But now the subsequent dominoes in the process of getting a vaccine may start wobbling.
The next step would normally be an ACIP meeting, but there is currently no ACIP, which is unprecedented. Two possible pathways are now in play, and both may end up being used:
- The standard federal pathway (blue below). Either an ACIP is chartered (a long shot), or the ACIP step is bypassed entirely, and the CDC director signs off on the vaccine independently.
- An alternative pathway (purple below) was developed last year by external organizations in response to federal disarray. Many states have already decoupled from ACIP and are instead following guidance from professional bodies like the American Academy of Pediatrics and the Vaccine Integrity Project (VIP). VIP will be meeting soon to review the evidence, enabling professional organizations to issue their own recommendations, which will then prompt health systems and physicians to begin ordering vaccines.
Key limitation: This pathway doesn’t resolve the issue of ordering and distributing vaccines purchased through federal programs, most notably Vaccines for Children.
Vaccine approval process with possible alternative pathways. Figure by Your Local Epidemiologist.
What this means for you: If you’ve been trying to time your Covid-19 spring vaccine before a wave, that moment may be getting close, though it’s still unclear. As for fall, I’m confident vaccines will be available, but expect some confusion and uncertainty in the run-up. But they will be there.
Good news, and lots of it
- Standing ovation for pancreatic cancer survival study.During a national cancer convention (ASCO) over the weekend, results from a Phase III clinical trial of a pancreatic cancer drug were announced, and the room erupted in applause. This is really rare, but it also signals the beauty of the discovery. What did scientists find? Patients taking a new, experimental drug lived nearly twice as long as patients offered standard chemotherapy. Daraxonrasib reduced the risk of death by 60% compared with chemotherapy. Pancreatic cancer is a devastating disease, with a low survival rate, and is really hard to target with drugs. While this isn’t on the market yet, there seems to be major hope on the horizon.
Source: Scott Morgan/ASCO; STAT news
- Major health insurers announced they will cover all vaccines at no cost through 2027, regardless of what ACIP, federal disarray, and ideological preferences say. This is incredibly abnormal, as they usually wait for federal guidance, but great news and, quite frankly, just the right thing to do.
- Americans are increasingly treating mental health like physical health. This news is a little older, but worth celebrating as we close out mental health awareness month: More than one in three Americans said they planned to make a mental health-related resolution this year, with younger adults ages 18–34 leading the trend at 58%. Growing cultural normalization of mental health care is itself a public health win, as stigma has historically been a major barrier to treatment.
- An obesity drug may not just “melt fat,” but also decrease inflammation that drives heart disease, joint pain, and diabetes. Lilly is testing a new drug called retatrutide, a weekly injection that targets three hormones for weight loss. In its latest clinical trial results, released this month, participants lost an average of 71 pounds over about a year and a half and also made significant improvements in markers of heart disease and overall inflammation. The addition of glucagon targeting helps the body to burn fuel, enabling greater weight loss and likely accounting for the additional benefits over earlier GLP-1 drugs. The drug isn’t approved yet, and more safety and effectiveness data are coming, but the early results are strong. If future trials hold up, this could become a single-shot treatment for obesity, diabetes, inflammation, and their related health problems all at once.
- Global teamwork (without the U.S.) towards health. The 79th World Health Assembly—whose theme was “Reshaping global health: a shared responsibility”—ended with 193 member states (notably the U.S. is no longer a member) agreeing on 20 decisions and passing 13 resolutions on a variety of health issues, including stroke, liver disease, tuberculosis, antimicrobial resistance, diagnostic imaging, emergency care, precision medicine, and radiation.
- Ebola patients were discharged from the hospital. Five patients were cured of the Bundibugyo Ebola virus: four left the treatment center today, and another had already returned home. As Helen Branswell, from STAT, noted, “communities can distrust treatment centers, because loved ones go in & often don’t come out alive. Hopefully, word of survivals will encourage people to seek care rather than staying home. Improves their survival chances & lowers risk to family members.” Ebola can be defeated.
Bottom line
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