While our progress in vaccinating Americans against COVID-19 is certainly worth celebrating, don’t set off your sparklers just yet – we still have a long way to go to achieve herd immunity, and the protection against emerging variants is essential.
The question now is, what new strategies can we use to get more gunfire? In early May, the president announced a solid plan to improve access to vaccines across the country. The measures included increasing appointments for walk-in vaccines at local pharmacies and state vaccination sites; the move to community vaccination clinics and smaller mobile units; and support community education on vaccines and local awareness efforts. However, the immunization rate has slowed, which means that we must redouble our efforts to reach vulnerable communities nationally and ultimately across the world.
Who does not get vaccinated?
Even in the face of an abundant vaccine supply in the United States, two threats to progress remain: resistance among major demographic groups and disparities in vaccine access among high-risk populations.
Indeed, much of our ability to stop the transmission of the virus rests in the hands of the rest of Americans who have not yet been vaccinated, either because they are hesitant or because they do not have access. The public health community is now charged with a dual responsibility: 1) convincing hesitant and resistant groups that the vaccine is, in fact, safe, effective, and essential for a COVID-free world, and 2) tackling obstacles that prevent certain groups from accessing vaccines.
There are clear distinctions between the vaccinated and unvaccinated groups in the United States. They differ in age (unvaccinated adults are significantly younger), education (unvaccinated adults are more likely to have a high school diploma or less), and political affiliation (adults who identify with as Republicans or Republican-leaning independents are much less likely to be vaccinated than Democrats). There are also important racial differences that highlight issues with equitable access to vaccines.
For some, the decision to forgo vaccination is rooted in concerns about safety and efficacy, although this group is shrinking. Among the 13% of adults who say they ‘definitely will not’ get the flu shot, nine in ten also say they don’t get the annual flu shot, suggesting some skepticism about the flu. vaccines in general. More recently, these concerns have been magnified by events such as the temporary suspension of the Johnson & Johnson vaccine following reports of rare but serious blood clots as a side effect.
Reluctance also persists among our country’s most vulnerable – including low-income communities of color – whose concerns stem from a legacy of neglect and oppression. Having historically and repeatedly sidelined the health priorities of our vulnerable communities, the United States has generated a deep-rooted distrust of our systems among those who need them most.
This is compounded by the fact that blacks and American Hispanics are less likely to receive vaccines than whites, while accounting for a larger share of cases and deaths.
Black Americans get vaccinated at lower rates – on average, 1.4 times lower – than white Americans. Black and Hispanic Americans are almost twice as likely to say their access to COVID-19 vaccines and resources (for example, quality treatment and care) is worse than that of other racial and ethnic groups. And most county vaccine deployments have had a 4-8 week lag in linguistic translation of registration and information documents. These disparities are compounded by structural barriers at the community level (such as poverty, health workforce shortages, and lack of reliable transportation to local health facilities, to name a few) that have also been corroborated by this history of neglect and position the most vulnerable at the highest risk of harm.
But there is hope. From March 1 to June 21, the United States saw small but large increases in vaccination rates among racial ethnic groups, with an increase of 1.5% among Asians, 1.4% for Hispanics, 1.2% for blacks and 0.8% for whites. people. While it is true that acceptability is increasing, much remains to be done to address persistent disparities within communities of color.
How can we increase vaccination rates?
To ensure that everyone who wants the vaccine can easily access it, we need to listen and learn from community organizations that work directly with the vulnerable populations we need to reach most. If the last few months of the pandemic response have taught us nothing else, we need new strategies. The current vaccine surplus in the United States indicates that we need to come together and take a targeted approach. The original strategies need to be reworked to demonstrate a deeper understanding of the physical, social, economic and racial factors that influence health, known in the public health community as the social determinants of health.
Distribution contracts with large pharmacies are a start. But what about drugstore deserts where low-income people can no longer fill a prescription, let alone get a shot, within a mile of their home? We also can’t forget the small neighborhood pharmacies that can provide vaccines and culturally organized information in languages relevant to the communities they serve. We need to bring more mobile vaccination units directly to places where residents have limited access to transport. We need to tap into the strong network of local churches, schools and businesses in our communities to serve as both immunization sites and reliable sources of up-to-date, evidence-based information. We need to encourage family members to encourage each other. We everywhere face the reluctance to immunize by delivering a realistic message about the protection that comes from community coverage: We get the vaccine for ourselves and our communities. Hurry up.
As we see mutant strains emerging, now is the time to be vigilant. Recently we have seen the emergence of the B.1.617.2 Delta variant, which scientists believe to be more transmissible and potentially cause more serious disease, and now Delta Plus is starting to worry experts. The slower the pace of vaccination at home and abroad, the more likely we are to see new, life-threatening variants emerge. The pandemic will not be over until all eligible people are vaccinated.
Bernadette Boden-Albala, DrPH, MPH, is Director of the UC Irvine Program in Public Health and Founding Dean of the future UC Irvine School of Population and Public Health.