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In Depth | COVID-19 vaccination in America: How the US lost its lead, vaccine hesitancy and the path ahead

In Depth | COVID-19 vaccination in America: How the US lost its lead, vaccine hesitancy and the path ahead

COVID-19 has not been untouched by the polarisation of politics in America with the Democrats and Republicans drawing clear lines on their stance towards the vaccines.

Having ensured that it secured the bulk of the world’s available COVID-19 vaccines, the United States initially rolled ahead of all others once production began. This lead has, however, been lost, and as of September 2021, it is last among the world’s seven wealthiest large democracies.

As per latest data released by ‘Our World in Data’, 61.94 percent of Americans are at least partially vaccinated against COVID-19, compared to 62.16 percent Japanese. Notably, only around 12 percent of Japanese had taken at least one jab by June, ahead of the Tokyo Olympics.

“We had the lead and then fell behind. We were quick to vaccinate the half of the population that was eager to be vaccinated but then hit a plateau,” Céline Gounder, an infectious disease epidemiologist told Vox.

For reference, vaccination rate in the US grew by 4 percent (around 700,000 daily vaccinations) between July 24 and September 9, while in Japan this figure jumped 25 percent (about 1 million daily vaccinations).

Cold comfort is that it is still leading Japan in terms of percentage fully vaccinated – 52.76 percent against 50.04 percent; but is behind Italy, Germany, France, Canada and Britain, the New York Times reported. Canada is the leader with at least 75 percent of its population fully vaccinated, followed by Britain (70-73 percent) and Germany (65 percent).

The US as of September, ranks 57th in the world in terms of percentage of population vaccinated, according to Bloomberg’s vaccine tracker.

From unwilling and sceptical citizens and lack of scientific approach to political and demographic divides, here is what went wrong.

Former President Donald Trump speaks to his supporters during the Save America Rally at the Sarasota Fairgrounds in Sarasota, Florida, U.S. July 3, 2021. (Image: REUTERS/Octavio Jones)

Trump Effect: Operation Warp Speed

In the run-up to the 2020 US Elections, then President Donald Trump launched ‘Operation Warp Speed’. Conceptually, the undertaking should have worked – and it did – but only on the R&D and production sides.

Stating that “the problem is Trump”, Vox earlier also reported that the former president severely damaged citizen’s confidence in COVID-19 vaccines – regardless of which company produced it, by repeatedly defying CDC guidelines and interfering in FDA processes for the vaccine evaluations.

In his bid to ensure that the US gets the COVID-19 vaccine approved in “record time” the administration undertook “unprecedented mobilisation by the federal government and private sector”, the report noted.

To this end, Trump “meddled … rather than let vaccine science run its course”. He wanted to stop the FDA from releasing its criteria for COVID-19 vaccine evaluation and also “reportedly called drug company CEOs to press for progress” in what many saw as intrusion on “a sacrosanct process driven by science”.

Nation-wide polls by the Pew Research Center showed that as vaccine development chugged along people’s trust in vaccines dropped – from 72 percent in May 2020 to just 51 percent in September 2020.

A majority expressing concern over the approval process “moving too fast” and scepticism that the vaccines would be safe or effective. Many others simply didn’t trust Trump himself and worried the process was being “politically driven”, the report noted.

Sep 12, 2021; Orchard Park, New York, USA; A fan holds a sign in support of vaccination during the game between the Pittsburgh Steelers and the Buffalo Bills at Highmark Stadium. Mandatory Credit: Rich Barnes-USA TODAY Sports - 16766720

Demographics a factor

Vox found that demographics is a pervasive factor affecting the vaccination rate: for example, Germany has 16 percent of its population aged 18 and below, compared to the US’ 22 percent – and a large chunk of this demographic (12 years and below) is not eligible for vaccination, which drags the overall figures.

But even among those eligible, vaccination rates are relatively behind – irrespective of age and gender demographics.

For example, leading country in vaccinations Portugal has 99 percent of its senior population (65+ years) inoculated, compared to 80 percent in the US; while in the 25-49 age group, 85 percent Portuguese took the jab, compared to less than 70 percent Americans.

