• Bincheng Mao

Dr. Jason Rosé on the Future of COVID: Fighting Vaccine Hesitancy with Reason and Kindness

In January 2022, Dr. Jason Rosé shares his insights on eliminating vaccine hesitancy, the potential impact of the SCOTUS decision on public health, and the future of this pandemic.

Dr. Rosé is our public health advisor at ECC. He is Co-lead of the Science Department at the King's Academy. Previously, he worked at Stanford University as a post-doctoral fellow, researching medicine and disease control. He earned his Ph.D. in Pharmacology at UCSF, where he was awarded NIH Training Grants. Dr. Rosé's works have been published in the American Journal of Respiratory and Critical Care Medicine, Biochemistry, and Advances in Experimental Medicine and Biology.

Q1: Recently, the LA Times published dueling op-eds about the proper societal response to prominent anti-vaxxers who died from COVID-19. From the perspective of saving lives and upholding morality, how should we properly react to the deaths of anti-vaxxers who once spread misinformation?

Dr. Rosé: Any death resulting from misinformation is a tragedy, and should be treated as such rather than as an opportunity to gloat or say “I told you so.” While it is tempting to feel that these individuals deserved what happened to them, that is not a reason to heap abuse on those who are suffering. I do think it would be appropriate to extend sincere condolences for the loss of a loved one and then plead with individuals in the anti-vaccine camp to consider that loss as an unnecessary tragedy that could have been prevented by vaccination. I have read many heartbreaking stories of unvaccinated individuals in hospitals regretting their decision to not be vaccinated on what eventually became their deathbeds. I think it is imperative that we extend grace to those who have made poorly informed decisions and encourage them to rethink their position. If this becomes yet another polarizing “I told you so” moment, that will only increase the resistance to changing their position of those who have preached anti-vaccine messages.

Q2: With the Omicron variant leading to rapid increases in case counts, how should we encourage vaccine-hesitant people, who cite “breakthrough” cases among the fully vaccinated as their reason for hesitation, to get vaccinated?

Dr. Rosé: Posted below is a chart from the New York Times Coronavirus Tracker page that I think shows very clearly why vaccination is critical in the face of the omicron wave.

(Source: New York Times Coronavirus Tracker)

You can clearly see there is an uptick in cases among the vaccinated, but that is NOT corresponding to an increase in either hospitalizations or deaths in that population. This is consistent with evidence from other countries that people with prior immunity from infection or vaccination are experiencing milder courses of illness with omicron. The much more significant increase in both cases and hospitalizations among the unvaccinated is an indication that omicron is both more likely to spread among the unvaccinated and more likely to result in hospitalization (and presumably death). I personally know many health care professionals who are watching their ICUs fill up with unvaccinated omicron cases, and they are telling me that there is nothing “mild” about this infection in these unvaccinated individuals.

Q3: On January 13, 2020, the Supreme Court struck down the Biden administration's vaccine-or-test rule for employers with over 100 employees. This mandate could encourage either vaccination or regular testing among 84 million Americans. From the point of view of public health, how does this Supreme Court decision change the future of epidemic/pandemic control?

Dr. Rosé: This is a complicated situation. What the United States has lacked all along is a clear Federal plan for dealing with pandemics, and this would have been the first step at creating such a plan. Although I realize it seems catastrophic, the existing mandate for Federal employees and health care workers remains in force. The Presidential mandate would have made it easier for employers to enforce vaccination and testing rules, which many private employers have already instituted pre-mandate. Those rules will remain in force. I saw the mandate as a means of providing protection for workers in industries that have traditionally overlooked worker safety, since it would probably have also resulted in funds to ensure adequate vaccine access and testing for those workers.

In light of the recent provision of testing kits subsidized by the government, I’m not sure this ruling is going to have much of an impact on the pandemic. A majority of transmission is taking place outside of the workplace, and although this ruling might have been able to facilitate vaccination of some hesitant or resistant individuals, it is unlikely to have made inroads in the populations where vaccine rates are low. I think we are back to relying on individual states to support rules for restricting transmission (masking, indoor venue limits, quarantine and isolation rules) as well as on private employers to ensure safe workplaces.

Q4: In the summer of 2021, many government officials were hopeful that the COVID-19 pandemic will soon be under control. In May, the CDC even dropped, and then quickly restored, the mask mandate for fully vaccinated people. Why did authorities get the future of this pandemic wrong, and what is an accurate picture of the years ahead with COVID?

Dr. Rosé: It is incredibly difficult to anticipate both the random variation of a virus and the impact of human behavior on the circulation of such a virus. Science deals with the most complete data it can get, and where little or no data exists there is only so much modeling and guesswork you can employ to predict what will happen. Many of our models are based on our experience with the four flu pandemics of the 20th century or on our experience with SARS 1. SARS-CoV-2 has unique features that render those models inaccurate. Sadly, in a manner consistent with the 1918 flu pandemic, officials and the general public seem to be constantly expecting that the end is just around the corner, rather than preparing for an extended struggle against this virus. I think that has weakened our resolve to invest time and resources for a protracted pandemic control effort.

Although the vaccines did relieve the burden of hospitalization and death on the health care system, our understanding of the role of the vaccine in preventing disease vs. transmission was not complete. Early decisions regarding masking were based on optimism stemming from early data showing the vaccine to be effective at preventing transmission, protection which time showed was not durable. A combination of widespread resistance to mask usage as schools started up in the fall of 2021, and the unanticipatable appearance of the omicron variant with its immune-escape phenotype have confounded our best efforts to control this infection.

In a manner consistent with the other human coronaviruses, it is entirely reasonable to expect that this virus will become endemic in the human population and circulate continuously for the foreseeable future. As the level of immunity in the population increases, it is also reasonable to expect that asymptomatic and mild infections will begin to dominate in the population, turning SARS-CoV-2 into a virus causing a disease very similar to the common cold. For the foreseeable future we need to consider COVID-19 and influenza as a combined threat during respiratory virus season and vaccinate appropriately to protect those at highest risk - the elderly and those with underlying risk factors. Continued efforts to increase the level of immunity in the world’s population as a whole through vaccination are critical to prevent the emergence of new variants and to reduce the impact of this virus on populations everywhere.