Former CDC chief: Think outside the box to offer COVID vaccines where they’re needed most

President Joe Biden’s announcement this month that all American adults will be eligible to receive COVID-19 vaccine by Monday marks the start of the next phase of the vaccination campaign that will end the epidemic in the United States. No more phased eligibility and having to figure out whether you have a qualifying medical condition or occupation. No more disparity in eligibility among states and even within states. Get in line and get your shot.

If only it were that simple.

We’ve done a great job getting shots into arms. About 184 million people in the United States have received at least one dose since Biden was sworn in Jan. 20, and we’re now administering about 3 million shots a day. We’re on track to beat his goal of 200 million shots well before April 30, his 100th day in office.

This is good news. Now the bad news: Many people most in need of a vaccine haven’t gotten it.

Well-targeted shots save many lives

Vaccine equity is not just about what’s right ethically but also about what’s essential for pandemic control. To succeed, we need maximum impact from vaccination: to reduce cases, hospitalizations and deaths, and to reduce the risk that even more transmissible and deadly variants will emerge. Aiming our shots — by getting the vaccine to where transmission is highest and to disproportionally affected populations — can achieve these goals

Right now, Black and Latinx people are being vaccinated at only about half the rate of other groups, despite having higher rates of COVID-related hospitalization and death. We must focus particularly on the more than 40 million unvaccinated people over age 50, who are disproportionately people of color and lower-income people. Vaccinating them will prevent many more deaths than vaccinating young people.

COVID vaccines on April 14, 2021, in Miami Gardens, Florida. (Photo: Chandan Khanna/AFP via Getty Images)

A single well-targeted vaccination can save 10 times more lives and prevent 100 times more cases than vaccinating a low-risk person in a low-risk community. Think of it this way: Vaccinating a young person who is working from home and won’t be exposed to COVID-19 prevents exactly zero secondary cases and zero deaths. In contrast, vaccinating a grocery store worker in a neighborhood with lots of COVID-19 who lives in a multigenerational family home could prevent dozens of infections, some of which could be fatal.

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In places with lots of disease spread, it may be necessary to dial back reopening until enough people receive vaccine. We can aim our shots better by strengthening five platforms:

►Community vaccination sites, but with a twist. Allow no-appointment, walk-in vaccinations for residents of high-prevalence areas (offer it to them first, then everywhere). Vaccination clinics need extended hours every day to maximize access. Too many people, especially older people, find it difficult to navigate the path to vaccination.

►Ramp up vaccinations in doctors’ offices. Shots should be offered at every medical encounter, including dental, optometric and mental health visits. Some states are starting to do this, but many are not.

►Pharmacies, especially pharmacies in communities with the highest case rates, should provide walk-in, fast-track vaccination.

►Expand vaccination capacity to workplaces. Many worksites conduct vaccination clinics for seasonal flu each fall and, as workers return, can pivot to COVID-19 vaccination. Most of the more than 120 million full-time workers in America want the vaccine, and employers want them to get it.

►Offer vaccination in community sites, including shopping malls, bars, restaurants, churches, dollar stores and community events. It will be critical to strengthen partnerships with community-based organizations in the communities most at risk.

Communicate that COVID-19 is no picnic 

Vaccines do no good if they stay in freezers. Vaccine hesitancy needs to be understood and addressed through targeted communication efforts. Community influencers, faith leaders and other trusted messengers will be instrumental to reach different demographic groups. They must help increase demand as supply outstrips it.

A similar approach to one used in tobacco control, featuring real stories of pain and suffering from long COVID-19 survivors, can be highly effective. Even for many young people, the coronavirus is no picnic, and young people who had had severe illness need to drive that message home.

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Vaccines are our route to more freedom and safety. Unfortunately, we’re facing a fourth surge — blunted by vaccination. There are three things each of us can do: Get vaccinated as soon as possible and encourage your friends, family and neighbors to get vaccinated as well; continue masking up, especially indoors near others; and reduce indoor contacts with people not in your household.

Fifty years ago, British doctor Julian Tudor Hart wrote that “the availability of good medical care tends to vary inversely with the need for it in the population served.” Today, it is essential that we reverse this. To beat COVID-19 for all of our sakes, we must get vaccines as quickly as possible to the people who will benefit most.

Dr. Tom Frieden, president and CEO of the global nonprofit initiative Resolve to Save Lives, is a former director of the Centers for Disease Control and Prevention and a former commissioner of the New York City Health Department. Follow him on Twitter: @DrTomFrieden

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