The COVID Vaccines Could Easily Squash The Pandemic. The Hard Part Is Finding The Best Incentives.

“Reaching ‘Herd Immunity’ Is Unlikely in the U.S., Experts Now Believe”

“Our Pathetic Herd Immunity Failure”

“Why Herd Immunity Is Slipping Away”

“What if We Can’t Reach Herd Immunity?”

“The World May Need To Learn To Live With The Virus”

If a reader consumed only these headlines from The New York Times over the past two weeks, they might assume the United States had already lost the battle against COVID-19. Together, they portray that the variants and hesitancy have outmatched the scientific achievement of a generation: the development of safe and highly efficacious shots against an emergent pandemic in less than a year.

Not only do these sentiments downplay the potency of the COVID-19 vaccines and their ability to snap community transmission of the coronavirus, but experts also say they can discourage people from taking the jabs.

“All it does is signal to vaccine-hesitant people is that, ‘Oh, there’s a lot of people like me who are hesitant, who are just not going to get it. That’s the worst possible way to frame that story,” said Dr. Jay Van Bavel, a social psychologist at New York University who studies how people perceive information. “When they do that, they run the risk of creating a self-fulfilling prophecy, where their messaging and the way they’re framing things or the way it’s framed in the media is potentially going to increase hesitancy.”

His objection speaks to the accidental misdirection that can come with communicating about health. Those New York Times articles all mention the value of vaccination. Yet, in isolation or when strung together, they could inadvertently give the impression that skipping the vaccine is more popular than it might be, Van Bavel said. It’s a fine line to walk because any single message might excite one person but discourage another.

He and other scientists are searching for ways to motivate people toward the COVID-19 vaccines. Some are calling for better access that directly delivers the shots to workplaces or transit hubs. New research says if vaccination rates stall before this autumn, it could cost patients, the health care system and the economy billions of dollars.

If everybody was vaccinated—that includes children—then we could indeed achieve herd immunity and effectively drive SARS-CoV-2 to extinction.

Paul Bieniasz, virologist at The Rockefeller University

Precise messaging can decide whether the holdouts ultimately seek a COVID-19 shot. As immunization rates decline nationwide, elected leaders and health officials have rolled out a smorgasbord of incentives in recent weeks—from Shake Shack burgers in New York City to a pound of crawfish in New Orleans to $1 million lottery tickets in Ohio.

“One of the reasons we tend to like those is they’re often more politically and publicly acceptable,” said Dr. Alison Buttenheim, an associate professor of nursing at the University of Pennsylvania and scientific director for the Center for Health Incentives and Behavioral Economics. “Common food, celebrated food, the local, regional specialty…what that does is evoke, ‘Hey, New Orleans, we’re in this together. This is going to be our vaccination effort.”

If these initiatives are closely studied and found to be successful, Buttenheim thinks they could break scientific ground. Just giving out cash for vaccines might work for COVID-19, but past research suggests it could create a backlash effect, especially in people who already distrust authorities or health care. “Why would leaders need to pay people for something that’s already a public good?”

The pandemic has repeatedly shown that collective goodwill cannot motivate everyone. Some Americans have burned masks in barrels and threatened physical violence against public health officials as COVID-19 took the lives of more than 580,000 fellow compatriots. Buttenheim added that the new federal policy to drop mask-wearing for the fully vaccinated, while posing as an incentive, could fail for this reason.

“Sadly, I don’t think anyone will be motivated by this incentive,” she said. “If I don’t feel like getting vaccinated, but I don’t want to wear a mask, I can just pretend I’m vaccinated and not wear a mask.”

Read More: Indoor Mask Mandates Still in Place As New Yorkers Raise Concerns About New CDC Guidelines

The United States is weeks or months away from squashing the hospital burden created by COVID-19. Rural areas—such as Lewis County in western New York—have fallen behind in vaccinations and are reporting case surges, even as public health improves in most places. The nation is still recording 34,000 cases and 600 deaths every day—a disease rate that inspired lockdowns a year ago. If a single 747 passenger jet were crashing daily, it would likely generate caution.

“I wish the CDC and White House had waited about 6 more weeks on [lifting mask restrictions],” Buttenheim said, “or tied it to reaching a threshold of vaccine doses given or percentage of the population with at least one dose.”

