At last, Covid vaccine shots are going into arms in significant numbers, but too many people could still fall through the cracks. Vaccines have brought the United States tantalizingly close to crushing the coronavirus within its borders. After months of hiccups, some 1.4 million people are now being vaccinated every day, and many more shots are coming through the pipeline. The Food and Drug Administration has just authorized a third vaccine — a single-dose shot made by Johnson & Johnson — while Pfizer and Moderna are promising to greatly expand the supply of their shots, to roughly 100 million total doses per month, by early spring.
If those vaccines make their way into arms quickly, the nation could be on its way to a relatively pleasant summer and something approaching normal by autumn. Imagine schools running at full capacity in September and families gathering for Thanksgiving.
But turning that “if” into a “when” will require clearing additional hurdles so that everyone who needs to be vaccinated gets vaccinated. This is especially true for racial minorities, who are being disproportionately missed by the vaccination effort.
There’s plenty of disagreement among experts as to why America is still having problems with vaccine uptake. Some officials have suggested that the main cause is that too many people are hesitant to get the vaccine. Others point the finger at overcautious public health officials who they say have undersold the promise of the vaccines. Still others point to long lines at clinics as proof that far more people want the vaccine than can actually get it.
There is probably some truth to all of these hypotheses, and the underlying problems are not new. Vaccine hesitancy had been growing steadily in America long before the current pandemic, so much so that in 2019 the World Health Organization ranked it as one of the leading global health threats. At the same time, poor health care access and other logistical constraints, such as a lack of public transportation and limited internet access, have long impeded public health efforts in low-income communities.
To maximize the number of Americans getting vaccinations, policymakers need to tackle each of these crises with greater urgency than they have so far.
As supply increases, health officials should mount ambitious vaccination campaigns modeled on ones that have worked to curb diseases in other countries. That will mean not relying solely on web portals for scheduling vaccine appointments. It will mean going block by block and door to door, through high-risk communities especially. It will mean setting up employee vaccination sites at schools, grocery stores, transit hubs and meatpacking plants, and community clinics at houses of worship, with local leaders promoting and running them.
“The easier you can make it for people to get vaccinated, the more likely your program will be to succeed,” said Dr. Walter Orenstein, a former director of the national immunization program at the Centers for Disease Control and Prevention. “It’s really that simple.”
Outreach efforts cost money. But they’re far less expensive than allowing the pandemic to fester. Congress has appropriated some money to help states with vaccine rollout. It should offer more, and states should put as much of those resources as possible toward vaccination efforts that meet people where they are.
Health officials should also recognize that vaccine hesitancy has many root causes — deliberate disinformation campaigns, mistrust of medical authorities in marginalized communities, ill-considered messaging by health officials. The best way to counter that is with campaigns that are locally led, that clearly outline the benefits of vaccination and that frame getting the shot as not just a personal choice but a collective responsibility.
Doctors and scientists can help those pro-vaccine messages stick by minding their own public communications. It’s crucial to be transparent about what vaccines will and won’t do for society — overselling now will only sow more mistrust later.
That said, underselling is its own problem. It’s true that these vaccines will not immediately restore the world to total normalcy. But they will eventually allow people to hug their loved ones, to return to their offices — and to be protected from dying from or becoming seriously ill with Covid-19. Health officials should be clear about that.
Policymakers at the highest levels of government should press social media companies and e-commerce sites to curb the most aggressive purveyors of vaccine disinformation.
To not only quell this pandemic but to try to prevent the next one, America will need to improve its health system and its public health apparatus, both of which have significant holes. “The problem with a lot of the response is that it was predicated on the idea that we have a good system in place for doing adult immunizations across the country,” said Dr. Peter Hotez, a vaccine expert at Baylor College of Medicine. “The fact is, we really don’t.”
In the end, lawmakers and the people who vote them into office will have to address the much broader problems that this pandemic has exposed.