SPECIAL BRIEFING

Facebook’s Approach to Covid-19 and Vaccine Misinformation

Editor’s note: Here at Brief19, we are committed to fighting medical disinformation, one briefing at a time. But what are the heavy-hitters of the internet and social media space doing to stop harmful stories from going viral? To learn more, we invited two Misinformation Policy Managers at Facebook to brief us on what they are doing to promote reliable health, science, and medical information during the pandemic. —Jeremy Samuel Faust MD, MS

Since covid-19 was declared a public health emergency almost a year ago, Facebook has been working to connect people to reliable information and limit misinformation about the pandemic. We have recently expanded these efforts to address concerns around vaccine hesitancy and covid-19.

A key part of our strategy to combat misinformation is to promote authoritative information. We have connected over 2 billion people from 189 countries to information from the World Health Organization (WHO) and other health authorities through our COVID-19 Information Center and messages in people's feeds. Facebook is now running the largest worldwide campaign to promote authoritative information about covid-19 vaccines, including promoting authoritative results in searches and giving $120 million in ad credits to national health ministries, NGOs, and UN agencies.

Connecting people to reliable information is only half the challenge. To limit misinformation, our covid-19 policies aim to minimize health harm while still allowing people to discuss, debate, and share personal experiences, opinions, and news. We remove content with claims that health authorities have confirmed are both (a) false and (b) would likely contribute to imminent physical harm—including increased likelihood of exposure to or transmission of the virus, or adverse effects on the public health system. For example, "vitamin C cures COVID-19," or "hospitals kill patients to increase their COVID numbers!" We also may remove Pages, Groups, and Instagram accounts that repeatedly share such information.

Building on these policies, we are now removing more misinformation to address vaccine hesitancy during the pandemic. Since December, we've removed false information about covid-19 vaccines, including claims that they contain a microchip, change DNA, or were designed for population control. Earlier this month, following consultations with health organizations like the WHO, we began removing additional debunked theories about vaccines in general, including claims that they are toxic or cause autism. We also began removing other common covid-19 hoaxes debunked by multiple of our independent fact-checking partners, including that covid-19 is man-made, patented, or not new.

For other content, we reduce distribution of posts rated false by one of our 80-plus independent fact-checking partners (covering over 60 languages), and we display a warning label with more context, prohibit it in ads, and further restrict repeat offenders. Under these policies, between March and October 2020, we removed more than 12 million pieces of content on Facebook and Instagram and displayed warnings on about 167 million pieces of content on Facebook.

Expanding these efforts will help us continue to take aggressive action against misinformation about covid-19 and vaccines. As the situation evolves, we'll continue to review content on our platforms and engage with experts to provide additional policy guidance.

—Aaron Berman and Krista Cox, Misinformation Policy Managers, Facebook

BREAKING NEWS

An in-depth analysis of Biden’s proposed stimulus package

The covid-19 pandemic has caused human suffering and economic consequences. The notion that one should be prioritized over the other is fundamentally flawed logic. There cannot be economic security (or a recovery) as long as covid-19 is spreading through the country as it is today.

Called "The American Rescue Plan," President-Elect Biden has announced a two-step plan to "build a bridge to economic recovery and invest in racial justice." Coming in at a whopping $1.9 trillion, it addresses issues caused by and exacerbated by the pandemic. In many cases, money spent today will save money down the road. For example, money spent on testing and vaccination rollout could mean gaining control of the pandemic sooner, and therefore a return to life and business as we once took for granted. Another is a stay on evictions. As covered in Brief19 in the past, this matters because when evictions occur, people tend to either become homeless or they move into more compact dwellings with extended members of their family. More compact living situations mean more disease spread. That in turn means more suffering, higher healthcare costs, and further strains on our hospitals. The proposal also has funding for tribal relief, which the present administration has often failed to connect on.

This is a sweeping proposal and it has an eye-popping price tag. But last spring, the non-partisan Congressional Budget Office estimated that the US economy would take a $15.7 trillion hit resulting from the pandemic during this decade. Unfortunately, things have gone so poorly that that number is probably such a low estimate so as to be quaint by now. While this package is expensive, the cost of inaction is likely to be far higher.

The covid-19 pandemic is one of two acute major threats to our way of life in the United States—the other is domestic terrorism. That the incoming administration has proposed a relief program of this magnitude, depth, and breadth sends one overarching message: they get it.

