Updates on the COVID-19 pandemic from the Johns Hopkins Center for Health Security.

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EPI UPDATE The WHO COVID-19 Dashboard reports 119.8 million cases and 2.7 million deaths as of 5am EDT on March 16. Global weekly incidence increased for the second time in 3 weeks*, up to 3.0 million new cases. This represents a 10.4% increase over the previous week. Global weekly mortality continues to decline for the seventh consecutive week. Mortality fell to 59,031 deaths, a 3.33% decrease from the previous week.
*The weekly incidence last week remained essentially consistent with the previous week (-0.15% change).

Global Vaccination
The WHO reported 325.6 million vaccine doses administered globally, including 190.7 million individuals with at least 1 dose. The dashboard does not yet include daily or weekly vaccinations.

Our World in Data reports that 381.3 million vaccine doses have been administered globally, a 22% increase compared to this time last week. The daily average is approaching 10 million doses per day. The current average of 9.7 million doses per day is a 37% increase compared to a week ago. At least 133 countries and territories are reporting national vaccination data.

The US CDC reported 29.3 million cumulative cases and 532,355 deaths. After several weeks of steady decline, the national daily incidence appears to have leveled off to some degree. The current 7-day window includes March 8, when Missouri reported more than 81,000 previously unreported cases, so the current average is still artificially inflated. We expect the actual average is closer to 55,000 new cases per day. This would indicate that daily incidence is still decreasing, but more slowly than it was previously. Daily mortality continues to decrease steadily, down to 1,212 deaths per day—the lowest average since November 15, 2020.

US Vaccination
The US CDC surpassed 100 million SARS-CoV-2 vaccine doses administered on March 9. In total, the US has distributed 135.8 million doses of SARS-CoV-2 vaccines and administered 109.1 million doses nationwide. This includes 71.1 million people (21.4% of the entire US population; 27.5% of the adult population) who have received at least 1 dose of the vaccine, and 38.3 million (11.5%; 14.8%) who are fully vaccinated. Among adults aged 65 years and older, 64.1% have received at least 1 dose and 35.9% are fully vaccinated.

The US once again surpassed 2 million doses administered per day*, including 829,356 individuals fully vaccinated (i.e., second dose of a 2-dose vaccine or a single dose of a 1-dose vaccine). Broken down by manufacturer, both the Pfizer-BioNTech and Moderna vaccines surpassed 50 million cumulative doses, and the J&J-Janssen vaccine is approaching 1.5 million doses**.
*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.
**As a 1-dose vaccine, all individuals receiving the J&J-Janssen vaccine are fully vaccinated.

As the US SARS-CoV-2 vaccination program continues to scale up, vaccination administration and coverage are becoming more even between states. Currently, the median state-level doses delivered is 41,289 doses per 100,000 population, and most states are within approximately 5% of that total. In terms of doses administered, the median state-level total is 34,066 doses per 100,000 population. The variation is only slightly larger for administered doses, with most states falling within 7-8% of that total.

With respect to distributed doses, only Utah (35,715) has received less than 90% of the median value. With respect to doses administered, only Alabama (26,644), Georgia (26,278), and Tennessee (28,589) are reporting less than 85% of the median. Notably, South Dakota and Alaska have received 26.1% and 56.4% more than the median value, respectively. Both states are also among the top 3 in terms of doses administered, with Alaska at #1 (35.3% more than the mean), New Mexico at #2 (+33.4%), and South Dakota (+25.6%). Similarly, the median proportion of doses administered—i.e., out of the number of doses received—is 82.4%, and most states fall between 78.5-85.9%. In total, 5 states have administered more than 90% of their received doses, including Washington state at #1 with 94.3%. At the other end of the spectrum, Alabama (68.1%) is the only state to administer fewer than 70% of its doses.

Looking at actual vaccination coverage (i.e., the proportion of the population that has been vaccinated), most states are within 6-8% of the median values. With respect to individuals who have received at least 1 dose of the vaccine, the median coverage is 22.2% of the total state population. Most states fall between approximately 20.5-24%. Eight states are reporting greater than 25% coverage for at least 1 dose, including New Mexico (29.3%), Alaska (28.1%), and South Dakota (27.6%). Ten states are reporting less than 20% coverage, including Tennessee (18.5%), Alabama (17.4%), and Georgia (15.9%). Trends in full vaccination coverage are fairly similar. The median coverage is 12.3%, and most states fall between approximately 11.25% and 13%. Alaska (18.1%), New Mexico (16.9%), and South Dakota (15.6%) are the only 3 states reporting full vaccination coverage greater than 15%, and Texas (9.9%), Tennessee (9.8%), Georgia (9.8%), and Utah (8.3%) are the only states reporting less than 10% coverage.

With respect to older adults, states are reporting wider variation in terms of vaccination coverage. Looking specifically at full vaccination for adults aged 65 years and older, the median coverage is 36.3%, and most states fall between approximately 32.5-41.5%. At the upper end, 2 states have fully vaccinated more than half of their older adult population: Alaska (55.6%) and Indiana (50.1%). At the other end of the spectrum, Oregon (21.8%) and Rhode Island (21.4%) are the only 2 states that have fully vaccinated less than a quarter of their older adult population.

