America could soon be swimming in COVID-19 vaccines: The shift from scarcity to surplus could bring its own problems

Elizabeth Weise, USA TODAY
·8 min read

In just two months, the United States could be swimming in COVID-19 vaccine. The 500 million 0.5 or 0.3-milliliter doses expected to be shipped by then literally are enough to fill a 55,000-gallon swimming pool.

As hard as it is to imagine now as people frantically call, click and line up to get vaccinated, the nation is close to shifting from a situation of scarcity to one of abundance.

“It's not a switch that flips, but it's a sliding scale that happens differently community by community,” said Andy Slavitt, White House senior adviser for the COVID Response Team. “This is not something that will start at some magical day in the future. It has begun today, and it's something that we have to make sure we're addressing."

With a plentiful supply of vaccines, there will be more urgency to convince the reluctant to accept it, experts say. Otherwise, the abundance of vaccines will become a stagnating surplus that threatens to undermine the nation's ability to move beyond the pandemic.

"When we start to have more vaccine available, we're really going to be in bad shape because what we're going to see is a lot of people who don't want to get vaccinated," said Bernadette Boden-Albala, dean of the public health program at the University of California, Irvine.

So far, about 18% of all Americans have been immunized against COVID-19. Boden-Albala thinks there will be vaccine surpluses in some areas as soon as early April.

Then, the challenges will start.

"If we've got whole states in this country that don't want to mask and don't want to socially distance, then I'm very concerned we'll have people there who don't want to be vaccinated either," she said.

Spreading the message: Free vaccine

Messaging will matter, experts say.

The easiest group to reach will be those who've simply put it off because of the hassle to get an appointment.

For them, the message needs to be that immunization's quick, easy and free, said Christopher Morse, an expert on health communication at Bryant University in Smithfield, Rhode Island.

"You want to tell them it's free and how easy it is to get an appointment," he said. "Something like, 'In the time it takes you to order a cup of coffee, you could be vaccinated against COVID-19.'"

The message should not be "we've got tons of vaccine" because then people will be convinced they can put it off for longer, he said.

Empty vials of the Pfizer-BioNTech COVID-19 vaccine are seen at a vaccination center at the University of Nevada, Las Vegas on Jan. 22.
Empty vials of the Pfizer-BioNTech COVID-19 vaccine are seen at a vaccination center at the University of Nevada, Las Vegas on Jan. 22.

Some people who haven't gotten vaccinated simply haven't had the time or felt rushed to do so. Messages about why it's worth their while will be needed, experts say.

"You might say, 'Get vaccinated, spend Easter with your family,' Or a church might encourage people to be fully vaccinated so they can sing together," said Dr. Kelly Moore, deputy director of the nonprofit Immunization Action Coalition.

Younger people who don't necessarily feel at risk might be convinced to get vaccinated to help others. But they might be more enticed so they can go out to the movies again, eat dinner with friends or hang out in bars.

"They're going to be focusing more on the social impact versus the health impacts," Morse said.

Mobile clinics, pop-up vaccination sites and public service announcements from local leaders will be important to reach those in low-income communities of color where vaccine uptake has lagged because of access and hesitancy.

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Such efforts have begun in some places, but they must ramp up significantly as a greater percentage of the population is immunized and the extent of vaccine reluctance becomes clear, experts say.

In California, Orange County is sending eight-person vaccination travel teams into homeless camps, jails and other hard-to-reach populations.

"They come in a van, no appointments required," and they vaccinate whoever is available, said Margaret Bredehoft, deputy agency director of public health services.

Dr. Rebecca Weintraub, director of the Global Health Delivery Project at Harvard University, says such "last mile" delivery channels need to be prepared now to reach vulnerable communities.

"We're going to see vaccination availability, for example, at food banks," she said.

Setting these smaller vaccination events up requires a lot of precision, said Moore.

"You want to make sure you have enough people together when you pop open one of the vaccine vials," she said. "For the Pfizer vaccine, you've got six hours to give five doses. For Johnson & Johnson, it's five doses and for Moderna, it's 10. You don't want doses to go to waste when only two people show up."