The proposal contains three main areas of focus. We review them here:

1. Mount a national vaccination program, contain the pandemic, safely reopen schools:

  • $20 billion will be invested to develop a national vaccination program, in coordination with state, local, and tribal officials, including community and mobile vaccine centers to encompass remote and hard-to-reach populations. These vaccines will be free-of-charge to the recipients.
  • $50 billion to purchase additional rapid tests, expand lab capacity, and implement testing protocols to support at-risk locations like corrections systems and long-term care facilities.
  • Funding for 100,000 public health workers to triple our ability to conduct vaccine education, contact tracing, with eventual transition into sustainable community efforts to improve quality of care and reduce hospitalizations in underserved areas.
  • Increased health services for the underserved, including tribal lands.
  • Support for strike teams to long-term care facilities experiencing outbreaks to assist with infection control and vaccination efforts as well as mitigation strategies for the corrections system via supplies and physical distancing, improved re-entry into society mechanisms, and vaccination of detainees and staff.
  • Improved sequencing, surveillance, and outbreak analytics of new and emerging strains.
  • $30 billion to refill the Disaster Relief Fund for critical supplies and 100% reimbursement for critical emergency response resources.
  • $10 billion for expanding domestic manufacturing of protective equipment under the Defense Production Act.
  • Further investment in novel therapies.
  • Development of a covid-19 Protection Standard by the Occupational Safety and Health Administration (OSHA) to protect workers from unsafe working conditions and retaliation as well as additional OSHA grant funding to keep vulnerable workers healthy and safe.
  • Support for an international and humanitarian response.
  • $170 billion from Congress, in addition to state and local support, in funding relief for K-12 schools and institutions of higher learning.
  • $130 billion for schools to be able to provide the equipment or physical restructuring necessary to safely reopen.
  • $35 billion to expand the Higher Education Emergency Relief Fund to provide millions of students with up to $1700 in financial assistance for college.
  • $5 billion for governors to support the educational needs of students significantly impacted by the pandemic.
  • Expansion of paid emergency leave. This would require employers to provide leave, remove the exemption for employers with more than 500 employees or fewer than 50, provide over 14 weeks of paid sick, family, and medical leave, include federal workers, provide a maximal benefit of $1,400 per week for eligible individuals, reimburse employers with fewer than 500 employees, as well as state and local governments, for the cost of this leave, and extend this plan through September 30, 2021.

2. Deliver immediate relief to working families bearing the brunt of this crisis:

  • $1,400 per person in direct stimulus with increased support to the Treasury Department to reach every eligible individual.
  • Extension and expansion of unemployment benefits.
  • Extension of eviction and foreclosure moratoriums until September 30, 2021.
  • $25 billion in rental assistance and $5 billion in critical utility assistance for low- and moderate-income households.
  • $5 billion in emergency assistance for people experiencing or at-risk for homelessness.
  • Extension of the 15% Supplemental Nutrition Assistance Program (SNAP) increase through September 30, 2021.
  • $3 billion to support the Women, Infants, and Children (WIC) program.
  • Partnership with the Federal Emergency Management Agency (FEMA) Empowering Emergency Deliveries (FEED) Act to provide food for families who need it.
  • Further support of SNAP by temporarily halting the state match.
  • $1 billion in assistance for territories to support their nutrition programs.
  • $15 per hour minimum wage.
  • Support for pandemic hazard pay from employers.
  • $25 billion emergency fund to provide financial support for childcare providers.
  • $15 billion added to the Child Care and Development Block Grant Program.
  • Childcare tax credits for 50% of expenses related to child care for children under the age of 13, with up to $4,000 for one child or $8,000 for two or more children. Families making less than $125,000 can receive the full benefit, and families making under $400,000 can receive partial reimbursement.
  • One year of refunds for the Child Tax Credit, with an increase in the dollar amount as well as including children aged 17.
  • Expansion of the Earned Income Tax Credit.
  • $1 billion for states to support the Temporary Assistance to Needy Families program.
  • Congressional subsidies for continuation health coverage (COBRA) through September 30, 2021.
  • $4 billion to expand the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration to expand their programs.
  • $20 billion for veterans' care.
  • At least $800 million in supplemental support for federal programs that support domestic violence and sexual assault survivors.

3. Support communities that are struggling in the wake of covid-19:

  • $15 billion in grants for small businesses affected by the pandemic.
  • $35 billion invested into small business financing programs to generate $175 billion in loans and investments.
  • $350 billion in emergency funding for state, local, and territorial governments to support front line public workers. $3 billion of this is dedicated to Economic Development Administration (EDA) grants to support bottom up economic development.
  • $20 billion for public transportation agency relief.
  • $20 billion to support tribal government response to the pandemic
  • $9 billion to expand the Cyber Security and Information Security Agency (CISA) and the General Services Administration (GSA).
  • $200 million for new hiring of experts to support the Chief Information Security Officer and U.S. Digital Service.
  • $300 million to the General Services Administration to develop and complete transformational IT projects across multiple agencies.
  • $690 million for increased security of federal civilian networks.

