Vaccine rollout to test Biden's unity plea

Vaccine hesitancy a bigger threat than bureaucratic bungling

The American people are about to put President Joe Biden’s heartfelt plea for national unity to its first major test. Whether they pass or fail will be measured by how well they respond to his plan for ending the COVID-19 pandemic.

As expected, the president has put fighting the pandemic at the top of his four major agenda items. The other three are restoring the economy, tackling the climate crisis and ending racial injustice and white supremacy.

Those four worthy goals are intimately linked. You can’t return the economy to full employment without getting the virus under control. And you can’t get the virus under control without addressing the conditions in minority communities that have forced them to bear the brunt of disease incidence and suffer a disproportionate share of the 400,000-plus fatalities. 

Fighting and winning the war against this and future pandemics will also require global cooperation, just like winning the war against the climate crisis. In a modern world with mass international travel, a new virus can travel to every corner of the globe within days. 

In executive orders issued shortly after taking office, the president ordered a national mask mandate on federal property and challenged Americans to wear masks and remain socially distanced for the next 100 days. He authorized the U.S. to rejoin the World Health Organization, the only institution with the capacity (but not yet the resources) to coordinate vaccination efforts in the developing world.

He also pledged to reach 100 million vaccinated people in the U.S. within the first 100 days of his administration. That’s an average of 1 million vaccinations per day. This ambitious goal will require tripling the current pace.

The logistics behind a mass vaccination campaign are daunting, but achievable. Biden has promised to mobilize the Federal Emergency Management Agency and the National Guard. Healthcare supply chain organizations across the U.S. will no doubt be asked to play a role.

That’s great for logistics, but soldiers don’t administer shots. One group of health experts, writing in the New York Times, estimated it will require at least 400 temporary vaccination sites operating 12 hours a day with a total staff over 100,000, including 17,000 qualified to administer the vaccines, to reach the 3-month goal. This is in addition to the current rollout effort, which recently expanded to include all older Americans in addition to healthcare workers and the elderly in nursing homes.

While you wouldn’t know it from mainstream media coverage, the U.S. is not lagging behind other advanced countries in getting the vaccine into circulation. Other than Israel, the UK and the tiny United Arab Emirates, no one is doing a good job, and we’re actually doing slightly better than most.  

But the real test is about to come. After the government, working in concert with providers, sets up that infrastructure, people must show up to get the jab (I love Brit slang). Polling on the issue isn’t encouraging. Only 47% of respondents in the latest YouGov poll (released Jan. 6) said they are willing to get vaccinated.

That number has never risen above 50% over the last six months. Health experts estimate vaccination rates must reach 70% or higher to achieve herd immunity. Polls also show there’s a die-hard group of people – about 1 in 5 – who continue to resist the necessary interim steps of masking and social distancing. 

Communication is key

With vaccines still in short supply, public health agencies administering the vaccination sites will be forced to continuously set and update priorities. This has the potential to alienate people denied immediate access in the name of the greater good.

Government officials will have to do a better job in presenting the reasons for their choices than they have thus far. They must communicate clearly, effectively and with one voice if they’re going to convince a skeptical public, which has been long conditioned to seek individual solutions to collective problems, to go along with their recommendations.

In other words, the Biden administration’s communication strategy will be key to a successful rollout.

Here’s a simple example. With vaccines in short supply, immediately expanding access to everyone over 65, for instance, runs the risk of temporarily crowding out younger people with multiple co-morbidities, who face a much greater risk of dying. It also crowds out people who live or work in prisons, meatpacking plants or minority neighborhoods with high infection rates. These places need to be at the front of the line — not the healthy younger seniors who are now filling all the available timed slots at various healthcare organizations simply because they have the time and internet savvy to figure out how to schedule their shots.

Near the end of his speech, the president addressed America’s role in the world. “We’ll lead, not merely by the example of our power, but by the power of our example,” he vowed.

Over the next few months, we’ll find out if a bitterly divided America is ready to set that example. The first great test will be whether its people can hear and then adhere to the basic principles of public health.

A shorter version of this article first appeared in Modern Healthcare.