September 3, 2021.
For the seven days preceding September 3, 2021, they computed the Covid-19 cases per 1 million people for each country and the percentage of the population that is fully vaccinated.
The country-level analysis in the US utilized the White House Covid-19 Team data, available as of September 2, 2021. They computed the number and percentages of counties that experienced an increase in Covid-19 cases by levels of the percentage of people fully vaccinated in each county.
They excluded counties that did not report fully vaccinated population percentage data yielding 2947 counties for the analysis.
The percentage increase in Covid-19 cases was calculated based on the difference in patients from the last seven days and the seven days preceding them. For example, Los Angeles County in California had 18,171 cases in the previous seven days (August 26 to September 1) and 31,616 cases in the last seven days (August 19–25), so this county did not experience an increase of patients in the dataset.
There is a dashboard of the metrics used in this analysis that is updated automatically as new data is made available by the White House Covid-19 Team.
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