BREAKING NEWS

Johnson & Johnson publishes early data for its covid-19 vaccine candidate. The vaccine is a few months behind the mRNA options but may eventually offer advantages

The past month has been a busy one on the coronavirus vaccine front. With the US FDA granting emergency authorization of the Pfizer and Moderna covid-19 shots, rollouts have begun among healthcare workers and other high-risk persons. We've been able to examine data from both of these mRNA vaccines as well as a third option, the Oxford-AstraZeneca candidate (the current DNA-based vaccine frontrunner). 

Today, new data published in The New England Journal of Medicine on the Ad26.COV2.S coronavirus vaccine, being developed and tested by Johnson & Johnson. This vaccine is a "recombinant adenoviral vector" vaccine, and it uses a mechanism similar to the Oxford-AstraZeneca approach. Scientists spliced a small piece of the SARS-CoV-2 genetic material in a harmless version of an adenovirus (naturally occuring adenoviruses can and do cause flu-like illnesses; the strains used for vaccines do not). One administered, the vaccine generates an immune response from the body. 

Today's results are from the Phase 1-2a trial of 805 participants which took place at multiple sites across the United States and Belgium. Three main cohorts were established and studied. Data from two of those cohorts were reported today: subjects between 18 and 55 years of age and those greater than 65 years of age. (Data from another cohort which will allow long term comparisons between one and two dose regimens were not reported in this new paper). The two cohorts in this study received either a low or high dose intramuscular shot in either a single dose or in a two-dose regimen scheduled 56 days apart. Participants were randomized to one of five groups: low dose followed by low dose, low dose followed by placebo, high dose followed by high dose, high dose followed by placebo and placebo followed by placebo. The main goal of the study was safety and reactogenicity (Phase 1 and Phase 2 trials are not adequately large enough to study efficacy). This differs from the recent vaccine studies which focused on efficacy and made global headlines when they were found to be around 95 percent effective in preventing covid-19 disease. 

At day 29 after the first dose, neutralizing antibody levels (titers) were detected in 90 percent or more of all participants. That number increased to 100 percent by day 57. These titers remained stable until day 71. Of note, the second booster dose was associated with antibody levels that were 2.6-2.9 times above levels after the first dose. This implies that a booster shot might provide a great deal of protection, but this study was not designed to study outcomes. Therefore, we do not know whether these higher titers mean greater and longer durability of protection, though it certainly implies that advantage. 

Meanwhile, side effects were similar to the mRNA vaccines, with most common complaints being fatigue, headache, myalgia and injection site pain. These effects were reported more often in the high-dose groups.

Similar to the mRNA vaccines, adenovirus-based vaccines cause our cells to produce just the spike protein of SARS-CoV-2 (which our body then generates antibodies to), but not the rest of the virus. In addition, adenovirus itself is "replication incompetent," meaning it has been engineered so that it can't replicate and spread in our bodies. Unlike mRNA vaccines, adenoviruses have been used in the past. A current example of an adenoviral vaccine is the rabies vaccine.

One criticism of adenoviral vaccines is that booster shots may be required, given a waning response over time. Another is that since in general, adenoviruses are common, some individuals may already have immunity prior to vaccine administration. In other words, if someone is immune to the adenovirus itself, the vaccine might fail to work because our body would neutralize it before it gains entry into our cells, a necessary step in order for the coronavirus spike protein to be manufactured and to then trigger an immune response. 

However, adenovirus vaccines have a major advantage: storage. Unlike the mRNA vaccines, the Johnson and Johnson vaccine is expected to be stable at normal freezer temperatures for two years or longer. Even at refrigerator temperatures, the vaccine is thought to have a three-month shelf life. The mRNA vaccines require freezers that are so cold that even most pharmacies don't have them, and transportation requires dry ice or unusually cold (and hard-to-come-by) freezers. So if this vaccine works as well as the mRNA options do, it will have substantial appeal. 

It must be cautioned that these data reflect early research of Phase 1-2a trials. The report provides information that supports further development of this method as a future vaccine candidate. Phase 3 trials will assess whether this vaccine is as protective as the current available options. While these initial results are promising, nothing can replace Phase 3 data, which we await with anticipation.


