Healthcare by mail: A quick and easy way to boost COVID vaccinations

In a remarkable post this month, Dr. Ashish K. Jha (a practicing physician and Dean of the School of Public Health at Brown University) pinpointed the reasons his elderly patients hospitalized with COVID-19 had not received booster vaccinations: They either did not know they were eligible for boosters or did not know boosters were recommended. This problem can be solved by the government with some modest effort, attention to detail, and a focus on effective practical action.

Specifically, the CDC, in partnership with the Social Security Administration (SSA), needs to immediately mail notices to the 70 million beneficiaries served by SSA. These notices need to communicate a few basic items:

• The CDC’s recommendations on vaccines and booster shots;
• The government’s toll-free number (1-800-232-0233), which individuals can call to find vaccine sites near them and to order free COVID-19 test kits;
• Where individuals can receive free N95 face masks (here and here) from the government.

The advantage of communicating by mail is that it reaches every individual and allows for clear and specific language. Additionally, the need for communication has increased because of several new initiatives, including new recommendations on vaccinations and booster shots and new large-scale efforts by the government to combat COVID-19 (the administration’s recent initiatives to make COVID-19 test kits and N95 masks widely available at no charge).

{mosads}There are good reasons to focus on beneficiaries served by SSA. First, the population at-risk for hospitalization and death from COVID-19 and the SSA population are one and the same. The SSA rolls are comprised of the elderly and the disabled (those with underlying medical conditions). To illustrate the seriousness of the issue, SSA reported — in 2020 alone — that there were 400,000 additional deaths among its beneficiaries.

Further illustrating the seriousness of the issue is first-ever data by the CDC on hospitalizations by vaccination status for older Americans. Unvaccinated seniors were 50 times more likely to be hospitalized than elderly people who had received vaccinations and booster shots. Nearly 6.5 million seniors are still not fully vaccinated.

In addition to disabled and elderly adults, SSA provides benefits to large numbers of children, including 1.1 million disabled children. The parents of these families need clear, written, and specific guidance on vaccinations and other CDC recommendations delivered directly to them.

Fortunately, the group most in need of information (the SSA beneficiary population) is also the group for which communication is easy. SSA maintains mailing addresses for all beneficiaries, and other federal agencies have used the addresses to send informational notices, such as when the IRS partnered with SSA to send out notices on economic stimulus payments. There is no reason the CDC cannot similarly work with SSA to provide needed information to elderly and disabled individuals.

Mailed informational notices are a way out of the communications box the Biden administration finds itself in. The administration’s attempts to communicate basic information have been — rightly or wrongly — co-mingled with political, policy, and legal issues.

Thus, when the president addressed the nation in December, he repeatedly emphasized the importance of vaccinations and booster shots, but the press questions following the address focused on hot button issues, such as negotiations with Sen. Joe Manchin (D-W.Va.) over the Build Back Better legislation. In a similar vein, Dr. Anthony Fauci’s efforts to communicate on COVID-19 via interviews and other media appearances have become hopelessly entangled in political discussions about Dr. Fauci himself rather than informational content.

The issue of booster vaccinations, in particular, needs greater communication.

Looking at statistics from the CDC, it is clear the federal government is not succeeding: 36 million people age 50 or older who are eligible for booster shots have not received them.

{mossecondads}Further, the bumpy rollout of the booster shot effort has likely left some unsure of what to do. For example, in the initial discussions in the fall of 2021, some scientists questioned whether booster shots were a wise policy. Boosters have proven their value against the Omicron variant, and earlier concerns by scientists have faded, but the public has been subject to a fair bit of dense discussion around policy, science, and COVID-19. Direct, clear, specific and written communication would go a long way to helping the public make good decisions about booster shots.

Finally, the Biden administration may need to shift, to some extent, from legislative policy to a focus on practical action. Recent news stories indicate the administration is considering how to pivot in light of disappointing poll numbers. Of interest, the president and his advisors are leaning towards more direct communication with the American public. Informational notices to 70 million Americans about ways to effectively combat COVID-19 clearly fit that theme.

More generally, it would be useful for the president to make his recent Executive Order on customer or public service by the federal government a centerpiece of his agenda in 2022.

The need for more practical action on the part of the federal government, in general, is illustrated by the specific communication failures around COVID-19. Stepping back, it is useful to ask why, two years into the worst pandemic in U.S. history, the federal government has not tried to directly communicate through the U.S. mail with the groups known to be at highest risk for hospitalization or death? The failure of the government to do the most basic and simple tasks reflects a lack of clear thinking and a preference for political debates over practical action.

Mailing notices would be one step to correct this imbalance. It might also be a catalyst for a different, more effective approach to governance.

David A. Weaver, Ph.D., is an economist and retired federal employee who has authored a number of studies on the Social Security program. The views in this article do not reflect the views of any federal agency.