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Biden, public health officials face crossroads on COVID-19

“We are now in a race between the vaccine and making sure we don’t have another peak or surge,” Dr. Anthony Fauci, the nation’s top infectious disease expert.
“We are now in a race between the vaccine and making sure we don’t have another peak or surge,” Dr. Anthony Fauci, the nation’s top infectious disease expert.Susan Walsh/Pool

WASHINGTON — In recent weeks, the US battle against the deadly COVID-19 pandemic has produced something it rarely has — good news.

Deaths are down dramatically nationwide compared to earlier this year. Over a quarter of the adult population is fully vaccinated, with millions more doses shooting into arms every day. And more studies have proven the vaccines remarkably effective in warding off death and hospitalization — even when faced with the proliferating variants of the disease.

But despite this parade of hopeful developments, the federal government’s public health officials — and experts nationwide — are not yet celebrating. Far from it. And that relative reticence about the remarkable power of the vaccines, along with some other recent Biden administration moves, has drawn rare rebukes in the public health world, even as experts praise the vaccine rollout overall.

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For President Biden’s public health team, it feels something like a heads-I-win-tails-you-lose moment, when it comes to policy choices. There is no one obviously correct way to go in this tricky moment in the battle against COVID-19, experts say, when even more infectious variants could overtake the pace of vaccinations, and push the country into a “fourth wave” of disease — one that could come just as Americans are less likely than ever to adhere to social distance guidelines due to fatigue with the pandemic’s strictures. The more contagious UK variant of the disease recently became the predominant strain of COVID in the country, the Biden administration said last week.

“We are now in a race between the vaccine and making sure we don’t have another peak or surge,” Dr. Anthony Fauci, the nation’s top infectious disease expert, said last week.

Dr. Thomas Tsai, a professor at the Harvard T.H. Chan School of Public Health, compares the moment to the “seventh inning stretch of the baseball game” with the fate of the match in our hands. “How we play the next two innings really determine whether we win the game.” Or have to play another.

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That race between the disease and vaccines has been evident in Michigan, which became a COVID-19 hot spot in recent weeks despite middle-of-the-pack vaccination rates. Michigan Governor Gretchen Whitmer called for voluntary shutdowns in the state as hospitals began filling up and has asked the Biden administration to surge vaccines to the hard-hit area.

The Biden administration has so far refused the request, with White House coronavirus adviser Andy Slavitt telling reporters on Monday that he doesn’t want to play “whack-a-mole” with the federal vaccine supply — rushing vaccines to various hot spots around the country after infections have already risen. Vaccines take weeks to kick in, and the administration is sending treatments and testing support instead, he said.

Some prominent public health experts disagree with this approach, however.

“From a policy point of view we absolutely should be surging testing and vaccines to Michigan,” Dr. Ashish Jha, dean of the Brown University School of Public Health, said on CBS on Monday.

Some epidemiologists are arguing the government should have been better prepared from the beginning to respond to hot spots with vaccines to slow the spread of more transmissible variants.

“We should have held a tranche of vaccines in reserve for surging to variants,” said Samuel Scarpino, an epidemiologist at Northeastern University.

And even as Biden announced that all Americans would be eligible to receive a vaccine by next week — a significant victory for his vaccine rollout plan — an iceberg looms ahead. The administration is starting to approach the point at which vaccine availability outstrips demand, according to some projections, underscoring that the challenge, increasingly will be to sell more reluctant Americans on the vaccine in the months to come.

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A recent Gallup poll found that a record low number of Americans are concerned about catching COVID, and another April survey from YouGov found that a far higher percentage of currently vaccinated Americans are worried about catching COVID-19 than Americans who say they plan not to get vaccinated.

This has experts worried that convincing the remaining determinedly skeptical or nonchalant tranche of people to get vaccinated will be an uphill battle. Vaccine demand could plateau by late April, well before the nation reaches herd immunity, according to an analysis by the nonprofit health data organization Surgo Ventures.

“If people aren’t afraid of coronavirus then they aren’t interested in vaccinating,” predicted Dr. Robert Horsburgh, an epidemiologist at Boston University.

Public health officials including Fauci are working to promote vaccines through local faith leaders, medical professionals, and other trusted people within communities around the country. But some believe the Biden administration should do more to sell the protective effects of the vaccines to individuals, arguing that many people do not realize how dramatically the vaccine cuts each person’s risk of getting severely ill with COVID-19. The administration has stressed the need for continued caution by the vaccinated, a pitch that, while factually based, may also discourage reluctance vaccinators from stepping up.

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“I do think a lot of us did not do a great job with the communication around the vaccine,” Scarpino said. “The vaccines really seem to turn this thing at the worst case into the common cold. There should be a lot more messaging around that fact.”

When presented with various facts about the vaccine in a survey by the Kaiser Family Foundation, vaccine hesitant people said the news that shots have been shown to be nearly 100 percent effective in preventing hospitalization and death was by far the most persuasive to them. (There is reason for some caution about such gaudy numbers, however. A large study from Israel on those fully vaccinated with the Pfizer vaccine estimated that the shots are 87 percent effective at preventing hospitalization, less than the clinical trial’s results which included fewer people.)

Dr. Aaron Richterman, an infectious disease specialist at the University of Pennsylvania, said some of his patients have no idea how protective the shots actually are, and that it would be helpful in convincing more people to get vaccinated if that message was front and center. “Nothing is ever 100 percent but these are as effective as any vaccine that’s ever been tested,” Richterman said. “That’s how I would frame that.”

But the Biden administration has to juggle both sides of this daunting equation, selling the vaccine’s effectiveness to those who remain unconvinced to take the shot while also encouraging people to stay masked in public and to follow other public health guidance until the pandemic is under control.

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“For those who are vaccinated this individual risk may be low, but public health is built on the backs of thousands of individual actions,” said Tsai, who supports the Biden administration’s approach. “Even if your individual risk may be low the goal is to put the lid back on the widespread transmission.”


Liz Goodwin can be reached at elizabeth.goodwin@globe.com. Follow her on Twitter @lizcgoodwin.