Lewis County, daily new cases per 100,000 residents, May 13th, 2021

Lewis County, daily new cases per 100,000 residents through May 13th, 2021 COVID Act Now

The COVID-19 vaccine rollout is arguably the biggest immunization drive in history—and if enough holdouts take the shots over a short period of time, then we wipe out the disease. Massive expedited rollouts of the HPV vaccine, for example, established herd immunity in places like Scotland in less than five years.

Frequently asked questions are emerging among those reluctant to get COVID vaccines. Here are ways to address their concerns.

So, You’re Worried The Vaccines Won’t Work…

The conversation around coronavirus variants has turned into a bonanza. The mutant strains undoubtedly created a new dangerous chapter in the pandemic, which has likely underlined recent surges across the planet—from the U.K. to Brazil to the United States to India.

But the latest data show the COVID-19 vaccines, namely Pfizer and Moderna, can neutralize every variant that’s been around long enough to be studied, including the one from New York. Early results suggest that these mRNA vaccines can also block the so-called “double mutant” circulating in India.

“Perhaps the one that is most challenging for the immune system in terms of evading the antibody response is the so-called B 1.351 strain that originated in South Africa,” said Dr. Paul Bieniasz, a virologist and a professor at The Rockefeller University in New York City. “But some recent studies are showing that the vaccines do have reduced effectiveness against the South African variant in particular, but that diminution in effectiveness still leaves you with a vaccine that is really still very good.”

Vaccine efficacy or real-world effectiveness against the variants

Vaccine efficacy (Pre-EUA) or real-world effectiveness (Post-EUA) against the variants, as of May 12th, 2021 Heather Scobie/CDC ACIP

Vaccine efficacy or real-world effectiveness against the variants, as of May 12th, 2021

The Pfizer vaccine is highly effective against severe disease in the real world (Post-EUA) Heather Scobie/CDC ACIP

The outcome is that the vast majority of vaccinated people who are exposed to the variants won’t catch the germs, and even greater numbers won’t develop symptoms. This trend counters a rising conspiracy theory that the variants can somehow stew in fully vaccinated circles, breeding more dangerous mutants that pose a risk to the unvaccinated. Vaccine immunity is showing us that the variants are highly unlikely to invade a body at all.

How long COVID-19 vaccine protection lasts is a topic of rolling studies around the world. Scientists have collected about six months of data from clinical trials, and so far, the defenses are holding.

This current strength explains why it is premature to cast doubt on the possibility of hitting the herd immunity threshold—the mark where the virus can no longer thrive in a community. The Pfizer and Moderna vaccines show real-world effectiveness against COVID-19 in the realm of 90%, whether it comes to stopping disease symptoms or the infection itself.

That puts these two-dose mRNA jabs on the same plane as gold-standard vaccines against measles, mumps, whooping cough and HPV—all of which are capable of establishing community-level shields. Even the Johnson & Johnson COVID vaccine is showing 76% effectiveness in the real world, according to an early study from the Mayo Clinic. The data around the Pfizer and Moderna shots reportedly buoyed the Centers for Disease Control and Prevention’s decision to lift mask restrictions for the fully inoculated.

“I’m pretty convinced that if everybody was vaccinated—that includes children—then we could indeed achieve herd immunity and effectively drive SARS-CoV-2 to extinction,” Bieniasz said.

Researchers expect this community protection to kick in after about 75% to 80% of a region is fully vaccinated or has developed natural defenses after an infection. That appears to be happening in Israel, which has a population about the size of New York City.

Of course, neighborhoods and nations can land short of completely stopping coronavirus infections and still prevent the majority of severe disease and COVID deaths. Our hospitals can go back to relative normality in this scenario—while our friends and families return to doing what we remember.

That’s happening across the five boroughs and New York state. But some neighborhoods and counties remain well under 50% vaccinated. They could be hit by a resurgence, especially as the variants keep spreading and mutating.

So, You Care About Others…And Your Medical Bills…

The variants are less of a problem in the short term if you’re fully vaccinated, but the mutants continue to circulate in communities and countries with less immunity. Each case is a new opportunity to evolve, a handful of mutations at a time.

When this slow buildup affects our immunity against the germ, it is called antigenic drift. The process partially explains why we need to update the flu vaccine every year. The coronavirus seems to be following this track, which could determine if and how often booster shots are needed.

