It’s been more than a year since COVID-19 started spreading across the US. More than 27 million Americans have been diagnosed with coronavirus, and more than 500,000 deaths have been attributed to the virus as of late February. 

Hospitals, health departments, pharmacies, and doctors are now rolling out vaccines from Moderna and Pfizer-BioNTech. A vaccine from Johnson & Johnson will join the fight soon. As more groups of people become eligible for the vaccine, three American University public health experts answered some questions about where the country stands in fighting the pandemic. 

Jessica Owens-Young is a health studies professor in CAS who focuses on health in economically distressed and under-resourced communities. Aparna Soni is a professor in the department of public administration and policy at SPA. Soni studies the relationship between public programs and policies on individuals’ health. Nina Yamanis is a SIS professor interested in finding the ways social and structural conditions lead to health disparities and focusing on the role of social networks in health. 

What concerns you about the variants of COVID-19?

Yamanis: One concern is that these new variants are more transmissible than earlier variants. That means that more people will get the virus, and more people will suffer from severe disease or die. On the bright side, the vaccines we currently have approved demonstrated success in preventing severe disease, even for the new variants. The more the virus has a chance to move around in the population, the higher the chance that variants will develop that can evade antibodies and our vaccines. We must vaccinate as many people as quickly as possible to stop the virus from spreading and mutating.

Owens-Young: One concern I have about COVID-19 variants is how they may affect both vaccinated and unvaccinated populations. I’m also concerned about possible mutations that may not respond as well to current medical treatments or that may be more contagious. The latter concerns me most in places where social distancing is not enforced, and masking has become hyper-politicized.

Soni: The emergence of new variants poses a serious challenge in the fight against COVID-19. It is not yet clear whether the vaccines currently in distribution will be effective against all the coronavirus's current and future mutations. Some of these new variants are more contagious, and their rapid spread could delay the end of the pandemic.

How do you feel about the speed of the vaccine rollout? How could it be quicker?

Yamanis: The rollout is constrained by the vaccine supply, which is understandable given how quickly the vaccines were made, and the US public health system, which has experienced substantial disinvestment for years. People are registering at multiple places just to try to get an appointment. Ideally, the system would be more coordinated, with a central hub for registration and appointment delivery. There would also be mass vaccination sites that could make thousands of appointments per day.

Soni: As we increase the speed of vaccine rollout, we should be mindful of the vaccine's equitable allocation within priority groups. States should incorporate racial equity into their considerations for vaccine distribution. This could mean setting up vaccination clinics in neighborhoods with a high minority population. Public health agencies can make targeted efforts to share information about the benefits of the vaccine to underserved populations—through phone calls, mailing letters, and distributing literature that is linguistically and culturally appropriate. Local health officials can also consider engaging with community organizations to spread the word about vaccine distribution plans and letting people know when and where to get the vaccine.

How can government officials ensure disadvantaged communities receive access to the vaccine, and what, if anything, has troubled you about this rollout?

Soni: Throughout the United States, there are large racial and ethnic disparities in COVID-19 vaccination rates, with Blacks and Hispanics being vaccinated at lower rates than whites. In all states that report vaccination rates by race/ethnicity, the share of vaccinations among Blacks is less than their share of cases and deaths. Black and Hispanic people have historically had lower access to health care in general due to high uninsurance rates, poverty, discrimination, and low levels of trust in government and medical institutions. It appears that access to the COVID-19 vaccine is no exception.

Yamanis: Government officials have prioritized groups that have higher levels of exposure to the virus or higher chances of dying from it. But, given our uncoordinated and underfunded public health system, we don't have a systematic way of identifying those people. Many people in the priority groups can't access vaccines because they don't have a primary health care provider or their primary health care provider didn't receive any vaccines, and/or the current system of registration is too cumbersome or technical, not in their language, etc. The entire system would be overhauled ideally to make it more straightforward and more user-friendly. I think we need to be investing in more outreach to communities, particularly Black, Latino, and Native American communities, that have suffered disproportionately during the pandemic. For example, in DC, we could be doing a mass vaccination campaign involving trusted leaders and community health centers for Black communities in Wards 7 and 8, which have seen the highest numbers of deaths from COVID-19 but have seen the lowest rates of vaccination. I would also like to see more outreach to the Latino community, who are more likely to be essential workers but are less likely to have access to the vaccine due to various barriers, including lost employment, low rates of health insurance, and mistrust of government officials.

Vaccination campaigns in communities disproportionately affected by the pandemic will only be successful when we combine them with more safety net resources to address urgent needs such as health insurance, eviction moratoriums, rent control, higher living wage and universal pre-K. We must demonstrate that vaccination is part of a larger effort to help and support communities recovering from the pandemic's trauma and devastation.

This is a global pandemic. If other countries aren't getting access to vaccines, what problems will that present going forward?

Yamanis: As long as the virus continues to circulate, we will see more variants that could evade vaccines. We have seen that new variants of the virus spread rapidly across countries. There is no reason to think that we will be immune from variants that originate in other countries. We also live in an interdependent world. Our well-being, both in terms of health and economics, is dependent on other countries' well-being.

Soni: When it comes to a highly contagious infection like COVID-19, what happens in one country affects all countries. Global travel is commonplace, and each transmission of the virus increases the chance that the virus will mutate. It is plausible that variants could mutate enough to evade vaccines.

How do you build trust among vaccination skeptics?

Yamanis: The National Academy of Sciences, Engineering, and Medicine put out a good report on this issue that mentions several communication strategies for promoting acceptance of COVID-19 vaccines, including meeting people where they are and engaging with and centering the voices of trusted messengers who have community roots. If someone were to come to me directly, I would first acknowledge that there are logical and genuine reasons why they might be hesitant about a vaccine. I would first ask about their concerns and listen to what they have to say. If they are interested, I would then offer information to address their concerns. For example, for people who worry about how quickly the vaccine was developed, I mention the fact that the mRNA vaccines were in development for a long time (around 10 years) before COVID-19, and so they are not new.

Owens-Young: Battling misinformation around vaccines is necessary for building trust among vaccination skeptics. There is a lot of misinformation about the vaccine in different spaces, including social media and other online platforms. Ensuring that folks have access to understandable and credible information about the vaccine is essential to build trust. I also think attention should be paid to those who are vaccine-hesitant, meaning those folks who aren’t necessarily skeptical of the vaccine but are hesitant to receive it at this time due to different reasons.

How close are we to normalcy?

Yamanis: That is a hard question to answer. Opening more depends on how quickly vaccines are rolled out, how the virus evolves, people's tolerance for closures and death, and, importantly, what you consider to be normal. Before the pandemic, my normal involved a yearly trip to Tanzania, in East Africa, where I've conducted research for over 14 years. Tanzania has no vaccines for its citizens, and it is unlikely they will obtain any vaccines in the next few years. Every day, I think about when I am going to be able to go back there safely.

Owens-Young: I think it depends on what “normalcy” means for different populations. For me, the question isn’t about returning to the exact normal that we knew before. Normal to me would mean being able to work, travel, learn, and socialize in ways that are health-promoting and protective for everyone. I don’t think that every community has reached that stage, and given the different cultural norms and social policies across communities, normalcy will be achieved at different rates. I hope that the pandemic helps us, as a society, reimagine health, safety, and prosperity for all people, not just those in privileged positions.

Soni: Most public health experts believe that we need at least 70 percent of the population to be vaccinated to achieve herd immunity. With only 10 percent of the US population vaccinated so far, we have a long way to go before we reach some semblance of normalcy.