The COVID Digest, 27Jan2023

Meeting a public health hero

The COVID-19 burden in the United States continues to decline. This is a really good thing and the winter surge was much, much smaller than what we saw last winter. That’s a good indication that we are on the tail end of this pandemic. COVID-19 will likely eventually fade into the background of our winter (and summer) respiratory illnesses. We aren’t all the way there yet, but it’s a relief to be here nonetheless.

The FDA has announced their plan to instead offer COVID-19 vaccines annually, timed around the same timeline as for the influenza vaccines. I want to talk about some of the positives and negatives of this idea. For positives, this certainly simplifies eligibility. Everyone can get their COVID-19 vaccine at the same time they get their influenza vaccine. It is also timed in such a way as to help provide protection in time for the winter surge of respiratory illness. Some drawbacks include that if this mirrors the production of the influenza vaccine, then pharmaceutical companies are trying to guess what the most common variant will be 6 months in advance. Sometimes they get pretty close, but often it’s not perfect. It’s possible that COVID-19 will evolve faster than we can develop new vaccines for it when we’re only considering an annual update rather than updating at a shorter interval. We also know that influenza vaccine uptake is unfortunately very low. In fact, CDC estimates that only about 46% of adults in the US got a flu vaccine in the current flu season, as of December 2022. If that’s the best we can hope for with COVID-19 shots, will that be enough?

---

Last week I traveled to Miami for a conference for work. I was pleased that the conference required proof of COVID-19 vaccination or proof of a negative COVID-19 test within 24 hours prior to arrival at the conference. On the first day of the conference, I sat down with my colleagues and a woman weaved her way through the chairs surrounding our table. As she did so, she sort of did a double take and stared at me. Clearly, she recognized me from somewhere. I didn’t immediately recognize her, but her stare made me look closer. It turned out that it was someone I used to work for at the Centers for Disease Control and Prevention. I’ve mentioned her in this newsletter and in public speaking events as the person who inspired me to stand up and start sharing data and explaining what was happening at the start of the pandemic. Her name is Dr. Nancy Messonnier.

When I first met her, she was the branch chief for the Meningitis and Vaccine Preventable Diseases Branch which included the Pertussis and Diphtheria Laboratory at CDC, where I did my post-doctoral fellowship. A fun fact - I arrived to CDC in January 2009, 18 weeks pregnant. I had not had a Tdap vaccine ever and so when I first arrived to work on pertussis, I wasn’t allowed in to the bacterial culture lab. There was no policy on the books nor was there a lot of data to tell us what to do with pregnant women and whether it was safe (or a good idea) to vaccinate them with Tdap for protection against pertussis. There were also questions about whether it would interfere with the newborn’s reactions to their DTaP series of vaccines. So I had many meetings with Dr. Messonnier and the other epidemiologists as we tried to figure out what to do. We ultimately decided to wait until the start of the third trimester to vaccinate me. In the meantime, my labmates worked with the bacteria to isolate the DNA that I needed for my experiments and then I worked with that DNA in our clean rooms. Everything worked out okay, my son was born perfectly healthy and seemed to do well with all of his shots. He’s now a teenager and fully up to date on his vaccines. A year after I was vaccinated while pregnant, a pretty scary outbreak of pertussis swept across southern California, ultimately killing 10 infants. When I delivered, the recommendation was that new moms get vaccinated before leaving the hospital after delivery. When the California outbreak happened, they ended up recommending that pregnant women get vaccinated during their third trimester and that remains the recommendation now. I don’t know that the change in policy had any roots in my experience, but I know there was precious little data that they had to go on. While my experience was not part of a clinical trial, I went first. Hopefully this change in policy is saving lives - lives that are difficult to count because those infants are healthy and safe (exactly what we want!).

My other big interaction was writing my postdoctoral research project for publication and going through the CDC clearance process. I remember wanting to make bigger conclusions than we were ultimately able to make about the effect of changes in the US vaccine policy on the genetic makeup of the Bordetella pertussis population. But I was cautioned against doing so by Dr. Messonnier to avoid causing a public panic. Truth be told, my conclusion was possible but not probably conclusive with the data we had available. I was a young post-doc lacking experience and wisdom and I probably needed to be reined in. But between these two experiences, I knew Dr. Messonnier as someone who is cautious about how we proceed and how we explain information to the public.

Fast forward to February 2020 and she was the director of the National Center for Immunizations and Respiratory Diseases at CDC. She was the first public official to come out to the public and say that COVID-19 was a disease that was going to cause significant disruption to our lives as we knew it. Because of my past experience working with her and her tendency to be cautious, I knew Dr. Messonnier was telling us this was the real deal. My husband and I started stocking our freezer and making sure we weren’t low on any toiletries. I warned my dad who lived in southern California to be careful since many of the early cases were in California, tied to cruise ships at port. Then I saw that Dr. Messonnier was increasingly sidelined from speaking directly to the public again. As I looked at our public health leadership, I found that the people I knew and whose expertise I trusted were no longer doing the talking that needed to happen. In this void of communication, I recognized that it would be up to any of us outside of the CDC who could speak to do so. And here we are, almost three years later.

I’m surprised that Nancy recognized me because I was just a (lowly) post-doc when I worked with her. But maybe she recognized me because of my COVID-19 work. In any case, as soon as I saw her name badge I knew who she was - she was wearing glasses that made it a challenge to recognize her. I ran up, shook her hand, and thanked her for her leadership during COVID-19, even though it wasn’t quite what she wanted to do because it inspired people like me to speak when she couldn’t. Although, I’ll tell you we all would have been better off if she had been doing the talking rather than a collection of science communicators. We updated each other on what we’re doing now. She’s Dean of the School of Public Health at University of North Carolina after leaving the CDC in May of 2021. As she walked away to her table with her colleague, I told my colleagues that they just saw an American hero. I told the story of who she was, what she’d done and her role in history. We don’t often get a chance to meet our heroes, even if they weren’t heroes the first time we knew them. It was important to me to honor her in the brief time we had together and to pay homage to the impact she had on me. I have no doubt that we were able to save lives and prevent suffering because she sounded the alarm when she did.

There were a number of folks at this conference from Georgia colleges and universities. It was really my first time being with so many folks from Georgia since we moved away. I was flattered to be recognized by some of them too while we were there (hi Sarah and friends!).

On the last day of the conference, I was invited to be a panelist on Georgia Public Broadcasting’s Political Rewind. With the other public health heroes on the panel, we marked the third anniversary of the first US case of COVID-19. It was odd the way that this three day conference on philanthropy in support of higher education featured so much public health for me. But I found a lot of beauty in it, considering the anniversary. We’re all a little more weary than we were three years ago, but we’re still here and we did what we could to help.

I hope you all have a great weekend!

---

Graphs and images that were not produced by me are linked to the original source if you click on them. Thank you for your support of the COVID Digest.

My Ph.D. is in Medical Microbiology and Immunology and I am Chair of the Division of Natural Sciences and Mathematics at the University of Saint Mary. I've worked at places like Creighton University, the Centers for Disease Control & Prevention and Mercer University School of Medicine. All thoughts are my professional opinion, do not represent the views or opinions of my employer and should not be considered medical advice.