Mutations, vaccines and patience: What the next six pandemic months look like

Patience and persistence.

That’s what Amy Rohling McGee, president of the Health Policy Institute of Ohio, is preaching about a vaccination process that’s as much a feat of scientific achievement as it is “extraordinarily slow.”

The mass immunization process against COVID-19 was always going to feel like a hurry-up-and-wait affair, but watching officials mete out a scarce supply of finnicky vaccines in real time is testing the world’s collective patience.

“Try to appreciate the complexity of cold storage, mass vaccination, in the middle of a pandemic when you need to keep people socially distanced and apart, which means appointments, with a multi-dose vaccine, all with an unstable supply chain,” said Dr. Robyn Strosaker, chief operations officer at the Cleveland Medical Center.

When measured by the percentage of citizens who have received one dose of the vaccine, only 12 U.S. states have moved slower than Ohio, according to federal data analyzed by The New York Times.

From the first shots Dec. 14 to Monday, the Ohio Department of Health has received 1.74 million vaccine doses from manufacturers and delivered 1.55 million of them to providers, according to department spokeswoman Melanie Amato.

About 854,000 Ohioans have started the vaccination process, according to ODH’s vaccination dashboard. Officials say this metric is prone to data lag.

Pitted against the mass vaccination campaign are new mutations of the SARS-CoV-2 virus, which causes COVID-19, arising in the U.S. Scientists say some of the mutations, including one originating in the U.K., spread more efficiently than the dominant U.S. strain; early data suggests the vaccines offer weakened, but still powerful protection against another rapidly emerging mutation from South Africa.

As of now, the U.S. Food and Drug Administration has only authorized two vaccines for use against COVID-19: one from Moderna, and one from Pfizer and BioNTech. They both require two doses, taken three and four weeks apart, respectively.

The Pfizer vaccine spoils without “ultracold storage,” requiring either special, expensive freezers or a more jerry-rigged dry ice approach. The Moderna vaccine requires simple refrigeration. Both are extremely temperature sensitive.

Whenever her hospital receives vaccines, Strosaker said the goal is to begin administering them within 72 hours and depleting the supply within a week. Using a converted conference room and cafeteria as vaccination clinic, she said the facility can administer about 1,200 doses per day.

Strosaker said new supply typically comes in a three-day window and on a few days’ notice, hence the “enormous logistical lift” of scheduling appointments and quickly administering doses with neither waste nor haste.

“If we had a stable, predictable supply chain, we could certainly plan against that much easier,” she said. “But right now, we’re sort of just waiting for information and reacting. When situations change, which happens all the time, we just have to react to it.”

The upshot: Johnson & Johnson said Friday its vaccine provided complete protection against COVID-19 related hospitalization and death and was 85% effective against infection in a clinical trial of nearly 44,000 participants. Better yet, the vaccine does not require special cold storage and it comes in a one-dose shot.

Vaccines from two more companies — Novavax and AstraZeneca (which is authorized for use in the UK) — have released promising data about their vaccines but have not yet requested that the FDA approve their use in the U.S.

While emerging mutations raise the stakes, experts aren’t surprised to see them come to light given the hundreds of thousands of new cases detected in the U.S. by day in January.

“It’s not too surprising that we have strains that are different, strains that are more infectious.,” said Dr. Bill Miller, an epidemiologist with Ohio State University. “That’s what viruses do.”

While the early vaccine rollout and distribution could have gone smoother, there’s reason for optimism, according to seven public health experts interviewed for this article. Many described the simple fact that there’s more than one vaccine for use within a year of discovery of the new coronavirus as a “miracle.”

In a moment where extra-contagious mutations and mass vaccination are both gaining speed, there has never been a more important time to follow the public health guidance of social distancing, masking, and limiting social contacts, according to Dr. Mark Cameron, an immunologist with Case Western Reserve University.

“The virus has all this new potential for harm against us now, all of a sudden,” he said. “We desperately need to keep up our own personal and public health fight.”

Ohio is currently vaccinating people 70 and older; people with certain chronic medical conditions or developmental or mental health disabilities; and starting this week, employees of K-12 schools that will be working in-person.

The rollout in Ohio has had its speedbumps. In Columbus, doses that likely otherwise would have spoiled wound up going to comparatively younger city prosecutors (Gov. Mike DeWine has since recommended providers create standby list with prioritized individuals). The Ohio Department of Health accused a provider of mishandling and spoiling 890 Moderna doses.

There are systems level issues as well.

Dr. Amy Edwards, an infectious disease physician at UH Rainbow Babies and Children’s Hospital, said while health care workers were prioritized in line, hospitals were left to coordinate vaccinating employees on their own without support — all in the middle of the worst infection surge to date.

She said physicians volunteered their time to vaccinate colleagues.

“At the beginning, it was a struggle to find volunteers to vaccinate,” she said. “It was a slow, painful trickle.”

McGee, from the Health Policy Institute of Ohio, said racial data is listed as “unknown” on about 14% of doses, obscuring whether minority groups receive equal access to the vaccine.

“That makes it difficult to assess whether we’re reaching Black Ohioans impacted by the pandemic,” she said.

Amato did not respond to questions about the missing race data, or whether ODH comprehensively tracks vaccine spoilage.

There are foreboding signs of vaccine hesitancy. Only 65% of Americans say they would be willing to take an FDA-approved COVID-19 vaccine today, according to a Jan. 12 Gallup poll. In the first month of vaccinations at nursing homes with at least one immunization clinic, only 34% of nursing home staff received the vaccine compared to 78% of residents.

The union representing workers at Ohio’s nursing homes says the trend holds true on a local level, citing ”trust issues,” perceptions of a rushed process, misinformation and other reasons nursing home staff are declining the vaccine.

The anti-vaccination movement in Ohio has built political clout with a faction of friendly lawmakers, one of whom was re-named to lead the House Health Committee.

Tara Smith, an epidemiologist with Kent State University, isn’t sweating it. She says the vaccine hesitant will come around, even if the lost causes won’t.

“Some people will just never take it,” she said. “We just have to be realistic.”

While there’s cause for doom and gloom, Miller said he’s feeling optimistic.

The U.S. hit a couple of days last months in which more than 1 million Americans were vaccinated in a day. The weather will soon warm in Ohio, luring people outdoors where transmission is less likely. More vaccines are coming. The coming months, he said, will require patience, but an end is coming.

“I think the main thing for people to remember is we have competing influences here,” he said. “We have new strains that are potentially more infectious, and we have vaccines. We’re potentially on the cusp of things getting better, but they will only get better if we stay strong and see our way through it.”