In the coming months, America could reach a point where it has more Covid-19 vaccines than people want.
Between efforts by the federal government and drug companies to ramp up manufacturing and distribution, U.S. vaccine supply is really increasing: at least 150 million doses are expected by March – a rate of more than 3 million shots a day, the rate at which the Vaccines To Be Made The country needs to achieve herd immunity if enough people are protected from the virus this summer to stop its spread.
However, public health experts are increasingly warning that America could get just inches closer to the finish line in its vaccination campaign: after the majority of people who want a vaccine have received a vaccine, there is a large minority of people who are in public Surveys have expressed skepticism. And if these people don't change their minds in the coming months, they could ruin any US chance of herd immunity.
"There will be a point … when there will be a vaccine, and the main problem will be getting people to take it," said Emily Brunson, a medical anthropologist at Texas State University.
To achieve herd immunity, experts generally estimate that we need to vaccinate at least 70 to 80 percent of the population – although this could be more or less the case as we don't know for sure with a new virus. According to a recent AP-NORC poll, 32 percent of Americans say they will definitely or probably not get a Covid-19 vaccine. If so and the herd immunity estimates are correct, it would make herd immunity impossible.
Public health experts say there are ways to increase people's willingness to be vaccinated, but such efforts need to be flexible to meet the different vaccine concerns that different communities and individuals may represent. What might sway skeptical white Republicans who don't see Covid-19 as a threat won't necessarily work for black communities that distrust a medical establishment that has long neglected and even abused them.
Whatever anti-hesitation campaigns take shape, they have to be done quickly. With each day the coronavirus spreads across America, the country is preparing for hundreds, if not thousands, more deaths each day – not to mention the constant need for social distancing, a weakened economy, and potentially stricter restrictions on daily life . Each day of uncontrolled spread also carries the risk of new, more dangerous variants of the coronavirus, as any replication of the virus carries the risk of a mutation that spreads further.
Now, the days when hesitation becomes the vaccine's main problem may be months away. But if the pandemic should have taught us anything, it's better to be proactive than reactive. It's not too late to resolve this issue before it becomes the next major bottleneck in America's efforts to end its outbreak.
The vaccine supply problem in the United States is getting better
The past few weeks have brought a lot of really good news in the vaccine field.
The number of recordings handed in has increased dramatically, from less than 1 million per day in mid-January to around 1.7 million in mid-February. (Though recent snowstorms likely slowed this down.) As bad as America's initial adoption was, the U.S. is still ahead of all but Israel, Seychelles, the United Arab Emirates, and the United Kingdom in vaccination rates – and they're improving fast enough. so far to maintain this lead.
Lately there have also been fewer breakdowns at the state level. In the first few weeks of the rollout there were some alarming reports – machine failures, staff problems, unused cans. These issues still crop up (the US is big and there's always someone here to be in trouble) but they seem to appear less frequently as states and localities get the hang of it. To this end, states are using many more of their vaccines: while it was rare for a state to report administration of more than 60 percent of vaccine doses in January, it is now common for them to administer more than 80 or 90 percent of vaccines.
Our world in data
Meanwhile, President Joe Biden's administration has taken some steps to improve both the supply of vaccines to states and communication with states about what supplies to expect. The latter is especially important because it allows states to plan the doses they will receive – something they often couldn't in the early stages of the vaccine introduction, as they would find out how many vaccines they would receive late on the day they got the cans. That could explain why the states are doing better.
There are still many problems. The current rate of 1.7 million recordings per day is still too slow. Experts want the country to hit 2 or 3 million to handle the bulk of the vaccination effort this summer. While the country seems to be on the right track to getting enough cans for them in the next month, the question is whether it has the distribution capacity to actually convert those cans into gun shots – and the logistical challenges there will be immense.
Still, a world is fast approaching where there are enough vaccines. Biden said vaccines will be available to all Americans by the end of July, while Anthony Fauci, the leading federal infectious disease expert, was a little more optimistic when he said it would be "open season" in late May or early June.
At this point, hesitation about the vaccine may make supply less of a problem than demand.
America has a hesitant problem
The views of a third of Americans may not always represent a national crisis, but those views are very important when the country has to do something that requires almost everyone on board. This is the case with the Covid-19 vaccination campaign, which requires 70 or 80 percent – or more – of the country to be vaccinated to achieve herd immunity. Polls that show up to a third of Americans are skeptical represent a real public health crisis.