“We’re still learning a little bit how that’s going to play out,” Bieniasz said. But the recent rise of the variants is evidence that the virus is now trying to learn how to thwart our immune systems. Early in the pandemic, the virus wasn’t accumulating mutations in such a purposeful way, he added.

The B.1.617 variant first isolated in India is showing signs of breaking through the non-mRNA vaccines. The Indian Medical Association told the Financial Times this week that “at least nine of 194 doctors that had died of COVID-19 during the recent outbreak were believed to have been fully vaccinated.” India is using their homegrown Covaxin jab as well as the shots from U.K.-based AstraZeneca and Russia’s Sputnik V.

British officials warned on Friday of a worrying rise of the B.1.617 variant in parts of their country. They’re now confident this mutant is more transmissible than the B.1.1.7 variant from the U.K.—which is now dominant in the U.S.—and are planning a “vaccine surge” to the most affected areas.

Fully vaccinating 50% of the U.S. by autumn could prevent 252,000 hospitalizations, almost 30,000 deaths and nearly $4 billion in direct medical costs.

Following the history of other chronic diseases, long-COVID seems ready to burden our medical care system and aggravate health disparities in our neighborhoods. We face a choice of settling for a lesser state of survival, wherein the coronavirus becomes endemic, and we perpetually wonder when our defenses might falter.

A viral shadow will hang over us as our sturdy vaccine-backed immunity wanes over time. Early reports show that even mild- to moderate cases can breed persistent impairments—so-called long-hauling. One large analysis reported that long-COVID symptoms occur in 50% of patients overall.

This chronic existence could be expensive, according to a recent computer model built by researchers at the CUNY Graduate School of Public Health. Suppose half the U.S. population is fully inoculated by this fall with a vaccine that’s 70% effective. In that case, it could stave off 6.6 million COVID cases, 252,000 hospitalizations, almost 30,000 deaths, nearly $4 billion in direct medical costs and around $8 billion in productivity losses, the report estimates.

“In other words, if you do it by the fall instead of the winter, you have substantial savings,” said Dr. Bruce Y. Lee, the study’s lead author, a CUNY professor and executive director of Public Health Informatics, Computational, and Operations Research.

So, You’re Worried About Missing Work…

The Kaiser Family Foundation, a health policy nonprofit actively studying America’s COVID-19 vaccine rollout, splits the remaining holdouts into four groups. As of late April, 9% of people say they want the vaccine “as soon as possible.” Another 15% comprise the “wait-and-see” crowd, followed by the “definitely-nots” at 13%. Approximately half that number says they’ll take the shots “only if required.”

These stragglers are often labeled as “hesitant,” a term laden with “anti-vax” undertones. But their survey responses convey a spectrum of reasons for their delays. Take the ASAP contingent. More than one in 10 of them said their main barriers were being too busy or not being able to take off work.

This polling also helps counter some stereotypes. Misinformation campaigns are targeting Black and Latino communities, but KFF’s analysis shows these groups support misconceptions about vaccine safety at the same rates as white people. The more considerable contrasts involve worries about missing a day of employment or paying out of pocket for the COVID-19 vaccines. Hispanic respondents report not knowing the shots are free of charge twice as often as white survey takers.

Over Half Of Adults Report Receiving A COVID-19 Vaccine, But Demand May Be Slowing As Eager Group Shrinks

Black And Hispanic Adults Are More Likely Than White Adults To Express Concerns About Potential Access-Related Barriers To COVID-19 Vaccination

“We want to eliminate that friction and that hassle,” said UPenn’s Buttenheim, who co-published a national vaccine plan in the Journal of the American Medical Association back in December. It explains how creating frictionless rollouts should be tailored for individual communities. One of her studies, for instance, shows that text message “nudges” can boost flu vaccine rates. “The top three messages there that worked all use language around a dose being reserved just for you,” she added.

Read More: More Than 1,100 People Vaccinated In NYC Subway And Rail Stations On First Day Of MTA Pilot Program

New York’s early emphasis on online appointments captured the most willing people with stable internet access and time to wait for availability. But now demand has reached a turning point.

“The mass vaccination clinic movement is over pretty much in the U.S. We need to be doing micro-clinics of 20 doses or 40 doses or 80 doses on a van,” Buttenheim said. But these efforts will only be successful if they’re deployed directly into the right communities.