The latest KFF COVID-19 Vaccine Monitor released by the NGO KFF in August 2021 found the unvaccinated in the US are divided into two categories: those who preferred to “wait and watch” and those who said their stance towards the COVID-19 vaccine is “definitely not getting it”.

-wait-and-see-group-has-larger-share-of-hispanic-adults-adults-with-a-h-s-diploma-or-less-definitely-not-group-has-larger-shares-of-white-adults

Further, difference between the two unvaccinated categories centre around demographics, the report said. E.g.: among those unvaccinated 4/10 in “wait and see” are people of colour – consisting Hispanic adults (16%) and black adults (11%).

The “definitely not” group is overwhelmingly white adults (65 percent), Republican or Republican-leaning (58 percent), and Evangelical Christians (32 percent).

Demographics wise, rural residents and those uninsured also make up unvaccinated groups.

Gender-wise more women (71 percent) are vaccinated compared to men (63 percent); and more men fall in the “definitely not” category of unvaccinated – 18 percent against 10 percent women.

An attendee wearing a "Biden Harris 2020" face mask watches Democratic U.S. presidential nominee and former Vice President Joe Biden at a campaign drive-in, mobilization event in Detroit, Michigan, U.S., October 31. (Image: Reuters)

Politics: Deep divide

COVID-19 has not been untouched by the polarisation of politics in America with the Democrats and Republicans drawing clear lines on their stance towards the vaccines.

The KFF Monitor showed that Republicans lag behind Democrats (89 percent) and independents (67 percent) in their willingness to get a COVID-19 vaccine. Data showed, 86 percent Democrats already vaccinated compared to only 54 percent Republicans. Further, 1/5 in the latter group also said they would “definitely not” take the vaccine.

republicans-rural-residents-younger-adults-and-uninsured-lag-in-vaccine-uptake

“This political divide over vaccines has contributed to the US falling behind European countries when it comes to coverage levels” Josh Michaud, associate director of global health policy at KFF told Vox.

And while Europe certainly has its own share of anti-vaxxers, as Gonçalo Figueiredo Augusto, who studies public health at NOVA University Lisbon said, “people want to get vaccinated”, they don’t have to be convinced to do so.

Notably, the gender disparity in vaccination can also be attributed to political leaning, with more men identifying as Republicans or Republican-leaning independents, KFF said.

The deep divide and distrust has increasingly led many Republican leaders to publically encourage their electorate to take the vaccines. The numbers are however less than encouraging seeing only a 2 percent jump from 54 percent to 56 percent between June and July 2021.

Representative image

The bogey of Delta variant

Vaccination rate in Europe and Japan picked up ahead of warnings that the Delta variant would likely cause second and third surges in COVID-19 cases. Both regions put their initial stumbles behind and quickly acquired vaccine stocks to scale-up mass inoculation drives. But they also had willing recipients.

In the US, after the initial surge of vaccinations the demand has plateaued despite supply more than meeting requirement. The US began enticing citizens with promise of mask-free public events, free donuts and even million dollar lotteries – all of which failed to push numbers as envisioned.

Neither has fear of the Delta variant been a factor. Among those unvaccinated, KFF found that those in the “definitely not” category, are “less worried about the Delta variant”, and have “less confidence in safety and effectiveness of vaccines”

Around 75 percent of those unvaccinated said they were “not worried” about serious sickness from COVID-19 and less than 50 percent expressed worry that Delta would worsen the pandemic. Further, more than 50 percent said the vaccine is a “bigger risk to health than COVID-19” and 25 percent said keep infected people from dying.

A silver lining here is that 1/5 or 22 percent of unvaccinated adults said news of variants made them more likely to get vaccinated for COVID-19 – including 34 percent from “wait and see”, but a meagre 2 percent from the “definitely not” group.

Child mask coronavirus pandemic

To mask or not to mask?

The Delta variant has impacted the use of masks in the US, with people more likely to wear a mask in public or avoid large gatherings. But here too, the vaccinated v/s unvaccinated divide is present: those more likely to favour masking-up are from the former group.

Majorities of vaccinated adults say news of the variants has made them more likely to wear a mask in public (62%) or avoid large gatherings (61%), while fewer unvaccinated adults say the same (37% and 40%, respectively), KFF found.