On top of that, a Covid-19 vaccine for children is not yet approved – and it may not be until later in the summer or even 2022. Given that children make up 22 percent of the population, herd immunity probably can't happen without them. But even if herd immunity only requires the lower 70 percent of Americans estimate, it will still be impossible if more than 30 percent of adults refuse a vaccine.
Based on public surveys, particularly in-depth surveys by the Kaiser Family Foundation, the skeptic reports a number of concerns about the Covid-19 vaccine.
Side effects, especially long-term health consequences, are a major problem. While the Covid-19 vaccines have side effects, they are almost entirely minor – temporary pain, fever, and cold symptoms – except for rare allergic reactions that need to be monitored but can be treated. Still, people worry about the risks.
Some of the skeptics fear that the vaccine approval process has been accelerated given its record speed. However, the Covid-19 vaccines were still going through the three-phase clinical test required by the Food and Drug Administration to test safety and effectiveness. The vaccines have also been available in the real world for months and there have been no reports of previously unknown and serious effects.
Some people of color also distrust the healthcare system based on their experience with an often discriminatory system and a history of experimenting with black bodies, such as the Tuskegee study. Surveys show that Latinos and Blacks in particular trust doctors and hospitals less in general. This is also likely to lead to distrust of the vaccine.
Part of the population, especially on the right of the political spectrum, is also skeptical that they even need a Covid-19 vaccine. Encouraged by people like former President Donald Trump, they tend to believe that the coronavirus threat has long been dubbed the media. Given other potential concerns, such as side effects and a rushed process, they wonder if they should be given a vaccine as they feel Covid-19 is not a real threat to them. The reality is that it poses a threat to everyone – killing more people under 55 alone than all the murders in a typical year – but the perception persists.
Then there are the concerns that fall more into the camp of conspiracy theory, be it about the involvement of certain wealthy people in the vaccination process, or more traditional (and debunked) anti-Vaxxer concerns. But these usually make up a very small minority of the US public and even skeptics of Covid-19 vaccines.
There is no single solution
As the above list shows, vaccine concerns tend to vary and can vary significantly from community to community. Some concerns may not show up in national surveys – they may be too localized to ever arise. This is a critical public health fact, but it is especially true here: Local problems require local solutions, which means that messages about addressing vaccine reluctance need to be tailored differently from community to community.
"There will be similarities and I think there will be some overlapping issues," said Brunson. "But there will be local iterations that can be very different."
That doesn't mean states or federal governments don't play a role. On the contrary, a major federal campaign on the basic facts, especially the benefits of vaccines, could really help – and experts have repeatedly told me that such a campaign should have started months ago. The federal and state governments can also provide support that local governments need to implement their plans with the money, staff, guidance and expertise.
According to experts, the underlying theme of these campaigns should be to meet people where they are. It starts with really hearing the concerns of the community and then transparently and honestly explaining why the benefits of vaccines still dramatically outweigh the disadvantages. In order to do so, it might, in some places, require acknowledging that people have a point – for example, the U.S. health system actually has a history of racism – but claiming that the evidence about vaccines is still strong and still take it worthwhile.
The messages need to be tested, and again what works best will likely differ from place to place and person to person. However, experts pointed to several ideas: Campaigns may point to the evidence that the vaccines are very effective, especially that the clinical trials mean that they reduce deaths from Covid-19 to zero and hospital admissions to near zero. You can highlight the importance of each vaccination to achieve herd immunity and then protect not only yourself but your friends, family and community as well. You can fall back on trusted or beloved sources, including doctors, but also potential celebrities.
A controversial idea is to educate people about the personal benefits of vaccines. Some of the public health reports in the US have actually covered this up, telling people that even if they were given a vaccine, they couldn't immediately return to their normal pre-coronavirus life.
Still, some experts argue that low key messaging can lead people to ask, "Why bother?" Masking and social distancing should be encouraged until America reaches or near herd immunity as we don't yet know how effective vaccines are at reducing transmission. However, people should be entrusted with factual information about how vaccines make certain activities less risky for them and others who will be vaccinated – and perhaps they could safely enjoy some of those activities again with their vaccinated friends and family.
"People don't sell the vaccine," said Amesh Adalja, a senior scientist at the Johns Hopkins Center for Health Security. "They don't understand that if you tell people that if they get a vaccine they won't have any incentive to get the vaccine, they won't have an incentive – which I don't think is true."
Regardless of the form of pro-vaccine campaigns, experts agree – and have done so for a long time – that a major campaign against hesitation must be launched soon. It should have started yesterday or last year. However, there is still time to act before the country reaches the point where supply exceeds demand.
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