We must ‘boost’ COVID vaccinations to prevent a winter surge

This month, many people will tune in to Food and Drug Administration discussions on boosters for the Moderna and Johnson & Johnson COVID-19 vaccines, and the impending emergency use authorization of the Pfizer vaccine for kids ages 5-11. While these events undoubtedly will be beneficial to America’s vaccination campaign, our primary focus must be accelerating the speed of vaccinating 68 million people who have not received a first dose of vaccine.   

There is urgency to delivering vaccines to unvaccinated people. As winter approaches, the risk of severe outcomes from COVID-19 to the unvaccinated continue to be high. Data presented by the Centers for Disease Control and Prevention (CDC) at a recent news briefing showed that case rates in lower-vaccinated states are more than twice those of states with high vaccination rates. A recent analysis from Boston University found that the most effective way to reduce transmission is through getting more people their first dose, compared to boosting groups of the population.  

As we cross the threshold of losing 700,000 Americans, almost all of the last 200,000 deaths might have been prevented through vaccinations. A recent report by the Department of Health and Human Services shows that about 44 percent of unvaccinated people were willing to get a shot, including some who were unsure about doing so. This “unvaccinated but willing” group represents around 33.6 million people; vaccinating even most of them would significantly boost our nation’s vaccination rate. We must reinvigorate our vaccine strategy and learn from other countries. The U.S. currently ranks 50th in the world for percentage of the population vaccinated. 

In his January 2021 plan, President Biden called for a vaccine communication campaign of unprecedented scale, in several languages, and with a focus on equity. This campaign needs urgent, ongoing investment and attention. Boosters can be given to some while first and second doses are given to others, so improved vaccine delivery to neighborhoods, workplaces and schools can help large numbers of people get vaccinated. Amplifying the messages of vaccine communication campaigns, such as Between Us About Us, could make a big difference.   

During a pandemic that continues to infect more than 100,000 Americans each day, vaccine rollout strategies must be rapid and focus on convenience. The barriers to vaccine uptake are numerous — including transportation, time scarcity, limited internet access and literacy, and internet forms and documentation to sign up and return for vaccine appointments. There is a large income gradient in vaccination. People who are food and housing insecure have been less likely to get vaccinated, as have those who have children and child care responsibilities, reflecting structural barriers. According to one CDC report, individuals with disabilities have increased willingness to get vaccinated but commonly face barriers with navigating websites and scheduling appointments. We need to bring the vaccine closer to workplaces and homes. 

Resources and staffing should be directed to community-based organizations with proven records of serving underserved communities, such as La Colaborativa in Massachusetts and the Black Doctors COVID-19 Consortium in Pennsylvania. Federally qualified health centers should receive additional funding to host vaccine drives and for sustained increases in staffing to confront the pandemic. Community organizations may be far more effective in delivering vaccines to those who need them than consulting companies that received a large sum of vaccination funds. 

Vaccine delivery should be done at workplaces such as construction sites, agricultural fields and manufacturing sites, and through community block parties. For example, a program in North Dakota helped vaccinate truckers traversing the U.S.-Canada border. Additionally, we need to increase uptake in eligible teens and younger children once vaccines are approved for them, so school-based vaccinations should be a priority. To expand the availability of walk-in appointments and hours, some states such as Vermont are bringing back mass vaccination sites. New York City expanded its public health service corps to offer vaccine appointments, counsel neighbors about diabetes and depression, and address hunger and food insecurity. Similar efforts across the country are needed to compensate community health workers for providing support that links residents to clinical and social services.  

Policies to provide structural support are essential. President Biden has instructed the Occupational Safety and Health Administration (OSHA) to develop policies to provide paid time off for employees to get vaccinated and recover from any side effects. These policies must be adopted in all workplaces. It is vital that employers offer paid time off for workers to complete COVID-19 vaccinations and catch up on missed immunizations.  

The public needs data to track progress during the vaccine rollout. It is vital that states, counties and other jurisdictions continue to collect and share comprehensive data on vaccination rates. In addition, communities should set goals to increase their vaccination rates before we enter the holiday season. Goals and campaigns help accelerate the sense of urgency — and remind people to recalculate their risk as they consider where they will congregate.   

Finally, vaccination should be complemented with other strategies and tools, such as data-driven mask policies, rapid testing, and better indoor ventilation to reduce transmission and exposure for everyone, vaccinated and unvaccinated, during surges. These are additional “boosters” we have that can mitigate risks and help create safer schools and workplaces. 

The U.S. vaccination campaign is at a pivotal point, but we must not lose sight of our end goals: to prevent severe outcomes and sustain societal functions by controlling surges. It is through focusing on vaccinating people who are unvaccinated and integrating tools to promote vaccine equity that we can prepare for the challenges this winter. 

Rebecca Weintraub, MD, is the faculty director of the Global Health Delivery Project at Harvard University. Follow her on Twitter @RWeintraubMD.

Julia Raifman, ScD, SM, is assistant professor of health law, policy and management at Boston University School of Public Health. Follow her on Twitter @JuliaRaifman.

Benjy Renton is an analyst at Ariadne Labs, a joint center for health systems innovation at Brigham & Women’s Hospital and the Harvard T.H. Chan School of Public Health. Follow him on Twitter @bhrenton.