The Vaccine Rollout Will Take Time. Here’s What The U.S. Can Do Now To Save Lives

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A sign warns against the Covid-19 virus near the Navajo town of Tuba City, Arizona. As the virus rages across the U.S., mitigation measures continue to be critical to save lives.

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And, they say, vaccines are only part of the solution — state and federal leaders can still take other actions to help save lives.

«If we really cared about people we wouldn’t be waiting for a vaccine,» says Dr. Camara Jones, an epidemiologist and past president of the American Public Health Association. «If we really cared about people, the government would do everything in its power to keep people safe right now.»

Nearly a year into the pandemic, NPR asked public health experts to reflect on what works — and what doesn’t — to control outbreaks. Here’s what they say is essential for getting through the current public health crisis — and preparing for the next one.

Act, and act quickly

Experts agree that when it comes to state actions to slow infections, timing is key.

«Every minute, every day counts,» says Dr. Sen Pei, a research scientist at Columbia University’s Mailman School of Public Health.

Pei co-authored a study that looked at social distancing and other contact-reduction measures across the U.S. between mid-March and early May. It found that introducing the same level of restrictions just one week earlier could have prevented more than 600,000 confirmed cases and 32,000 deaths, with a two-week difference growing those numbers even more.

A two- or three-day delay can double the number of cases during the exponential growth phase of an outbreak, Pei explains.

«It’s really necessary to bring down the prevalence in the population to actually control the spreading of the coronavirus,» he says. «That’s why, initially, you need to take decisive and kind of harsh measures.»

Choose smart, targeted restrictions

As communities reopen, Pei says, they should be quick to respond to subsequent surges by reimposing limits on businesses and activities. The longer they wait, the higher the cost, he added.

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A sign reminds people to wear face masks at an empty Grand Central Market in November in Los Angeles, California. Los Angeles has urged citizens to stay home since early December to slow its outbreak. Stay-home orders can help control a coronavirus surge.

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President Joe Biden released his pandemic response plan shortly after taking office.

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«With strong and effective federal action … states can act more rapidly and decisively without the trade-off being such a high toll,» Heymann says.

Heymann says she is confident that people would be more likely to follow health recommendations, such as staying home when exposed to the coronavirus, if such protections existed.

Jones, the former American Public Health Association president, says support such as eviction protections and financial assistance to states and localities would all help, and also signal that leaders are taking the pandemic seriously.

«If the government paid people to stay at home [when they’re sick or exposed], if we protected the people who had to be at work, then we would have no huge forest fire of an infection in this country,» Jones says.

Coordinate the national response on key issues

While experts say states and localities should tailor their response to the conditions on the ground, they agree that a coordinated response and certain federal measures are needed. Key among those are a federal plan for vaccine distribution and a national approach to mask-wearing.

Heymann says that while local and state mask mandates are better than nothing, wants to see a national policy on masks, given the amount of travel across borders. Heymann, like many of the experts interviewed for this story, noted with concern that masks have become politicized, but expressed optimism about conditions improving under the Biden administration.

Two of Biden’s first acts as president were signing executive orders mandating masks on federal property and for interstate travel. And his plans for his first 100 days in office include asking all Americans to wear masks for that time.

Nuzzo points to New York City as an example of the fact that without a nationwide approach to COVID-19 precautions, even places that had been doing relatively well can flare up when the virus rages elsewhere.

States have increasingly implemented their own travel requirements and recommendations, which are inconsistent across the country and hard to enforce. Nuzzo says this makes screening and education measures, like telling travelers where they can get tested, all the more important.

«If you could wall off New York City from the rest of the world, and you wouldn’t let anybody come in with the virus — like New Zealand has been able to do because it’s an island — I think that would have an important impact,» she says. «But I just don’t think it’s practically feasible in the United States.»

Be consistent in public health communication

How can states get more people to take public health precautions? The answer, or a large part of it, lies in better communication.

«One of the first tenants of a crisis is being transparent and having consistent messaging, and we failed at that over and over again,» says Ranney, the emergency medicine physician and Brown University professor.

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She runs through a list of examples, including: conflicting messages that created confusion; messages that eroded trust in public health by downplaying the threat of the virus, playing up nonexistent cures or injecting partisan politics into science; responses that failed to take into account the structural racism, economic inequality and urban-rural divisions exacerbated by the pandemic.

Even some scientists, she says, initially fell short of «creating coherent messaging that both acknowledged the uncertainty of the moment and that enabled people to do the best they could to keep themselves and their families safe.»

Dr. Rita Burke, a professor of clinical preventive medicine at the University of Southern California’s Keck School of Medicine, says communication around COVID-19 has been especially challenging because the response comes from multiple agencies.

She stresses the need for one coherent message across the board, and being clear with the public about the science guiding the restrictions.

Replace «personal responsibility» with support for behavior change

Measures like in-home gathering limits and social distancing requirements only work if people actually follow them — and laws do not always lead to changed behaviors.

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Students arriving at New York University last fall were required to get tested for the virus upon arrival, and then have to be tested again seven to 10 days later. Experts say community leaders could learn a lesson from how campuses have handled the pandemic.

