U.S. hospitalizations and deaths from COVID-19 are surging, and projections indicate a dark winter, in which an additional 160,000 Americans will lose their lives to the virus before February. A vaccine could still help shift that trajectory, but only if policy makers apply the hard lessons from past U.S. failures in distributing vaccines to adults. They will need to do so amid a contentious presidential transition and with the same decentralized and resource-starved U.S. state, local, and tribal public-health systems that have administered H1N1 and seasonal-flu vaccines.
According to a recent analysis, three out of every four Americans would need to receive a vaccine that prevents at least 80 percent of infections for that vaccine to extinguish this coronavirus pandemic on its own. In the past decade, the United States has never managed to vaccinate more than half of adults for seasonal influenza in any single year; in most years, coverage hovers around 40 percent. The flu vaccination rates among Black people, Latinos, and high-risk adults aged 18 to 49 are generally even lower. During the last pandemic for which we had a vaccine—the 2009 H1N1 pandemic—fewer than a quarter of American adults were vaccinated, even though Medicaid covered the cost and the Centers for Disease Control and Prevention managed the distribution to state, local, and tribal authorities.
Seeing the devastation to the economy and the deadly threat to their loved ones, more people might feel an urgency to be vaccinated against the coronavirus than against the flu, and the availability of a highly effective vaccine for the new disease could help too. Yet on both scores, caution is warranted. The Pfizer-BioNTech vaccine might inspire more public opposition than the H1N1 vaccine, which was a modification of an already-proven influenza vaccine. In contrast, the first coronavirus vaccines will involve technology—messenger RNA, or mRNA—that the FDA has never before approved, which may make some patients wary. Furthermore, compliance with even the soundest public-health measures will not be universal. Masks are harmless to their wearer, and yet 40 percent of Americans refuse to use them on a daily basis, according to the Institute for Health Metrics and Evaluation. In North Dakota, which has more COVID-19 infections per capita than any other state, more than half of residents are still not wearing masks. Foreign and domestic social-media disinformation campaigns around vaccine safety have increased over the past decade and are growing in intensity now.
In this situation, the U.S. government’s priorities must be to prepare state and local infrastructure and communication strategies to boost vaccine coverage among high-risk and high-priority populations, and then to convince the rest of the country that a highly effective vaccine provides future hope—rather than an immediate promise—of life returning to normal. Well into next year, the best way to protect Americans will still be to convince them to stick with proven non-pharmaceutical measures, such as wearing masks and avoiding indoor gatherings, a few months longer.