So, You’re Worried About Side Effects…

The toughest hesitators—the wait-and-see clan, the only-if-required comrades and the definitely-nots—all cite serious side effects as their top reason for delaying their coronavirus shots. After hundreds of millions of administered doses, the COVID-19 vaccines have proven themselves overwhelmingly safe.

Even the atypical blood clots behind the Johnson & Johnson pause may have had much to do with how those patients were treated with a standard remedy for cardiovascular disease. So far, only 28 cases of these atypical clots have been reported out of 8.7 million recipients.

But KFF surveys show the April 13th pause has had a measurable impact on the “wait-the-see” group, which also features the largest share of holdouts that could eventually take a shot.

Majority Of U.S. Public Is Confident That COVID-19 Vaccines Are Safe, But Far Fewer Express Confidence In Johnson & Johnson Vaccine

Confidence In Safety Of Johnson & Johnson COVID-19 Vaccine Is Low Among Key Unvaccinated Groups

Buttenheim said these folks might be the ones most swayed by food incentives or locally-tied prizes like Ohio’s $1 million spoils. That program also comes with an option for free tuition at a state college for those younger than 18.

“To that middle group where ‘I’m not so sure,’ a lottery ticket seems shiny and fun and new and exciting,” Buttenheim said. “You’re not supposed to be able to buy a lottery ticket if you’re under 18. So linking it again to this like pride in our state institutions and investing in your future. I thought that was a really smart, smart design component.”

Another powerful motivator for those who are side-effect wary is messengers that resonate with their identities. Van Bavel’s team at NYU has tracked how partisan divides led some people to ignore rules around social distancing and worse outcomes with COVID-19.

“From pretty much all the polls and data that we can see right now with the core vaccine-hesitant community is Republicans and some independents. What you need to do is get representatives that they trust to share information about the safety and efficacy of the vaccine,” Van Bavel said, citing an opportunity missed when President Donald Trump recently took the shot in private. “Fox News spent more time that week covering the Dr. Seuss books that were being taken out of print than they did Donald Trump’s vaccination.”

Majorities Across Demographic Groups Are At Least Somewhat Open To COVID-19 Vaccine; Older Adults, Democrats Most Enthusiastic; Younger Adults, Republicans Least Enthusiastic

So, You Subscribe To FOMO…

Vaccine messengers can be anyone—a friend, a doctor, a family member, a religious leader. But be prepared to practice patience. Van Bavel and Buttenheim said social norms are among the powerful motivators for taking vaccines yet require time to build. People won’t want to be left out of the return to normal.

“Social norms are persuasive because even if you don’t believe the vaccines are good or you’re hesitant about it, people will tend to just do things that other people are doing,” Van Bavel said. “It turns out, and evidence backs us up. Messages about how many people plan to get it are actually really powerful.”

Those among the only-if-required and definitely-nots will be harder to convince. Some in the latter group are actively spreading misinformation to discourage the consumption of the shots. This week, researchers proposed launching a corps of “infodemiologists” to use what’s been learned about the internet virality of false claims to create digital inoculations.

Julian Boyce, 14, gets a hug from his mother, Satrina Boyce, after he received his first Pfizer COVID-19 vaccination dose at NYC Health + Hospitals/Harlem, May 13th, 2021

Julian Boyce, 14, gets a hug from his mother, Satrina Boyce, after his first Pfizer COVID-19 shot at NYC Health + Hospitals/Harlem, May 13th, 2021 Richard Drew/AP/Shutterstock

Good messengers don’t only identify with their audiences but portray why the number of vaccinations matters. People flock to data patterns when explained through core messages, like “flatten the curve.” Just give them the gist.

“Numbers like words have to be interpreted,” said Dr. Valerie Reyna, a professor of human development and the director of the Human Neuroscience Institute at Cornell University. Her work shows that our memories and emotional reactions tend to rely on remembering the gist, including when vaccines are involved.

Civic leaders often recite how many shots are taken overall or other stats—rather than expressing the practical value of each benchmark. Kentucky, as a counterexample, has an incentive where capacity restrictions on bars and restaurants will end after 2.5 million residents take at least one shot.

“People do need categorical goalposts. They need milestones,” Reyna said. “They need to know we’ve achieved this.”