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Will We Ever Reach Biden’s Moving Vax Target?

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As of this writing, over 320 million COVID-19 vaccines have been administered in the U.S., with 56% of adults fully and 66% at least partially vaccinated. Based on these numbers, it’s unsurprising that the White House conceded it wouldn’t hit President Biden’s goal of vaccinating 70% of adults, at least partially, by July 4. The administration has since amended its goal, announcing a new, more realistic target of vaccinating 70% of Americans ages 27 and older by Independence Day.

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 reach herd immunity, and protecting against emerging variants is essential.

The question now is, what new strategies can we use to get more shots into arms? In early May, the president announced a robust plan to improve access to vaccinations across the country. Measures included increasing walk-in vaccine appointments at local pharmacies and state vaccination sites; shifting to smaller, community-based vaccination clinics and mobile units; and supporting community vaccine education and local outreach efforts. However, the rate of vaccination has slowed, meaning we need to work harder to reach vulnerable communities nationally and, ultimately, across the globe.

Who Isn’t Getting Vaccinated?

Even in the face of an abundant U.S. vaccine supply, two threats to progress remain: resistance among key demographics and disparities in vaccine access among high-risk populations.

Indeed, much of our ability to halt transmission of the virus lies in the hands of the remainder of Americans who are yet to get vaccinated, either because they are hesitant or lack access. The public health community is now charged with a two-pronged responsibility: 1) convincing hesitant and resistant groups that the vaccine is, in fact, safe, effective, and critical to a COVID-free world, and 2) addressing the longstanding barriers that prevent certain groups from accessing vaccines.

There are clear distinctions between the vaccinated and unvaccinated groups in the U.S. They differ in age (unvaccinated adults are significantly younger), education (unvaccinated adults are more likely to hold a high school degree or less), and political affiliation (adults identifying as Republican or Republican-leaning independents are far less likely to be vaccinated compared to Democrats). There are also significant differences in race that illuminate issues around equitable vaccine access.

For some, the decision to forego vaccination is rooted in concerns about safety and efficacy, though this group is shrinking. Among the 13% of adults who indicate they will “definitely not” get the vaccine, nine in 10 also say they don’t get the annual flu shot, suggesting skepticism toward vaccines in general. More recently, these concerns have been amplified by events like the temporary suspension of the Johnson & Johnson vaccine following reports of rare but serious blood clots as a side effect.

Hesitancy also persists among our nation’s most vulnerable — including low-income communities of color — whose concerns stem from legacies of neglect and oppression. Having historically and repeatedly sidelined the health priorities of our vulnerable communities, the U.S. has generated deep-rooted mistrust in our systems among those most in need.

Compound this by the fact that Black and Hispanic Americans are less likely to receive vaccines compared to whites, while accounting for a larger share of cases and deaths.

Black Americans are getting vaccinated at lower rates — on average, 1.4 times lower — than white Americans. Black and Hispanic Americans are nearly twice as likely to say their access to COVID-19 vaccines and resources (for example, quality treatment and care) are worse than that of other racial and ethnic groups. And most county vaccine rollouts had a 4- to 8-week lag time in linguistic translation of registration and information materials. These disparities are compounded by the structural, community-level barriers (such as poverty, healthcare personnel shortages, and lack of reliable transportation to local healthcare facilities, to name a few) that too were borne out of 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 U.S. saw small, but important increases in vaccination rates across racial ethnic groups, with a 1.5% increase among Asian people, 1.4% increase for Hispanic people, 1.2% for Black people, and 0.8% for white people. While it is true that acceptability is increasing, there is still much to do to address the persisting disparities in communities of color.

How Can We Drive Vaccination Rates?

To ensure that everyone who wants the vaccine can easily access it, we must listen to and learn from community organizations that work directly with the vulnerable populations we most need to reach. If the past few months of pandemic response have taught us nothing else, it is that we need new strategies. The current U.S. vaccine surplus signals that we need to regroup and form a targeted approach. The original strategies must be reworked in a way that demonstrates a deeper understanding of the physical, social, economic, and racial factors that influence health, known to the public health world as the social determinants of health.

Distribution contracts with large pharmacies are a start. But what about the pharmacy deserts where low-income individuals can no longer fill a prescription, let alone get a vaccine, within a mile of their home? We also can’t forget about the small neighborhood pharmacies that can deliver vaccines and culturally organized information in languages relevant to the communities they serve. We must take more mobile vaccination units directly to places where residents have limited access to transportation. We must tap into the robust network of churches, schools, and local businesses in our communities to serve as both vaccination sites and trusted sources of up-to-date, evidence-based information. We must encourage family members to encourage one another. We must attend to vaccine hesitancy everywhere by speaking a realistic message about protection borne from community coverage: We are getting the shot for ourselves and our communities. Time is of the essence.

As we see mutant strains emerge, now is the time to be vigilant. Recently, we have witnessed the emergence of the B.1.617.2 Delta variant, which scientists believe to be more transmissible and potentially cause more severe disease, and now, Delta plus is beginning to worry experts. The slower the pace of vaccination at home and abroad, the greater at risk we are of seeing potentially deadlier novel variants emerge. The pandemic won’t be over until every eligible person is vaccinated.

Bernadette Boden-Albala, DrPH, MPH, is the director for the UC Irvine Program in Public Health and Founding Dean of the planned UC Irvine School of Population and Public Health.

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