Jul 20 2021

We’re Losing the Vaccine Race

In February on SBM I wrote about the Race Against Vaccine Hesitancy. At that point in time the pandemic was receding in the US in the face of a rapid vaccination program, but also the first new variants of SARS-CoV-2 were starting to appear. Essentially I argued that we were in a race between achieving herd immunity and the spread of new variants that might be more contagious or even vaccine resistant. Experts believed that we would know the answer by Summer.

Well, Summer is here, and the answer is in. We lost the race. Vaccine hesitancy won.

This doesn’t mean that the vaccination program has not been massively helpful. It has. As of now 48.6% of the US population is fully vaccinated, with 56.1% having received at least one dose. This includes children under 12, however, who are not currently eligible for any vaccine. A total of 68.3% of adults have been vaccinated, close to the 70% goal set by the Biden administration. From a logistical perspective, this is a success. The program peaked at over 3 million doses given per day. The program meant that the limiting factor was not the availability of vaccines or the ability to distribute and administer them. The limiting factor is people willing to get vaccinated.

While we may have come close, we did not achieve sufficient herd immunity. Part of the problem is that the vaccinated are not evenly distributed throughout the population. Vaccine uptake is patchy, which means there are clusters of unvaccinated people where the virus is free to spread. Arkansas, for example, is only at 35% fully vaccinated.

The question always was – will vaccinations be sufficient to prevent the spread of emerging more contagious variants when they hit the US? After a Spring of steadily declining we are now starting to see an increase in the number of new COVID infections, due largely to the delta variant, which is more than twice as infectious as the original variant of the virus. Mask mandates are starting to come back. The stock market took a tumble. Our brief glimpse of life returning to normal is now being threatened as we face a potential new wave of the delta variant. And it is literally all due to people who refuse to get vaccinated. The data tells a very clear picture.

While the delta variant is more contagious, the available vaccines still cover it well, about 80-90% effective (compared to 95% for the original variant). But even better, the vaccines are almost 100% effective at preventing severe disease, including hospitalization and deaths. New hospitalizations with the delta variant are almost entirely unvaccinated individuals. There is also a clear regional pattern here, with red states having lower vaccination rates and higher infection rates than blue states. There is no mystery what is going on here – anti-vaccination sentiments have been embraced by the political right. I see this in my own patients.

This explains the Biden administration’s pivot toward tackling vaccine misinformation – because that is now the limiting factor to achieving sufficient immunity to shut down this pandemic. Again, this is one of those times when I hate to be right. Humanity’s greatest threat is itself. We are very clever, and can develop amazing technology. Developing effective vaccines in a year was an amazing scientific achievement. But that means nothing in the face of misinformation, conspiracy thinking, and dedicated anti-science campaigns. We are more dangerous to ourselves than this virus. In short, the greatest risk to humanity is our own stupidity.

Pandemics provide a particularly challenging situation, because we cannot be saved by scientists or political leaders. This challenge requires that the large majority of people all work together responsibly. The more people you need to get on the same page, the less likely the probability of success.

We are also in a particularly challenging social and political environment. Trust levels are very low. Misinformation has been weaponized very effectively. The technology of propaganda and disinformation campaigns has also improved, exploiting social media to great effect. Trolling is now a profession, and a highly developed skill set. It also presents a no-win scenario – a free and open system simply cannot function with a critical amount of bad-faith actors.

The only good solution is education in scientific literacy, media savvy, and critical thinking – but this takes a long time. That is a generational solution, not something that can happen during a pandemic.

Perhaps the race is not entirely over. We can still sprint to the finish line with a huge pushback against misinformation, and making sure people understand how serious this delta variant is. It’s also likely not the pandemic’s last word – there will be more variants, and they may be more contagious and/or deadly. Science won’t passively save us. It is a tool only, but we have to use that tool wisely.


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