One of Texas’ top vaccine experts opened the TexMed 2021 General Session with mostly good news about the impact of COVID-19 vaccines, but he cautioned fellow physicians that antivaccine forces have become more formidable and that stronger efforts will be needed to combat them.
Peter Hotez, MD, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and co-director of the Texas Children’s Hospital Center for Vaccine Development, told Texas physicians the good news about COVID-19 vaccines is that they appear to work well against the B.1.1.7 variant from the United Kingdom that has become dominant in Texas.
“So I think we’re going to be in good shape if we can get everybody vaccinated,” he said.
The U.S. needs about 60% to 70% vaccination levels to slow or halt COVID-19 transmission, Dr. Hotez says.
Currently, 59% of U.S. adults 18 and older have received at least one dose of COVID-19 vaccine, according to Centers for Disease Control and Prevention.
Previously, Dr. Hotez had predicted the U.S. would reach 60% by June, and that would prompt the Centers for Disease Control and Prevention (CDC) to ease guidelines on masking and social distancing. Instead, CDC Director Rochelle Walensky announced an easing of the guidelines last week.
“I don’t actually have any real criticism of what she’s done,” he said. “I just would have thought it would come in June … So it came a couple of weeks early.”
Assuming the U.S. can reach proper levels of vaccination, life should return largely to normal by summer, Dr. Hotez says. However, there may be a lot less international travel for a while.
The pandemic will still be raging in Africa, Latin America, and many low-income countries in Asia because they remain mostly unvaccinated, making all international travel more difficult, Dr. Hotez says.
“That’s going to limit our ability to accelerate our economy, especially in the industries we have here in Texas, like the oil and gas industry,” he said.
Older Texans – those most vulnerable to COVID-19 – are well-vaccinated, Dr. Hotez says. But Texas and other parts of the South have low overall vaccination rates compared with other parts of the country, and that could lead to higher rates of COVID-19 this summer.
Texas ranks 41st of the 50 states and Washington, D.C., in percentage of population fully vaccinated, according to Becker’s Hospital Review.
“I don’t want to call it a fifth wave – that’s a bit dramatic,” he said. “But we could see a small surge in cases in Texas as we hit July and August, especially if we don’t pick up our vaccination rates because we’re still in the bottom half nationally.”
Getting tough on antivax efforts
Dr. Hotez’s frequent showdowns with antivaccine forces over the efficacy and safety of vaccines have made him a regular speaker on news shows.
A father of four children, Dr. Hotez wrote Vaccines Did Not Cause Rachel’s Autism, about one of his daughters who is on the autism spectrum. The book also debunks one of the founding myths of the antivaccine movement – that vaccines cause autism.
That experience has led him to believe that physicians need to become much more aggressive in fighting antivaccine messages.
“Just turning the other cheek and ignoring it is not enough,” he said. “We have to get educated and launch some kind of counteroffensive. And what that is, I don’t know. But it’s clear that we need to get advice from people who are outside the health sector who have experience in countering things such as global terrorism or cyberattacks or nuclear proliferation, because it’s reached that level.”
That effort is needed in part because the antivaccine efforts are increasingly sophisticated and diverse, Dr. Hotez says. The myths about vaccines are spread by different actors for different reasons.
Antivaccination groups like Texas-based Texans for Vaccine Choice have millions of followers, Dr. Hotez says. Also, right-wing podcasters like Alex Jones, based in Austin, regularly spread antivaccination views as part of various conspiracy theories. And the U.S. government has accused Russia of using antivaccine propaganda to make its own Sputnik V COVID-19 vaccine look more attractive.
“In the U.S., [the antivaccine movement] has taken a number of different forms,” he said. “It started in the early 2000s with what I call version 1.0 claiming that vaccines cause autism. And then it got this curious spin around 2015, when it became politicized under this banner of health freedom and medical freedom, especially here in Texas. And now we’re enduring version 3.0, which is the globalization of the antivaccine movement.”
Future outbreaks
During the question-and-answer period, American Medical Association President Susan R. Bailey, MD, a Fort Worth allergist and immunologist, asked Dr. Hotez what kind of influenza season physicians can expect later in 2021. She pointed out that the U.S. has seen a later-than-normal spike in cases of respiratory syncytial virus (RSV), an illness that frequently overlaps with flu.
Dr. Hotez said it’s hard to say how the flu season will play out, but the U.S. had a mild flu season in 2020 in large part because of masking and social distancing brought on by COVID-19. Without those measures in place, 2021’s flu season will be more robust.
“I know we’ll see a lot more cases just because how human behavior is going to change dramatically,” he said.
Houston psychiatrist Clifford Moy, MD, followed up with a question on what type of novel disease outbreaks are likely in the future.
Physicians should expect further coronavirus outbreaks, Dr. Hotez said, pointing to the three major ones since 2000: severe acute respiratory syndrome (SARS) in 2003, Middle East respiratory syndrome (MERS) in 2012, and COVID-19 in 2019.
“I have to believe we’re going to be seeing COVID-26 and COVID-32,” he said. “That’s going to be a new reality. So we have to also start putting some infrastructure to do surveillance for that and the possibility of a universal coronavirus vaccine, which is something we’re looking into as well.”
This long-awaited general session presentation (postponed from TexMed 2020 due to the pandemic) is supported by the TMA Foundation Louis J. Goodman Leadership in Medicine Fund.