COVID-19 vaccination rates have fallen off a cliff, despite extensive interventions. It might take a deadly summer surge to change things.<\/b>
\nAmerica\u2019s vaccination rates have fallen off a cliff, and nothing seems to help. On June 2, President Joe Biden announced a frantic plan to reverse what already seemed to be an awful, exponential slide: At the peak of the country\u2019s vaccine rollout in mid-April, almost 3.5 million doses were being put into arms every single day, but that number had quickly dropped by half, and then by half again. Biden\u2019s \u201c month of action \u201d came and went, and nothing really changed; or rather, the situation kept on changing for the worse. Demand for vaccinations shrank in July, as it had in May and June. Even statewide vaccination lotteries, described here and elsewhere as a great idea, had turned out to be a flop. With every passing day, the pace of vaccinations only seems to drag a little further toward the gutter. As of July 12, it had fallen off by half again. The Great Vaccine Decline now appears to be an ugly force of nature. If it continues, further horrors are all but guaranteed to follow. Sadly, those horrors may be the only thing that stops it. The problem, it\u2019s been said, is that we live in two Americas, riven by both ideology and immunology: In blue America, vaccination rates are standing up just fine; in red America, they\u2019re slouchy and exposed. Indeed, the latest vaccine numbers show that 17 states have now provided at least one dose to more than 60 percent of their population\u2014and every single one of them voted for Biden in the last election. Another 16 states are struggling to reach a rate of 50 percent; all but one of those went for Donald Trump. But there\u2019s another, better way to think about what\u2019s happening here: If the distribution of vaccines keeps slowing down, it\u2019s not because America is divided but because we\u2019re running out of people who think vaccines will save their lives. It certainly hasn\u2019t helped the vaccination drive that Fox News and other right-wing outlets are sowing fear about the safety of the COVID-19 shots, and about the efforts to distribute them. Still, the recent wave of right-wing propaganda hasn\u2019t clearly made the problem worse. Going by the numbers that we have so far, Tucker Carlson\u2019s summer monologues aren\u2019t really changing many minds. In fact, enthusiasm for the vaccine has been growing, overall, in both Americas alike. According to the Kaiser Family Foundation, which has been carefully following vaccine attitudes and behaviors since December, almost half of Democrats were saying that they planned to get immunized as soon as possible (if they hadn\u2019t done so already) at the end of 2020; by June, that rate had nearly doubled, to 88 percent. Republicans started from a lower baseline, but they\u2019ve also gotten more accepting: Just like the Democrats, the proportion saying that they wanted the vaccine almost doubled over time, from 28 percent to 54 percent. Party rhetoric notwithstanding, the overall partisan gap in vaccine enthusiasm has been holding steady, at a little more than 30 points, through all of 2021. Rather than diverging politics, people\u2019s willingness to get vaccinated might best be understood as a function of how they perceive risk. Although there are more noble reasons to be immunized than self-protection, surveys show that they\u2019re not the ones most often cited. Kaiser finds that among those who have gone in for their shots, more than half say the \u201cmain reason\u201d was to reduce their personal risk of illness. Meanwhile, among the unvaccinated, one-half assert that COVID-19 case rates are now so low that further vaccinations are unnecessary. Risk perception is just one of many factors that determine vaccine uptake. You could be terrified of getting COVID-19, for example, and desperate to be immunized, but still find yourself unable to reach a distribution site. A person\u2019s sense of danger could also modulate these other factors, at least for some people: The time and effort that it takes to get vaccinated may matter less to those who worry more. Risk certainly seems to help explain the other major gap in vaccination rates across the U.S. population, between the gray America of retirees and the green one of Millennials. Some 85 percent of seniors have now been vaccinated, versus 55 percent of young adults\u2014a gaping,30-point spread that matches up, almost perfectly, with the spread between Democrats (86 percent) and Republicans (52 percent). If these two Americas of old and young are making different choices about vaccines, it can\u2019t be just because they\u2019re watching different cable talk shows, or because they vary in their trust in institutions, or because they disagree about the legal merits of Jacobson v. Massachusetts. No, old people are much more likely than young people to get their COVID-19 shots because old people are much more likely to die from the disease, and they know it. The same pattern holds for uptake of the flu shot every year: Seniors, who are at the greatest risk of influenza, are much more likely to be immunized. (The age gap for the flu shot, like the one for COVID-19 vaccination, is roughly 30 points.) Since the very start of the pandemic, Republicans and Democrats have differed widely in their sense of the virus\u2019s dangers. From March of 2020, the Pew Research Center has been asking American adults whether the coronavirus outbreak represents a \u201cmajor threat to the health of the U.S. population as a whole\u201d\u2014and from March of 2020, Democrats have almost always been about twice as likely to say yes. In May last year,82 percent of Democrats agreed that it was a major threat, compared with 43 percent of Republicans. Politicians were working hard, from March of 2020, to shape those very perceptions among their constituents, and it worked: The partisan worry gap was in place long before any vaccines