Moderna vaccine phase III trial results released in New England Journal of Medicine

The phase III randomized double-blinded multi-center trial of the Moderna vaccine against SARS-CoV-2 has now been published.The trial enrolled 30,420 volunteers, randomly assigned to receive either two doses of the vaccine 28 days apart or a pla

Read article

Phase III SARS-CoV-2 vaccine trial results appear in a medical journal for the first time

Vaccines are hoped to be the cornerstone in helping to control the covid-19 pandemic. Vaccination outside of clinical trial settings began in the United Kingdom yesterday and will likely begin in the United States next week, assuming that the US Food and Drug Administration grants emergency use auth

Read article

New trial of convalescent plasma for covid-19 falls flat, another setback for hyped treatment

Is convalescent plasma the miracle treatment we were promised? The answer in the latest published clinical trial appears to be no. This is more worrisome news for a proposed treatment that has been bandied about and for which the US Food and Drug Administration granted emergency use authorization, d

Read article

Moderna announces interim covid-19 vaccine data – reports 94.5% effectiveness

As we mentioned last week with our briefing on Pfizer's mRNA covid-19 vaccine, the short-term future of the country may be riding on an effective vaccine. A glimmer of hope was revealed last week as Pfizer and BioNTech released interim data from their phase 3

Read article

Another hope dashed - Tocilizumab not as promising as hoped in a new trial

Earlier this week we covered three JAMA Internal Medicine papers assessing drug called tocilizumab, a monoclonal antibody that targets interleukin-6 receptors, thought to contribute to the human body's counterproductive immune response to SARS-CoV-2, the vir

Read article

Monoclonal Antibody Trial Halted for Safety Concern

Brief19 has learned that the ACTIV-3 monoclonal antibody trial for the treatment of covid-19 has been paused due to a potential safety concern. An email obtained by Brief19 (below) made the announcement today. 

The ACTIV-3 trial is a randomized

Read article

Final remdesivir results published after 139 days of waiting

The preliminary results of the Adaptive Covid-19 Treatment Trial (ACTT-1) randomized trial were published May 22 in The New England Journal of Medicine and covered by Brief19. ACTT-1 was a double-blind, randomized, placebo-controlled trial of the antiviral drug remdesivir, given to patients intr

Read article

President Trump and First Lady of the United States have SARS-CoV-2

Last night, President Trump announced that he and the First Lady, Melania Trump have tested positive for SARS-CoV-2. The President's physician, Sean Conley, released a memorandum for Kayleigh McEnany stating that he had "received confirmation" of the results. Conley stated that both are "well at thi

Read article

Primate study suggests mRNA vaccine effective in fending off SARS-CoV-2

The great hope in getting society "back to normal" in the face of the covid-19 pandemic is the development of herd immunity through vaccination.  A new publication reporting research conducted at the National Institutes of Health was released today in *New England Journal of Medicine(https://www.n

Read article

Editorial Board Memorandum

Race as a social determinant of health takes center stage.

Read article

GetUsPPE Weekly Briefing

This document features the GetUsPPE.org's weekly briefing in an edited and condensed format for brief19.com.

Read article

GetUsPPE.org’s Weekly Briefing 5/15

This document features the GetUsPPE.org's weekly briefing in an edited and condensed format for brief19.com.

Read article

GetUsPPE.org’s Weekly Briefing

This document features the GetUsPPE.org's weekly briefing in an edited and condensed format for brief19.com.

Read article

Lancet Lifts Embargo to Sound Cautionary Note about Remdesivir

The move came in response to contradictory news from unpublished studies. (Updated)

Read article

The Lancet has unexpectedly lifted an embargo on a remdesivir trial

The move comes in response to contradictory news from other studies.

Read article

GETUSPPE.ORG and PROJECT N95 Combine Forces to Create the Largest Demand-Side Database for PPE Nationwide

This document features the GetUsPPE.org's weekly briefing in an edited and condensed format for brief19.com.

Read article

This Week In PPE: What Happens When We Run Out?

PPE Update: Demands for a centralization of the supply chain grew louder in the face of bidding wars between state governments and federal agencies for critical supplies.

Read article

Update about our partners at GetUsPPE.org

While the outcry over the lack of PPE available for clinicians in the United States continues to escalate, help bridging the gap in supplies is mounting.

Read article

Pregnant Mother with SARS-CoV-2 Delivers Virus-Free Baby

A New England Journal of Medicine report outlined the case, suggesting some approaches that may keep infants safe.

Read article

The Centers for Disease Control and Prevention COVID-19 Nationwide Tracking System is Now Live

Dozens of hospitals are reported to have begun uploading troves of data that will help officials guide the response to the pandemic.

Read article

Boston University School of Medicine Becomes First School Outside New York to Offer Students Early Graduation

Information about how medical students can rejoin the clinical team upon early graduation has not been provided.

Read article