The political divide carries on here to, with majorities of Republicans saying they “never” wear a mask outdoors in crowded places, outdoors with friends and household members, at work, or in a grocery store. Democrats, on the other hand, are more likely to report wearing a mask in all of these locations, except when outdoors with household members and friends.

most-republicans-report-never-wearing-masks-at-outdoor-or-indoor-settings-while-democrats-largely-report-wearing-them-except-when-outdoors-with-household-members-and-friends

The centres in Tokyo and Osaka will vaccinate thousands of people every day, giving a boost to Japan's sluggish inoculation drive as officials battle a fourth wave of infections.

How did Japan pull up its socks?

The pacific east-Asian nation began its vaccination programme only in February this year, but pulled its weight to bring numbers up to Europe’s equal in half the time. Plagued by vaccine supply shortages, numbers only picked up in May, with the country clocking 1 million doses per day since, Bloomberg reported.

Japan’s Economy Minister and COVID-19 measures in-charge Yasutoshi Nishimura had then told media that they expected 60 percent population to be vaccinated by September. Real numbers have crossed this figure – sitting at 62.12 percent.

What Japan did on war-footing was set up two large-scale centers run by the country’s Self-Defense Forces, where over 66,000 Moderna jabs were administered within the first week. The country also re-employed retired pharmacists and nurses in its vaccination campaign and started programmes at workplaces.

Corporates such as Toyota and TKP Corp lent their offices as vaccination sites for free, while Rakuten Inc’s Hiroshi Mikitani also offered the Vissel Kobe football stadium as a venue, besides also drafting its star player Andres Iniesta to encourage inoculation.

“Night-time entertainment” districts, believed to be a recurring source of outbreaks were also targeted for mass vaccination plans. And dealing with public hesitancy was left up to local authorities.

A healthcare worker gives a dose of the COVISHIELD vaccine against the coronavirus disease (COVID-19), manufactured by Serum Institute of India, to a farmer in his field, during a door-to-door vaccination drive in Banaskantha district in the western state of Gujarat. (Representative image: Reuters)

India story: lessons in outreach

India has been making vaccination history with its COVID-19 vaccine programme – the largest such campaign in the world. There are close to 110,000 operational vaccine centres in the country – a number steadily scaled up from 50,000 to 75,000 and then higher, News18 reported.

“The number of operational vaccination centers today is nearly double the average sites which were operational earlier,” a senior government official told the publication.

Notably, the large chunk of this is state-government driven, with only around 3,400 vaccination centre being privately run. Medical staff for vaccination sites are also ensured through special buses to and from the village vaccination camps.

A Mint report noted how local ASHA workers are the back-bone or India’s widespread outreach. For example, at a primary health centre (PHC) in Madhya Pradesh’s Chindwara district, Dr Alka Jain recognised villager’s reluctance to take the vaccine and decided to reach out to them personally.

“…villagers in this area were not showing any interest. Our ASHA workers were doing their best, but villagers could not be convinced. Eventually, I decided to step out of the PHC and go out on the ground (sic) to bring about a change in people’s behaviour," she said.

The house calls made a dramatic difference, Dr Jain found. India reported sharp rise in daily COVID-19 vaccinations over the last two weeks – largely rural driven.

Dr Raj Kumar, the district immunization officer (DIO) of UP’s Amroha district told Mint he hopes for 100 percent inoculation within 50 working days. He also noted that personal visits to religious places by field workers and himself led to a change.

“Religious beliefs and misinformation were keeping people away. I have to give credit to my field workers, but there were times also when I have had to intervene… to motivate people to get vaccinated," he added.

The method seems to be working. In September, the average rural-urban vaccination ratio is 2.3:1. Balaji S Reddie, assistant professor of operations at Balaji Institute of Modern Management told Mint that for every person vaccinated in an urban area, at least 2.3 in rural India gets jabbed.

US President Joe Biden (Image Source: Reuters)

America: land of the free

US President Joe Biden on September 7 announced sweeping vaccine mandates – including a few punitive measures, and blamed the unvaccinated for “preventing the US from overcoming the coronavirus pandemic”.

He noted that a significant 25 percent of the eligible population of 80 million people are still unvaccinated and pose a threat to the gains made in the fight against COVID-19.

