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We already know how to prevent pandemics
In 2020, then-candidate Joe Biden left open the possibility of targeted coronavirus vaccine requirements. Now, Biden is encouraging mandates for many workers. (Video: JM Rieger/The Washington Post, Photo: Ricky Carioti/The Washington Post)
5 min

Eight months ago, President Biden unveiled a plan to deliver coronavirus booster shots to all vaccinated American adults.

But today, booster shots are a significant shortcoming in the federal government’s coronavirus response — with no easy answers for why it has happened or what to do about it.

While Biden aimed for all vaccinated adults to get a booster, only about half have gotten one thus far. The number of Americans overall who have received a booster has essentially flatlined at 30 percent — about half the rate in some other Western countries — with new vaccinations overall hitting post-2020 lows.

While booster uptake surged in countries such as Germany, Canada and Britain as the omicron variant emerged, that surge never reached the United States.

Certainly, the reasons are varied.

One is that we have lower vaccination rates, in general, than many of these countries — meaning the population eligible for boosters is smaller. Even so, our booster uptake has been significantly smaller as a share of eligible people.

A big factor is how partisan vaccines have become in the United States. Republicans make up a disproportionate share of the unvaccinated, and vaccinated Republicans are also significantly less likely to get boosted than vaccinated Democrats. That means the booster campaign has effectively exacerbated the partisan gap in protection from the coronavirus. It also means that most of the unboosted are unlikely to listen to the Biden administration.

But partisanship doesn’t explain it all. These are people who were willing to get two shots and, for whatever reason, haven’t been persuaded to get a third.

Another potential reason is the confusing rollout. When Biden made the announcement in August, health officials made clear they weren’t quite ready for it. The boosters wouldn’t be authorized for all adults until three months later — and two months after the Sept. 20 date the White House had pegged for the launch of its campaign. Some health advisers grumbled that Biden’s announcement put pressure on apolitical health advisers, something that happened repeatedly in the Trump administration. And mixed and muddled messages followed about who was eligible to get boosters, who was advised to get them and when.

The Atlantic last week included this among the reasons for slower booster uptake. Others include the original belief that vaccination was a one-time deal, as well as the high number of infections among the vaccinated that occurred during the omicron surge — which some people, especially in conservative media, cited as a sign that the vaccines didn’t really work. (In fact, though infection rates among vaccinated people did rise, unvaccinated people were many times more likely to wind up in the hospital or dead.)

What’s troubling is that there’s little to indicate that uptake will increase soon. In fact, there are signs that opposition to boosters is increasing and hardening among the vaccinated.

The Kaiser Family Foundation in January found that more than 40 percent of vaccinated Americans said they definitely wouldn’t get boosted or would do so only if required. A survey the following month showed that number rising to 47 percent. Part of the increase was probably due to some in the original survey group getting boosted — removing them from the universe of responses — but the percentage of vaccinated but unboosted Americans didn’t increase by that much over that period.

A recent poll from Monmouth University also speaks to this. In September, when Biden’s booster campaign was due to launch, two-thirds of American adults said they were at least “somewhat likely” to get boosted when the extra shots became available to them. By late March, though, the same poll showed that only 48 percent said they had been boosted, and the percentage who were boosted or at least “somewhat likely” to get boosted had dropped from two-thirds to 6 in 10.

The same poll in September and November showed that about one-quarter of Americans said they were “not at all likely” to get boosted, but that number rose to 3 in 10 in January and is now 33 percent.

That suggests that many of the people in the “somewhat likely” or “not too likely” categories have since moved away from the boosters, rather than toward them; people who said they were open to being convinced haven’t been. And whatever the reasons for this trend, the resulting booster uptake is far different from what we’ve seen in comparable countries.

Thus far, the booster gap doesn’t appear to have resulted in worse outcomes in the United States, relative to other countries with higher uptake. Data shows that the protection gap between unvaccinated people and vaccinated but unboosted people is the really significant one.

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

To be clear, the death rates for both remain extremely low. The weekly death rate over the final three months of 2021 was a little more than 1 per million for boosted people, and about 6 per million for vaccinated-but-unboosted people. Those compare to the 78 per million weekly rate we see from unvaccinated people. But we’ve also seen that protection from the vaccines wanes over time — more so for protection from infection, but also somewhat for protection from hospitalization and death — which is a big part of the reason for the booster push.

In other words, it has been very good to be vaccinated and significantly better to be boosted. But given that vaccine immunity wanes over time and that new variants could be unpredictable and more deadly, our lagging booster rate creates all kinds of potential consequences down the road.

Coronavirus: What you need to know

Where do things stand? See the latest covid numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people.

The state of public health: Conservative and libertarian forces have defanged much of the nation’s public health system through legislation and litigation as the world staggers into the fourth year of covid.

Grief and the pandemic: A Washington Post reporter covered the coronavirus — and then endured the death of her mother from covid-19. She offers a window into grief and resilience.

Would we shut down again? What will the United States do the next time a deadly virus comes knocking on the door?

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot. New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

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