were ever tested, and long before the right-wing media started talking up the risks of deadly side effects. It hasn\u2019t budged for months and months and months. Differences in risk perception are not as clearly linked to other important (and somewhat narrower) vaccination gaps, such the one between Black and white Americans. But looking at the numbers overall, you can see some hints of how these factors might have played out into the timing of America\u2019s Great Vaccine Decline. It\u2019s clear enough that vaccinating people drives down the spread of COVID-19: Over a period of about six-months, the number of new cases recorded every day in the U.S. has dropped by 95 percent, while the number of Americans who have been fully vaccinated increased a hundredfold. But the effect might also go the other way, with a decline in COVID-19 cases driving down the rate of vaccination. On March 11, Biden announced a huge expansion of the vaccine rollout, and over the next month, the number of doses being given out per day increased by 25 percent. But case rates were increasing too, by about the same amount. Then, around April 12, both trend lines hit a ceiling: From that point on, fewer Americans were getting sick, and fewer were getting vaccinated. By the end of June, both rates had fallen off by more than 80 percent. It\u2019s not surprising that demand for vaccination would tend to fall off over time, given that the most enthusiastic people line up first. Once they\u2019ve gotten all their doses, the pace can only slow. But the coincidental timing of the drop in case rates hints that people\u2019s sense of risk could be a factor too. Imagine that you\u2019re not so sure about getting the vaccine yourself, and then you hear that the pandemic is receding. Maybe that makes you somewhat less inclined to take the day off work and find a mobile clinic. Maybe it\u2019s a reason to wait a little longer. \u201cOne of the main problems that vaccination programs face is that they\u2019re effective,\u201d Noel Brewer, a psychologist who studies health behaviors at the University of North Carolina, told me. \u201cAnd their effectiveness undermines people\u2019s interest in vaccination.\u201d If our sense of danger\u2014or lack thereof\u2014is behind the Great Vaccine Decline, then maybe there\u2019s a fix. Should we try to make the holdouts more afraid? Scared Straight programs for vaccines have been tried before, and they haven\u2019t done much good. Studies tend to find that pointing to the dangers of disease will certainly freak some people out\u2014but that feeling is short-lived and doesn\u2019t seem to change behavior. \u201cThey found small increases in perceived risk but no increases in vaccine uptake,\u201d Brewer said. \u201cOn balance, it\u2019s not going to work.\u201d It\u2019s also possible that some people who are disinclined to get their COVID-19 shots might not be wrong, per se, in their assessment of their own, relative risk of dying from the disease, even if they\u2019re neglecting the bigger picture. Young people really are hundreds of times less vulnerable than seniors, and Republicans are, on average, a lot more realistic than Democrats about a person\u2019s chances of developing severe disease once they\u2019ve been infected by the coronavirus. (At the same time, they\u2019re much less realistic about COVID-19\u2019s harms in aggregate.) In other words, efforts to scare more young people or Republicans into getting vaccinated could end up encouraging them to be less informed about the facts, at least narrowly construed, instead of more so. Brewer warns that any form of intervention aimed at people\u2019s \u201cthoughts and feelings\u201d about vaccines isn\u2019t likely to succeed. We know that those thoughts and feelings help determine people\u2019s actions, but that doesn\u2019t mean they can be changed by PSAs or other public-health campaigns. It\u2019s better to focus on behavior, he told me. \u201cWe have to help folks take action; we have to help them take time off work; we have to help lower the barriers that are currently preventing them from acting on their good intentions.\u201d It\u2019s important for people\u2019s own doctors to be involved in the process, encouraging and delivering vaccines, Brewer said. Vaccine requirements might make a difference. Full FDA approval for the vaccines could help, too\u2014though how much is debated. Of course, helping folks take action is just the sort of thing that the White House has been pushing, and they haven\u2019t done much good. Brewer acknowledged that the effects have been pretty small so far, but he said that doesn\u2019t mean they\u2019re unimportant. Changing people\u2019s health behaviors tends to be slow and difficult work. \u201cWhen looking at other vaccines, an increase of 2 percent year over year is a big deal,\u201d he told me. Even tiny bumps like these save lives. But as the Delta variant rips through Arkansas, Florida, Missouri, and the rest of the United States, we may see the vaccination numbers start to rise in tandem. If a drop in cases dampened people\u2019s urge to get vaccinated, then perhaps a surge in cases will do the opposite. If ICUs keep filling up, and COVID-19 deaths increase again, then a growing sense of danger may envelop some among the vaccine-hesitant, nudging them toward action. It\u2019s a pattern that we\u2019ve seen before: In 2019, when measles struck parts of the Pacific Northwest, local rates of measles vaccination tripled in response. The economist Emily Oster has looked at pertussis outbreaks, county by county, going back to 1991, and found that child vaccination rates increased in the years that followed. The two lines plotted on the chart above, for new COVID-19 cases and vaccine doses, have started to diverge. It will be a somber consolation if they come back together in the weeks ahead. A national month of action did little to arrest the Great Vaccine Decline. Now a national month of pain and suffering is all we have.<\/p>\n