The US, the worst-hit nation by the pandemic, is reporting an average of 151,500 new cases per day, according to data compiled by Johns Hopkins University, hovering around levels seen in late January. An average of 1,500 people are dying from COVID-19 every day in the US, Johns Hopkins data shows.

“We can and we will turn the tide of COVID-19. It’ll take a lot of hard work and it’s going to take some time. Many of us are frustrated with the nearly 80 million Americans who are still not vaccinated even though the vaccine is safe, effective and free,” Biden said in an address to the nation from the White House on Thursday.

Biden laid out a six-part plan intended to get more people vaccinated, allow schools to reopen safely, increase testing, improve care for patients and boost economic recovery.

Per this, all federal employees are to get a COVID-19 vaccine, with no option for regular testing. Further, contractors that work with the US government will also be bound to then requirement – affecting 2.1 million employees.

Also, all businesses with 100 or more employees have to ensure their workers are vaccinated or tested once a week and companies could face thousands of dollars in fines per employee if they don't comply. This caveat affects 80 million workers.

Other rules include doubling of fines for passengers on planes who refuse to wear a mask, invoking the Defence Production Act to accelerate the creation of rapid at-home testing kits, deploying healthcare workers to areas experiencing surges in cases and increasing the weekly pace of shipments of free monoclonal antibody treatment to hospitals.

"My message to unvaccinated Americans is this: What more is there to wait for? What more do you need to see? We have made vaccinations free, safe and convenient. The vaccine is FDA approved. Over 200 million Americans have gotten at least one shot. We've been patient but our patience is wearing thin and your refusal has cost all of us. So please, do the right thing," Biden said.

Biden also asked nearly 3,00,000 educators in the federal head start programmes to get vaccinated and called on all governors to require vaccination for all teachers and staff.

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Biden plan: All aboard?

The public is divided (51 percent for and 45 percent against) on whether the federal government should recommend employers require vaccines among their employees, KFF said, pointing out that views are “sharply divided” by party identification.

Corporates however are likely to favour Biden’s plan. Many already required their employees to be vaccinated before restarting office work or hybrid work models.

Many corporates such as Amtrak, Cisco, Citigroup, Deloitte, Delta Air Lines, Facebook, Ford, Goldman Sachs, Google, McDonald's, Uber, Tyson Foods, United Airlines, Walgreens and Walmart, announced wide vaccinations plans for their employees.

(Image: AP)

Back to normal when?

Vaccines are the best bet at preventing hospitalization and death and controlling the COVID-19 pandemic. Infectious-disease experts say that vaccinating 70-85 percent of the US population would enable a return to normalcy, as per the Bloomberg COVID tracker.

Vaccine supply has been unequal since the start of the global vaccination campaign – in the US, 115.4 doses have been administered for every 100 people, Bloomberg data showed. Only 1.9 percent of people in low-income countries have received at least one dose.
Global Vaccination Campaign
% of population
Countries and regionsDoses administeredEnough for % of peoplegiven 1+ dosefully vaccinatedDaily rate of doses administered
Global Total5,850,947,88331,132,322
Mainland China2,156,938,0007778.569.34,937,857
India772,045,15028.242.213.56,904,446
EU552,876,04262.266.562.41,058,260
U.S.383,038,40359.863.554.2781,574
Brazil216,611,64852.568.435.91,811,626
Japan148,775,01158.965.152.81,211,318
Indonesia118,994,10522.328.216.11,256,699
Germany104,949,54563.266.962.7198,618
Turkey104,046,14962.662.949.8534,823
Mexico93,588,71936.748.131.8703,885
U.K.92,732,95869.472.666.297,069
France91,962,59870.976.772.7197,031
Russia86,956,25429.631.627.4296,642
Italy81,731,98567.772.967.2216,303
Pakistan71,311,56717.425.811.2829,367
Spain68,955,19174.280.376.8136,107
South Korea56,145,16654.367.640.9777,413
Canada54,743,90972.974.768.783,227
Argentina47,936,96253.364.342.4233,962
Data from Bloomberg’s Covid-19 Vaccine Tracker

 

At the current rate of vaccination of average 781,574 doses per day in the US, it will take the country another four months to cover 75 percent of the population – if all eligible take a vaccine.

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