WPoultry Disease Control and Prevention Advisory Committee Voted Tuesday As for the Covit-19 vaccine, residents of long-term care facilities should be at the forefront of the line – with health care providers – from a researcher who disagrees alone with a researcher who studies vaccines in the elderly.
Helen Keep Talbot – better known by her middle name – raised serious concerns during a meeting of the Advisory Board on Immunization Practices for the Use of Vaccines for the Vulnerable Elderly, and there is no data yet to recommend that vaccines work in this population.
All phase 3 trials of Govt vaccines based in the United States should include people 65 years of age and older. But no one has tested the vaccine specifically for those in long-term care. He said the findings indicate that people over the age of 65 are healthy enough to accept a medical examination.
At an earlier ACIP meeting, Talbot warned that it would be dangerous to vaccinate these people at the beginning of the vaccine roll because long-term care residents have high levels of clinical events that can confuse them as side effects of the vaccine and undermine confidence in vaccines. “My grandmother got vaccinated and she passed away,” he said.
STAT spoke with Talbot, an associate professor of infectious diseases at Vanderbilt University on Zoom, asking why they voted against including long-term care residents into “Phase 1A” to access the Govt-19 vaccine, which will be released in the second half of December.
The dialogue is easily edited for clarity and length.
It is somewhat unusual to see ACIP – this is an evidence-based decision-making body – recommend on the assumption that vaccines work for the weaker elderly.
I think they did it based on the data. Only data on the number of deaths in that population. The death toll in that population is much higher than the number of victims. That was the impetus for that referendum.
You study vaccinations for the elderly. Tell me why you think vaccinating long-term care residents is not the right approach.
I think it would be the right approach if we had data.
That’s the kicker. We routinely, and until recently for all of our adult vaccines, tested them on college-age children and military recruits, found they worked, and used older ones for them.
The first example is the flu. In the 1960s, the General of Surgery, it worked on young, healthy adults, so it should work to some extent in the elderly. Since 1960, “because it might work to some extent.”
We need to get out of assuming that these vaccines work, actually design them and test them in this population and use them properly.
Are you worried that these are wasted amounts?
I will not say in vain. But they were not used as efficiently as they could have been.
If I knew it worked in a healthy healthcare worker, I would love to vaccinate all healthcare workers so that when they are around vulnerable elderly people they will not get sick to the vulnerable elderly.
We do not have enough vaccines for all health workers. We will come at the end, but we have not come yet.
Do you have any safety concerns about the use of the vaccine for long-term care residents?
Is there anything other than anyone else? No, but what is typical for adults is a randomized control test for viewing security data.
What do you say?
If anything happens to me following the vaccination, we go to randomized control test data and see if this happens in both groups. Whether or not the placebo happened in the group. We cannot do that for the long term maintenance facility because a test has not been done on the long term maintenance facility.
Can’t you extend from the General Phase 3 test?
We can try. But that is not certain. Because it is a different population with different comorbidities and weaknesses.
The chances of something like a stroke or death on the 30th, 60th, or any day after vaccination are very high among long-term care residents[Talbot nods vigorously.]
Here’s the deal. Events are all temporarily related. But how to take care of that patient and explain it to the nurse’s assistant who loves her like her own grandmother? Who says she decides not to vaccinate and not to vaccinate everyone else?
In the general population, the way you tease whether a health event seen after vaccination is due to it or is temporarily linked to it – it happened all at once – you can tell by knowing the underlying rates of these types of events: it is within the range of the number of strokes we expect at this time in this population .
Do long-term care residents not know the rates of events?
I googled the mortality rate in nursing homes and could not find anything. Now, I got a call with a group of elderly doctors, and I heard it. Some of them – not all of them – knew the data. I don’t know how common that knowledge is.
What is your fear? How do you see it playing?
I fear losing faith in the vaccine. The vaccine is actually really safe, but there will be temporary related events, and people will be afraid to use the vaccine. We can’t take our kids back to school and work – important things.