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«People of color are more likely to get infected because we’re more exposed and less protected, and then once infected we’re more likely to die because we’re more burdened by chronic diseases … with less access to health care,» Jones says. «All four of those things are deeply rooted in racism.»

The challenges that people face, and risk calculations they make, vary widely, Ranney says

«When we forget to pay attention to the fact … that different people are going to have different needs both in terms of care delivery and in terms of trustworthy messaging, we fail,» says Ranney.

Jones adds that the vaccine rollout and messaging should also prioritize vulnerable populations — including communities of color — who are more likely to be exposed where they live and work.

For example, she suggests broadening the category of long-term care residents to include people who are incarcerated and those who live on highly-isolated reservations or in high-prevalence communities.

And, when it comes to actually choosing to get vaccinated, Jones says it’s important to recognize the reasons why people might hesitate, like scientific questions or the history of racism in medicine. The goal should be not to try to convince, she says, but to inform people about the efficacy and safety of the vaccines.

Speed the vaccine rollout with more federal coordination and funding

The same challenges that have hampered the country’s pandemic response are also playing out in its sluggish vaccine rollout.

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Boxes containing the Moderna COVID-19 vaccine are prepared to be shipped at the McKesson distribution center in Olive Branch, Mississippi. The vaccine campaign needs further federal support, experts say, to speed the effort.

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She says the virus will continue to mutate, and the longer it takes to get the public vaccinated, the greater the risk of another, more lethal mutation emerging.

«The only protection that we have right now are two things: One is physical distancing and mask wearing, which we are not doing a good job of, and the other is the vaccine,» Ranney says.

Ranney says the solution lies in more money to support efforts like hiring and setting up vaccination clinics, as well as a more flexible approach to distribution in which states aren’t so worried about vaccinating everyone in the first subgroup before starting to address the second.

President Biden’s plan to jump-start the vaccination campaign — including by distributing 100 million doses in his first 100 days — incorporatessome of these elements. It also requires a substantial amount of federal funding.

Prepare now for the next public health emergency

A lack of investment in public health limited the country’s ability to respond to the pandemic from the very beginning, experts say. It’s not too late to boost our efforts in the short-term and to start investing in the future so we’re never caught as unprepared again.

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The pandemic is forcing the health care and public health communities to organize and mobilize outreach, with testing, contact tracing and vaccination campaigns. Experts say further investments in such efforts will help the country manage future health crises.

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The pandemic is forcing the health care and public health communities to organize and mobilize outreach, with testing, contact tracing and vaccination campaigns. Experts say further investments in such efforts will help the country manage future health crises.

Tom Pennington/Getty Images

«You cannot wait until there’s a problem to invest in science and public health,» says Ranney. «What we saw during this pandemic was everybody scrambling to set up communication, to set up data systems, to set up supply chains, and these things can’t be set up effectively overnight.»

On the other hand, she says, the U.S. has seen success in areas that receive longer-term funding and commitment, like scientific research.

«We have vaccines in less than a year not because of some miracle of science but because of a decade-plus of research into mRNA,» Ranney says. «Science and public health work, but it can’t be created out of thin air.»

Countries that have developed a strong COVID-19 response all have strong digital infrastructures for monitoring and detecting the early spread of disease in order to implement preventive measures, Ranney says, in contrast to the U.S. where certain places still rely on faxes and paper tracking of test results and contact tracing.

Experts say the country needs to reinvest in public health by increasing budgets and promoting science.

Many public health departments were underfunded and understaffed even before the pandemic hit, leaving them ill-equipped to carry out operations like contact tracing, Nuzzo says. That’s why having resources in place is so crucial, she says.

«We don’t shut down fire houses just because there hasn’t been a fire in a community for a year,» Nuzzo says. «And[it’s]the same thing for public health.»

Ranney notes that a number of public health officials have quit during the pandemic after being the target of vitriol. State and national leaders set local and state health departments up to fail when they don’t take scientific evidence seriously, she argues.

The next few months will see a ramping up of public health infrastructure if Biden’s COVID-19 relief plans become a reality. Key elements of his administration’s strategy include creating more large-scale vaccination sites, hiring 100,000 new community health workers and launching a major public education campaign.

But while the pandemic may be the country’s most pressing public health problem, it’s not the only one.

«I don’t want us to lose sight of the fact that there are other coexisting epidemics in this country that are worsening during COVID-19,» Ranney says, pointing to issues like opioid abuse and preventable chronic diseases.

A lot of the infrastructure required to meet the needs of the pandemic — systems set up to help with vaccine rollout and increased funding for public health departments — can be repurposed to deal with these other issues, Ranney points out.

Nuzzo says once the country is no longer reacting to the pandemic, it should take stock of its experience in order to better prepare for the next inevitable public health emergency.

«This is not going to be the last situation we go through, it may not even be the worst,» she says. «We absolutely need to make sure we have the resources to act when and if the next thing happens, and keep them in place.»

• coronavirus in the U.S.