With the dominant talk in Massachusetts these days about how the Baker administration can accelerate its vaccine rollout, we are being blinded to another huge danger that is right ahead of us and needs to be addressed urgently: Within the next couple of months, Massachusetts may hit a vaccination plateau where all the people willing to be vaccinated have been covered fall short of reaching the 80 percent population coverage needed to attain herd immunity and drastically lower COVID-19 transmission.
At present, there is a risk that vaccination will stall out in Massachusetts at less than 50 percent of the total population, given that roughly 20 percent of residents are younger than 16 and not eligible for vaccination, and vaccine hesitancy may limit the willingness of the remaining 80 percent to receive the shot. That is what is happening in Israel, which rapidly vaccinated half of its population in three months but is now seeing daily vaccinations slowing and is scrambling to find ways to reach the 25 percent of “vaccine skeptics” who are so far unwilling to be inoculated
Stalling out here in Massachusetts and across the United States would be a disaster. It would allow the virus to continue to circulate widely, leading to more infections, deaths, and increased chances that we will encourage more genetic mutations of the virus that are increasingly contagious and harder to stop with vaccines.
With all the recent stories of shortages of vaccines and appointment slots in Massachusetts, how could hitting the wall be a serious possibility? The reason is simple: For each of the eligible groups, only a fraction are getting vaccinated.
Nearly 25 percent of the state’s patient-facing health workers have refused to be vaccinated since the program started two months ago, and 40 percent of nursing home employees have also declined, reflecting national trends. More than 50 percent of prison workers have turned down the vaccine.
As the state advances to the next phases of vaccine eligibility, vaccine hesitancy will probably knock down the share being inoculated.
In a December survey, only 28 percent of Black and 22 percent of Latino residents in Massachusetts said they would get vaccinated “as soon as possible.” People of color are highly represented in front-line occupations, underscoring the urgency of having them get vaccinated to protect themselves, their families, and their clients.
And yet the biggest challenge in overcoming vaccine hesitancy will be in the group that we have not begun to touch — younger adults. A survey by the Kaiser Family Foundation found that 43 percent of American adults aged 18-49 would rather wait and see and not be vaccinated immediately. The experience from Israel corroborates this sobering news — many young Israelis do not consider themselves at enough risk from COVID-19 to seek vaccination. If trials currently underway lead to licensing of COVID-19 vaccines by late summer for those under the age of 16, this will improve overall coverage, provided that parents give consent for their children to be inoculate. Since late summer is six months away, this is another reason we need to increase the share of adults reached now.
Adding these data points indicates Massachusetts could be far below the 80 percent vaccination threshold, which could otherwise be reached by July when there is enough supply required to diminish the virus.
To avoid this looming disaster, we must implement a combination of measures targeted at the specific barriers facing each group:
▪ Vaccination should be a condition of employment for health care workers, as is already the case for the flu vaccine in nursing homes. It is inexcusable that the health workers we entrust to take care of our most vulnerable population are not themselves protected from COVID-19 and risk transmitting it to their patients.
▪ We must reach people in communities of color with a vigorous vaccine awareness campaign, crafted with language and messaging tailored to our state’s diverse cultures. We need to build distribution around the fact that 80 percent of people in Massachusetts report they trust their personal doctors regarding vaccine safety and efficacy.
▪ Employers should give their workers paid time off to be vaccinated, while vaccination sites should extend their hours to accommodate those on fixed shifts who can only show up for vaccination at night or on weekends.
▪ To encourage vaccination among younger adults, incentives including cash bonuses or vouchers for being vaccinated, as well as penalties for declining the vaccine, should be explored. Israel is already experimenting with these measures, as well as tax rebates and the issuance of “green passports” that are legally required to access gyms, restaurants, and sports events.
It is urgent that we solve the vaccine equity issue to save the most lives, and since people of color live in our most severe virus hotspots, intensifying vaccination in these communities is a highly effective way to slow the spread of COVID-19
As with masks and social distancing, we must remember that we are truly in this together, and what each of us does to get vaccinated as quickly as possible will have a positive impact on the rest of us.
Robert Hecht is the president of the Boston-based Pharos Global Health Advisors and a clinical professor of epidemiology at the Yale School of Public Health. Shan Soe-Lin is managing director of Pharos Global Health Advisors and a lecturer in global health at the Jackson Institute for Global Affairs at Yale University.