America needs a better vaccine plan — and story
Why President Biden's most urgent pandemic task might be messaging
President Biden's team has reviewed their predecessors' agenda for COVID-19 vaccine distribution and reportedly discovered the plans had the significant problem of failing to exist. "There is nothing for us to rework," an unnamed source with knowledge of the new administration's COVID-19 efforts told CNN. "We are going to have to build everything from scratch."
In that it means months of potential progress have been needlessly lost — that the abysmally slow vaccination pace we've seen since mid-December was not inevitable — this is a horrifying revelation. But there may be an advantage here: The Biden administration can craft its vaccine distribution plan and, crucially, its messaging with a free hand.
The message the Biden administration should be preaching is this: The vaccines are good. In fact, they are remarkably good. They are best-case scenario good. Our goal now is to get these good vaccines into as many people as possible as rapidly as possible so we can return to normal as soon as possible, because that is what the vaccines will enable us to do. Do you hate masks? Are you tired of social distancing? Do you want this whole stupid, awful thing to be over? That is what the vaccines can do — if we get them into our bodies, for, as epidemiologist Walter Orenstein observes, "vaccines which remain in the vial are 0 percent effective." It is vaccinations, not vaccines, that save lives.
This seems simplistic, I know. It is certainly simple, and yet somehow it still needs to be said.
Far too much of our public health messaging around the vaccines has been negative, as David Leonhardt has compellingly argued at The New York Times. "Right now, public discussion of the vaccines is full of warnings about their limitations," Leonhardt writes. "They're not 100 percent effective. Even vaccinated people may be able to spread the virus. And people shouldn't change their behavior once they get their shots." These warnings have a "basis in truth," he adds, but their collective impression is deeply — dangerously — misleading. They're adding to the very fears discussion of the vaccines should be relieving.
"We're underselling the vaccine," one expert told Leonhardt. "It's driving me a little bit crazy," said another. A third: "It's going to save your life — that's where the emphasis has to be right now."
There are two very different sources for the underselling Leonhardt describes. One is what we saw with the Trump administration: unjustified skepticism of vaccines generally, of the COVID-19 vaccine specifically, and (somehow, after 400,000 deaths even with all the lockdowns and distancing and so on) the reality of COVID-19 itself. This is the mindset encouraged by an ex-president apparently unwilling to get his own shot even though it might enhance his personal immunity and convince millions of his followers this vaccination is safe and desirable.
The temptation for the Biden administration will be the opposite extreme, what critics have dubbed "doomerism." This is the perspective in which all risk is unacceptable, the mindset that last spring castigated Floridians for taking perfectly safe walks on the beach and now produces headlines like, "Vaccinated Brits told not to hug kids amid fears millions will ignore COVID rules once they have jab." However good the intentions here, any health message to the general public which says to refuse to hug your children indefinitely even after vaccination — and the article doesn't specify adult children in a separate household; it seems to be a blanket directive — should be a non-starter. It is utterly hopeless. Perhaps nothing is more certain to push an already-anxious public into pandemic nihilism and dismissal of vaccination as useless or worse.
The goal in the public health response to this pandemic never was (or never should have been) no risk. That is unachievable, particularly for the great bulk of the public without the luxury of working from home and outsourcing risk to delivery drivers. No, the goal was managed, informed, minimal risk with adequate medical capacity until the vaccine arrived. Think harm reduction for the real world, not all-or-nothing maximalism with which many are unwilling or unable to comply.
And at this stage, the best way to reduce harm is "accepting a more positive vaccine message," as Josh Barro writes at Business Insider. The worry "driving cautious vaccine messaging is that if we tell people too positive a story about the vaccine, they'll go nuts with transmission risks as soon as they've been injected," Barro observes. (This is the exact reason cited in the "don't hug your kids" piece.) "There's one problem with this worry," he continues: "People have already gone nuts with the transmission risks. Look around you. In most of the country, COVID is spreading like wildfire." The priority now is to get vaccines in arms, and that will happen faster if we stop underselling them.
Messaging, of course, is not the only concern. The other is the actual distribution logistics, in which it's not yet clear the Biden administration's plan will be substantially better than the Trump administration's alleged non-plan. The timeline we've heard — and hoped for — was full vaccination for all who want it by mid-summer, but Biden's goal (per the 10 pandemic-related executive orders he signed Thursday) is only 100 million vaccine doses distributed in his first 100 days. As each vaccination requires two doses, that's just 50 million people, less than a sixth of the country, vaccinated by May 1. It's barely faster than what we're already doing. It's not enough.
Almost a year in, we need to be able to see how the pandemic ends. The wonderful thing is an ending that consists of fast delivery of good vaccines is possible, and an ending like that can make the final wait more bearable, vaccination more widely acceptable, and the last stretch of compliance (including the six weeks required for two vaccine doses to take full effect) more feasible. This is the story the Biden administration should be telling — and making a reality.