What might have been
For all of the United States’ success with its vaccine rollout, about 100,000 people have died since February, when the rollout was underway. Many more were infected, hospitalized and are living with long-term problems.
My colleagues at The Times asked more than a dozen experts to look back on the vaccine rollout and identify what could have been improved. They came up with five alternate scenarios.
Some suggested that the U.S. should have delayed second doses of the vaccine for several weeks, delivering first shots more widely to high-risk people, in order to give some protection to more people. This approach was hotly debated; Dr. Anthony Fauci said he was opposed. The U.K. took this approach, delaying shots by up to 12 weeks, and deaths there plummeted.
A younger rollout
Some have argued that the nation might have prioritized those most likely to spread the virus, rather than those most vulnerable to dying, as officials tried to do in Indonesia. In recent months, people aged 50 to 64 have made up a growing share of Covid deaths, underscoring the remaining risk to people who are slightly younger and unvaccinated. However, experts who spoke to The Times generally said that the U.S. was wise to prioritize older people, who have died at much higher rates.
A targeted approach
Again and again the experts said the U.S. fell short in vaccine equity. Across much of America, the lowest-income neighborhoods had the highest per capita rates of cases and deaths, and the lowest vaccination rates. Black and Hispanic Americans, who have been at higher risk of being infected and of dying from Covid-19 compared with white Americans, have received the vaccine at lower rates. One data analysis suggests that simply targeting vaccines early on to the hardest-hit ZIP codes might have saved lives.
Faster congressional action
After passing a $2 trillion stimulus in March 2020, Congress haggled for months over further legislation. A final package, including billions for vaccine distribution, did not become law until just after Christmas — after the Pfizer and Moderna vaccines had been authorized for emergency use. If the money had come earlier, health departments could have scaled up earlier, experts said.
A better PR campaign
Former President Donald Trump, who had arguably his biggest pandemic success in quickly producing vaccines, did not use his popularity to convince skeptical members of his base of their effectiveness. The Biden administration has also been unable to overcome pockets of hesitancy. Some experts fault communication errors: starting vaccine literacy campaigns too late and with too little star power; the branding of Operation Warp Speed, which may have suggested haste at the expense of quality; poor information about cost and access.
“We should have had massive billboards from the beginning: ‘THE VACCINE IS FREE, YOU DON’T NEED AN I.D.,’’’ one Harvard Medical School professor told The Times.
A treatment pill
The U.S. government announced that it would invest $3.2 billion in a neglected area of research: developing antiviral pills for Covid. Such a treatment could fight the virus early in the course of infection, keeping people out of the hospital, and potentially save many lives.
Dr. Anthony Fauci, a key backer of the program, said he looked forward to a time when patients could pick up antiviral pills from a pharmacy as soon as they tested positive or developed symptoms.
Dr. Fauci described the scenario in an interview: “I wake up in the morning, I don’t feel very well, my sense of smell and taste go away, I get a sore throat. I call up my doctor and I say, ‘I have Covid and I need a prescription.’”
Scientists now know that the best time to try to block the virus is in the first few days of the disease, when the virus is replicating rapidly and the immune system has not yet mounted a defense. Blocking the infection early may prevent later, more damaging stages of the disease, when immune systems begin misfiring and damage tissues instead of viruses.
A number of other viruses, including influenza, H.I.V. and hepatitis C, can be treated with a simple pill. But despite more than a year of research, no such drug exists for the coronavirus. The new investment will be used to speed up the clinical trials of a few promising candidates. If all goes well, some of those pills could become available by the end of this year.
What else we’re following
What you’re doing
Yesterday we learned of a cousin-in-law who passed away in January from post-Covid complications — seizures and hallucinations. The subsequent suicide of his severely depressed wife last week left behind a 2-year-old child. The 600,000 milestone does not take into account the collateral deaths.
— Romulo Ramos, Irvington, N.Y.
Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.
Email your thoughts to [email protected].