ASTRAZENECA-OXFORD VACCINE & BLOOD CLOTTING Multiple countries in Europe—including Germany, Italy, France, Spain, the Netherlands, Norway, Iceland, Ireland, Denmark, Bulgaria, Sweden, and Latvia—have temporarily suspended use of the AstraZeneca-Oxford SARS-CoV-2 vaccine due to reports of blood clots occurring in a small number of vaccinated individuals. The suspensions are creating additional challenges for vaccination campaigns across Europe, as the region faces a third surge. AstraZeneca has reported 15 events of deep vein thrombosis and 22 events of pulmonary embolism in vaccinated individuals as of March 8.

The European Medicines Agency (EMA) and the WHO will meet today to review data on the vaccine and blood clotting. The EMA then plans to hold a meeting on March 18 to discuss the findings of their investigation and announce any resulting recommendations. A WHO spokesperson noted the agency thus far has not received reports of blood clotting events outside of Europe. In a press release on March 14, AstraZeneca said a review of data from 17 million vaccine recipients in Europe and the UK demonstrated “no evidence of an increased risk of pulmonary embolism, deep vein thrombosis (DVT) or thrombocytopenia, in any defined age group, gender, batch or in any particular country.” As the EMA and the WHO investigate the reports, the agencies continue to advise there is no evidence the AstraZeneca-Oxford vaccine has caused the blood clotting events and that the benefits of the vaccine outweigh the potential risks of adverse events. 

GLOBAL VACCINE ACCESS & PRODUCTION US President Joe Biden is under increasing pressure to share the nation’s SARS-CoV-2 vaccine supply with other countries. On Friday, President Biden met virtually with the leaders of Japan, India, and Australia—members of the Quadrilateral Security Dialogue, an alliance to address mutual concerns about China—and agreed to work together to increase production of SARS-CoV-2 vaccines in India to bolster the Indo-Pacific region’s supply. The summit committed to supplying at least 1 billion vaccine doses to the region by the end of 2022. Though not the focus of the agreement, the leaders hope these efforts will challenge China’s growing influence in the region and other parts of the world, as China’s ability to produce millions of vaccine doses and ship them to low- and middle-income countries has offered it advantages in terms of strengthening diplomatic and economic relations.

ITALY LOCKDOWN Italy is reinstating lockdown measures in order to curb Europe’s potential third wave of COVID-19. The measures came into effect on March 15 and are set to last through April 6, spanning the upcoming Easter holiday weekend. Unlike previous national lockdowns, not all areas of the country will be subject to the same measures, based on their risk level. Italy’s regions are broken down into 4 levels—red, orange, yellow, and white—with red being the highest level of risk and white being the lowest level of risk. Red zone regions will be subject to the most restrictive lockdown measures, including stay-at-home orders (except for essential work or shopping), closure of non-essential businesses, and suspension of indoor and outdoor activities. Additionally, Italy is strengthening measures in yellow and orange zones to include restrictions previously designated for the next higher level.

Approximately half of Italy’s regions are currently in the red zone, including Rome, Milan, and Venice. The risk classifications are subject to regular review, but areas with more than 250 weekly cases per 100,000 population will be classified automatically as a red zone. Additionally, all regions will be subject to red zone measures over the Easter weekend, April 3-5, in order to limit travel and family gatherings during the holiday. The nationwide mask mandate remains in effect, as well as a national curfew from 10pm-5am.

Italy is not the only European country attempting to stave off a third wave. Germany’s daily incidence appears to be rising, and hospitals in Hungary are mobilizing surge capacity to combat a COVID-19 patient surge. 

COMBATING VACCINE HESITANCY As we have covered previously, vaccine hesitancy remains a major challenge during the COVID-19 pandemic. Existing hesitancy toward routine immunizations is compounded by skepticism regarding the pace of research, development, and testing for the novel SARS-CoV-2 vaccines as well as apathy and concerns regarding inequitable access. In an effort to combat vaccine hesitancy in the US, the White House is reportedly implementing a nationwide public relations campaign with the hope of influencing both those who are opposed to SARS-CoV-2 vaccination and those who remain uncertain whether they should get vaccinated.

According to a report by STAT News, the US$1.5 billion effort will target younger individuals, who may not view themselves as being at risk for COVID-19; racial and ethnic minorities, who may face barriers to accessing the vaccine and mistrust of government; and those on the conservative end of the political spectrum, who may not view COVID-19 as a threat or may oppose the Biden Administration on political grounds. While the program will be initiated at the federal level, the plan includes a significant focus on supporting local community outreach efforts. And while much of the initiative’s funding comes from the most recent COVID-19 funding package, the White House already has pledged an additional US$500 million from other sources for education and outreach programs, including those aimed at racial and ethnic minorities and other underserved communities.