The politics of vaccine hesitancy

Public health officials are buoyed by one apparent shift: Vaccine hesitancy among Black Americans, which started out high, appears to be falling. In December, just 42% said they planned to get vaccinated. That number is now 61%, according to a Pew Research Center poll released Friday.

Vaccine hesitancy overall also is falling. In September, 49% of Americans told the Pew research group they probably or definitely wouldn't take the vaccine. By last month that number had fallen to 30%.

But that still leaves 75 million people who may not be taking the doses already purchased by the U.S. government for use. Experts say at least 65% of people, and likely closer to 85%, must be vaccinated to reach herd immunity.

And there are significant partisan differences in terms of who wants a vaccine. Pew found 83% of Democrats said they'd gotten vaccinated or planned to get vaccinated, compared to only 56% of Republicans.

"We’re going to see a point where there’s a real polarization where people are getting vaccinated and people are not," said Dr. Corey Casper, CEO of the Infectious Disease Research Institute in Seattle and a professor of global health at the University of Washington.

While areas with high vaccination rates will see few infections, communities with lower rates may continue to see cases. "They’re going to see a huge use of resources in those areas. It’s going to hurt their economies," he said.

He had expected COVID-19 would be the nation's common enemy, but it hasn't played out that way. The extreme distrust of anything from the government from people on the right has surprised him. "I've never seen anything like this," he said.

"We’re making progress with other groups, but we haven’t seen the dial moving very much among white Republicans. That’s a concern,” said Thomas Bollyky, director of the global health program at the Council on Foreign Relations, a Washington, D.C., think tank.

Will employers require vaccination?

It appears unlikely Americans will be forced to get a shot. Employer mandates for vaccination would be tricky, said Michelle Mello, a law professor and legal health expert at Stanford University.

From a regulatory standpoint, it would be difficult to enforce because so far all three vaccines being used in the United States have emergency use authorization from the Food and Drug Administration, not a license, said Mello.

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There's also not yet solid data showing vaccination makes it less likely someone can transmit COVID-19.

"Once that exists, it would allow employers to say it's an intervention that prevents harm to others," Mello said. But for now, she thinks most employers will embrace incentives rather than mandates.

"Everyone sees the benefit of making it voluntary," she said, though employers might think of sweetening the pot. "If some percentage of your workers are going to feel like crap after their doses, maybe you give them the day after off."

What would US do with extra vaccine?

If the U.S. does end up with a surplus of vaccines, what will it do with it?

The Council on Foreign Relation's Bollyky said there might be an appetite to help the rest of the world.

Vaccine nationalism: 'Unethical' that young Americans could get vaccinated before other nations' elderly, vulnerable

"You might start to see, sometime this summer, a willingness to donate some, though not necessarily, all vaccine," he said.

Moderna Covid-19 vaccine on Feb. 26, 2021, in Los Angeles.
Moderna Covid-19 vaccine on Feb. 26, 2021, in Los Angeles.

There are two reasons for it: One based on health, and one on politics.

Diseases don't respect borders. If COVID-19 continues to rage elsewhere, the U.S. will remain at risk. Almost all high-income countries – 94% – have begun vaccinating residents. Only four out of the 29 lowest-income countries have, according to the Council.

While the U.S. has held back its vaccine for its residents, Russia and China have stepped into the breach, making doses available to other nations.

"There are reports the Biden administration is looking into starting to donate more vaccine in Asia to counteract the potential influence that China may gain from donating doses," Bollyky said.

Helping other nations won't just score political points, it will also help protect Americans against a wily foe we're still figuring out, said Moore, of the Immunization Action Coalition.

"The virus will exploit its advantages if we let down our guard or allow many around the world to go without the protection of vaccination," she said.

Contact Elizabeth Weise at eweise@usatoday.com

This article originally appeared on USA TODAY: COVID-19 vaccine, scarce now, could be in surplus across US by April