The big problem with ‘herd immunity’

6 月 1, 2021World News

Richard E. Besser, a physician, is president and chief executive of the Robert Wood Johnson Foundation in Princeton, N.J. and former acting director of the Centers for Disease Control and Prevention. Follow him on Twitter @DrRichBesser. The views expressed in this commentary belong to the auth

(CNN)The United States reached a significant milestone this week: More than 50% of adults have been fully vaccinated against Covid-19.

Richard Besser

This Memorial Day marks a threshold moment in the pandemic — and we should anticipate better days as the nation starts reopening. Most states have lifted mask mandates and capacity restrictions in response to rising vaccination rates, falling case counts and guidance from the US Centers for Disease Control and Prevention that deemed it safe for the majority of fully vaccinated people to take off their masks in most outdoor or indoor settings.
But in Mississippi, only 35% of adults are fully vaccinated. In Alabama, it’s 37%. In Arkansas, Georgia, Idaho, Tennessee, West Virginia, and Wyoming, they’re all at or under 43%.
Ever since the vaccine rollout started, the US has obsessed over herd immunity, or the idea that when enough people become immune to Covid-19 — whether through infection or vaccination — the risk to those without immunity becomes negligible. Estimates for achieving this nebulous goal vary widely, but states are clearly on different trajectories, and disparities in vaccination rates are sometimes even more stark at the local level.
While the US is doing well on the whole, ultimately what matters is how many people have had Covid-19 and how many are fully vaccinated in each community. As such, it is long past time to retire the idea of a national herd immunity and instead focus on local case levels and vaccine coverage.
At this point, it’s not enough to simply say, “Get vaccinated.” Although lack of supply in the US is no longer an issue, access and trust still are. A new Kaiser Health News analysis of the 42 states reporting racial and ethnic breakdowns of vaccine recipients offers a compelling portrait of the challenges ahead. Some populations hit hardest by Covid-19 still have among the lowest vaccination rates: only 22% of Black Americans and 29% of Hispanics have been vaccinated nationwide, compared with 33% of White Americans. Vaccination rates for Black Americans trail that of Whites in nearly every state.
On the other hand, American Indian and Alaskan Native people, who have also suffered disproportionately from Covid-19, have the highest vaccination rates at 45%. But there are stark differences depending on where they live. More complete data would allow us to identify not only success stories but also areas of need.
Take my home state of New Jersey, for example, where 60% of the adult population is fully vaccinated. This is one of the highest percentages of any state in the country, but the number doesn’t reflect conditions across different communities. In Princeton, a predominantly White community where the Robert Wood Johnson Foundation is located, 66% of the adult population is fully vaccinated; in Trenton, a predominately Black and Latino city about 14 miles away, it’s 32%. This difference reflects broader health inequities and disparities between these locales: residents of Princeton, on average, live 14 years longer than Trenton residents, according to an analysis by Virginia Commonwealth University’s Center on Society and Health. The reasons for these differences are numerous and require specific actions, but the point is, state level data tell an incomplete story.
Such community level challenges have been further exacerbated by politics. People have been forced to reconcile politically driven decisions that tell them one thing with the public health science that tells them another. States that are forgoing mask requirements in schools, for instance, are substituting political judgments for scientific ones. After all, most older children are not yet vaccinated, and those younger than 12 won’t be eligible for at least several months. This consideration must be reflected in how we reopen schools, businesses, places of worship and other establishments. It will not be easy balancing the freedoms of the fully vaccinated with our duty to protect those who are still unvaccinated, but we must be up to the task.
Too often, though, we take a simplistic and myopic view of health and progress in America, touting national numbers while neglecting community needs at the local level. With unemployment, the overall national number masks higher rates in communities of color. With health insurance coverage, the laudable progress of the Affordable Care Act has not eliminated the gaps in underserved communities; that work continues. And today’s red-hot housing market signals growth and prosperity in many zip codes, while safe and affordable housing remains out of reach in others. For each of these examples, the data tell a different story when we take a closer look at different communities and break down figures along race, ethnicity, gender, disability, and other factors.
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As we have seen since the start of the pandemic, the impact of Covid-19 has not been felt equally in every community. This public health crisis has revealed the nation we are, and it has provided us the moral clarity and urgency to dismantle the racist systems and entrenched barriers that have left so many people in this country vulnerable. A single national number is not our ticket out of this pandemic, but a national unity of purpose to make sure as many people are vaccinated as possible in all communities would go a long way.

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