FACEBOOK VACCINE ACCESS & VACCINE HESITANCY Beyond outreach and education efforts by national, state, and local governments and community organizations, social media platforms also are beginning to recognize their role in combating vaccine hesitancy. On March 15, Facebook announced plans for a global campaign to support SARS-CoV-2 vaccination. The company will now add labels and links to official information (eg, from the WHO) on Facebook and Instagram posts discussing SARS-CoV-2 vaccination. In addition to providing updated, factual information about the vaccines, Facebook’s Covid Information Center will add a tool to help individuals schedule vaccination appointments. Facebook also is partnering with national governments to support communication efforts via WhatsApp, including official notifications to inform individuals they are eligible to schedule vaccination appointments.

Facebook is also conducting internal research on the spread of vaccine hesitancy and misinformation via its various social media platforms. The research includes an examination of both vaccine hesitancy-related content as well as the social networks through which misinformation spreads. Preliminary analysis found that only a small portion of the users and networks on Facebook platforms engage in the majority of vaccine hesitancy content. In fact, 10 of 638 “population segments” analyzed contained half of all vaccine hesitancy content, and in the most prominent segment, only 111 users were responsible for half of the vaccine hesitancy content—out of more than 3 billion users worldwide. In partnership with Carnegie Mellon University and the University of Maryland, Facebook is providing data and analysis of SARS-CoV-2 vaccine hesitancy trends that can support government efforts to implement effective outreach campaigns.

J&J-JANSSEN VACCINE WHO EMERGENCY USE LISTING On March 12, the WHO issued an emergency use listing for the J&J-Janssen SARS-CoV-2 vaccine. The WHO made the designation only one day after the European Commission authorized the vaccine, with WHO and outside evaluators using an “abbreviated assessment” based on the review by the European Medicines Agency (EMA). In addition to the EMA review, the WHO considered quality, safety, and efficacy data and suitability requirements for low- and middle-income countries, including cold chain storage and risk management plans. The J&J-Janssen vaccine is the first single-dose vaccine to receive emergency use listing by the WHO, which should help facilitate vaccination campaigns in many countries, according to the agency. The WHO also has listed the Pfizer-BioNTech and AstraZeneca-Oxford vaccines for emergency use. 

US SECOND-DOSE VACCINATION COVERAGE Researchers from the US CDC COVID-19 Response Team published findings from a study on the proportion of vaccinees who received their first dose of a SARS-CoV-2 vaccine that went on to receive their second dose. The study, published in the US CDC’s MMWR, included 2 analyses based on data from more than 40.5 million first doses of the Pfizer-BioNTech and Moderna vaccines administered December 14, 2020-February 14, 2021. Current guidance recommends that Pfizer-BioNTech vaccine recipients receive their second dose 21 days after their first dose and that Moderna recipients receive their second dose 28 days after their first dose. However, individuals may receive their second dose up to 42 days after their first dose for either vaccine, if a delay is unavoidable. Among vaccinees who received their first dose, 88% received the second dose within the recommended timeframe, and 8.6% had not received the second dose but had not yet reached Day 42. Among all individuals who received both doses, 95.6% completed the vaccination series within the allowable time.

The researchers noted differences among jurisdictions and demographic groups and recommended that public health officials identify and address challenges to receiving a second dose to ensure equitable distribution. Some of their recommendations include scheduling an appointment for a second dose at the time of first-dose administration, rescheduling any cancelled vaccination clinics, and sending appointment reminders to first-dose recipients.

US CDC CHILDCARE GUIDANCE Following its issuance of updated COVID-19 guidance for schools, the US CDC published revised recommendations for childcare programs. The new guidance, published on March 12, includes updates regarding mask use for younger children, cohorting and staggering children’s schedules, communal spaces and playgrounds, and ventilation. The guidance is intended for a broad range of childcare settings, including dedicated childcare facilities, pre-kindergarten and Head Start programs, and home-based services, and it includes specific guidance for children with disabilities or special needs as well as individuals, including staff, at elevated risk for severe disease and death. In addition to the guidance itself, the CDC discusses evolving evidence regarding SARS-CoV-2 transmission risk in childcare settings and COVID-19 disease risk in children.

The new guidance increases the emphasis on mask use by all children 2 years and older, except when eating or sleeping, and reinforces consistent and proper use by children. The new guidance reiterates that mask use should be used in combination with proper physical distancing, not as a substitution. The guidance also discusses vaccination for childcare staff, noting that childcare workers are covered in the federal Phase 1b vaccination priority group guidance as essential workers as well as the recent Department of Health and Human Services directive to states to expand eligibility to educators. The guidance also reiterates that COVID-19 risk mitigation measures need to remain in place even after childcare personnel are vaccinated.

COMMUNIVAX WEBINAR The Johns Hopkins Center for Health Security is hosting a webinar as part of the CommuniVax initiative to discuss recommendations from its first report on engaging communities of color to promote equity in SARS-CoV-2 vaccination. The webinar will include presentations by Dr. Monica Schoch-Spana from the Johns Hopkins Center for Health Security, Lois Privor-Dumm from the Johns Hopkins International Vaccine Access Center, Dr. Stephen B. Thomas from the Maryland Center for Health Equity, and Ysabel Duron from The Latino Cancer Institute, with Dr. Emily Brunson from Texas State University as moderator. The webinar will be held on Thursday, March 18 at 2pm EDT. Advance registration is required.