The inconvenient recall gap in the United States

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Eight months ago, President Biden unveiled a plan to provide coronavirus boosters to all vaccinated American adults.

But today, booster shots are looming as a significant gap in the federal government’s response to the coronavirus — with no easy answer as to why it happened or what to do about it.

While Biden aimed for all vaccinated adults to get a booster, only about half have gotten one so far. The total number of Americans who received a booster essentially held steady at 30% — about half the rate in some other Western countries — with new vaccinations globally reaching new lows after 2020.

While the use of boosters increased in countries like Germany, Canada and the UK with the emergence of the omicron variant, this increase never reached the US – and still has. not been reached.

Of course, the reasons are various.

The first is that we have lower vaccination rates, in general, than many of these countries, which means that the population eligible for boosters is smaller. Even so, our reminder usage rate was significantly lower as a share of eligible people.

An important factor is how partisan vaccines have become in the United States. Republicans form a very disproportionate share of the unvaccinated, and vaccinated Republicans are also significantly less likely to be boosted than vaccinated Democrats. This means the recall campaign has effectively exacerbated the partisan divide in coronavirus protection. It also means most unboosted people are unlikely to listen to the Biden administration.

But partisanship does not explain everything. These are people who were ready for two shots and for some reason weren’t convinced to get a third.

Another potential reason is the confusing deployment. When Biden made the announcement in August, health officials made it clear they weren’t quite ready for it. The reminders would not be allowed for all adults until three months later – two months after the September 20 date when the White House had set its campaign launch. Some health advisers lamented that Biden’s announcement put pressure on apolitical health advisers, which has happened repeatedly in the Trump administration. And what followed was a series of mixed and confused messages about who was eligible to get boosters, who was advised to get them, and when.

Last week, The Atlantic included this among a series of reasons for slower adoption of callbacks. Others include the initial belief that vaccination was a one-time affair and the high number of breakthrough infections that occurred during omicron – which some people, especially in the conservative media, have cited as a sign that vaccines have failed. really worked. (In fact, although infection rates among vaccinated people increased, unvaccinated people were much more likely to end up in hospital or die.)

What is troubling is that there are few signs that adoption will increase any time soon. In fact, there are signs that opposition to boosters is growing and hardening among vaccinees.

The Kaiser Family Foundation found in January that more than 40% of vaccinated Americans said they would definitely not receive a booster or would only do so if necessary. A survey the following month showed that number to rise to 47%. Part of the growth in this share is likely due to the fact that some members of the original survey group were boosted – removing them from the universe of responses – but the percentage of Americans who were vaccinated but not boosted did not increase. as much during this period.

Another recent survey from Monmouth University also speaks to this. In September, when Biden’s booster campaign was set to launch, two-thirds of American adults said they were at least “somewhat likely” to be boosted when boosters became available. By the end of March, however, the same poll showed that only 48% said they had been boosted, and the percentage of those who had been boosted or at least “somewhat likely” to be boosted had fallen from two-thirds to 6 in 10. .

The same poll in September and November showed around a quarter of Americans said they were “not at all likely” to be boosted, but that number has since risen to 3 in 10 in January and is now by 33%.

This suggests that many people in the “fairly likely” or “not too likely” categories have since moved away from the boosters, rather than towards them; people who said they were open to being convinced were not. And whatever the reasons for this trend, the resulting adoption of boosters is very different from what we’ve seen in other comparable countries.

So far, the recall gap does not appear to have led to worse outcomes in the United States, compared to other countries with higher recall usage. The data shows that the protection gap between unvaccinated people and vaccinated but unboosted people is really large.

But data from the federal government also shows a significant discrepancy between boosted and unboosted results, as we wrote in January:

To be clear, the death rates for both remain extremely low. The weekly death rate in the last three months of 2021 was just over 1 per million for boosted people and around 6 per million for those vaccinated but not boosted. These compare to the weekly rate of 78 per million that we see in unvaccinated people. But we’ve also seen that protection from vaccines declines over time — more so for protection against infection, but also a little for protection against hospitalization and death — which is a big part of the reason for the booster push.

In other words, it was very good to be vaccinated, and much better to be boosted. But since vaccine immunity wanes over time and new variants could be unpredictable and more lethal, our lagging recall rate creates all sorts of potential consequences down the road.


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