We now have a solution to COVID-19 hot spots. Let’s use it.
As America beats back Covid-19, it’s likely going to see more Michigans — hot spots where the coronavirus is surging in what’s hopefully a final hurrah for the pathogen that’s twisted our lives so much over the past year. But experts now say the solution for these hot spots is the same thing digging many other places out of the pandemic: vaccines.
The idea is straightforward: If a place sees a surge in COVID-19 cases, it should get a surge in COVID-19 vaccinations. That doesn’t mean just more doses of the vaccine, but also more people who can actually administer the shot, resources that bring vaccines closer to workplaces and homes, and education and awareness efforts to convince more of the public to get the shot.
“Why not?” Monica Gandhi, an infectious diseases doctor at the University of California in San Francisco, told me. “Luckily, we actually have quite a lot of vaccine supply. And new rises in cases in any given region will lead to hospitalizations and deaths that didn’t have to happen if we could vaccinate more quickly.”
It’s the kind of solution that Michigan Gov. Gretchen Whitmer called for. As Michigan saw a new wave in Covid-19 cases, hospitalizations, and deaths, she asked President Joe Biden’s administration to ramp up vaccinations for her state. But the Biden administration seemed skeptical, saying it would send more vaccinators and other treatment resources to the state but otherwise refusing to send extra doses to Michigan.
Some experts were critical of the administration’s decision. They argue that not only should the Biden administration have sent more vaccines to Michigan — where an outbreak no longer seems to be getting worse yet cases, hospitalizations, and deaths remain very high — but that the administration should be ready to surge vaccines to future places, down to the local level, hit by new waves of COVID-19. That may require the federal government to even set aside some vaccines going forward exclusively for hot spots
“It’s a strategy we’ve used in public health for a long time,” Ashish Jha, dean of the Brown University School of Public Health, told me, pointing to recent vaccine surges used against Ebola across Africa. “And we use it because it largely works.”
This is not the US’s current strategy. The Biden administration is committed to a model that distributes vaccines based solely on population. The administration seems to be skeptical that some places really could use more supply, given that no state, including Michigan, has administered all the vaccine doses they’ve obtained. There’s also questions about fairness — if some states see the administration as taking away doses to give them to another state.
But vaccine surges could help curb hot spots.
A vaccine surge really could work
If you need evidence a vaccine surge could work, look at Israel. With the speed and success of its vaccination campaign, Israel effectively surged vaccines to the entire country. About 62 percent of Israelis already got at least one shot, compared to 40 percent of Americans.
That’s come with very good news: Even as Israel has almost fully reopened its economy, its daily new Covid-19 cases are down more than 98 percent from a mid-January peak.
Israel’s example is a shot of mercy for the world and particularly the US. For the past year, America has struggled to contain its many Covid-19 hot spots. Masks are easy enough, but they didn’t seem to be enough on their own. Social distancing works, but requires a kind of sacrifice that doesn’t seem sustainable. A testing-and-tracing regime could have worked, but it seems contingent on keeping cases below a certain threshold — one the US has long since passed — to avoid overwhelming tracers.
Now, we have a better answer: the vaccines. If a place gets enough of the shots, it can get back to normal and eliminate the threat of Covid-19.
One lingering question is what the inflection point is for vaccine efforts: At what level is enough of the population vaccinated that cases start to truly plummet? Israel’s decline in cases appeared to begin in earnest around early February, when about 40 percent of the population had received at least one shot. Perhaps that’s close to the inflection point — though it’s likely an underestimate, because natural immunity from getting sick with Covid-19 also offers protection from future infection but isn’t counted in the vaccination numbers.
Whatever the figure might be, the goal of a vaccine surge would be to get the population to that inflection point as fast as possible.
That comes with a big caveat: The vaccines take a while to take effect. The two currently available vaccines require two doses, spaced weeks apart, and then the vaccines build up immunity further over at least two more weeks. Johnson & Johnson’s vaccine only requires one shot, but it’s on pause due to an investigation over blood clots, and it still needs two or more weeks to take full effect. So the full effects of a surge won’t be immediate.
But that doesn’t mean a surge can’t help. A COVID-19 wave can last far longer than the time it takes for vaccines to take effect — the fall-winter wave in the US lasted months. Vaccine surges could help in that time window, potentially causing a decline in cases or, if nothing else, at least speeding up the decline as vaccines kick in.
And while vaccines need weeks to take full effect, the evidence suggests they produce at least some level of immunity against the coronavirus within days, even after the first dose from one of the two-shot vaccines. It’s just that immunity continues to build up further over weeks and with the second shot. So vaccine surges could still lead to short-term benefits.
“This is a broader public health problem: People are continuing to underappreciate how valuable these vaccines are,” Jha said. “If three weeks ago, when a bunch of started saying Michigan should get [a vaccine surge], Michigan would be in a totally different place right now.”
It’s about more than extra vaccine doses
The most obvious element of a surge is flooding a Covid-19 hot spot with way more vaccine doses. After all, more doses would let more people get the vaccine — ending the outbreak.
But that alone wouldn’t be enough. As the Biden administration has pointed out, the states aren’t using all the doses they’ve been given. The vast majority of states have administered less than 90 percent of their supply, and more than half are below 80 percent.
That suggests other kinds of resources could be needed along with more doses. Maybe a state doesn’t have the people it needs to actually administer the shots, so a surge of health care workers or other trained personnel would be just as valuable, if not more so, than just getting more doses. Or maybe a state needs to find a way to get vaccines closer to where people actually are, so giving it vaccine vans or helping it build makeshift vaccination sites could help.
Or maybe a state’s real problem is hesitancy and apathy toward a vaccine, so the best support could come through extra expertise to create and deploy public education and awareness campaigns, focused on local issues, to encourage people to get vaccinated. Or it could be a mix of all of the above.
“It’s not just vaccines,” Shan Soe-Lin, a global health specialist at Yale University, told me. “It’s vaccination.”
To put it another way: More vaccines have to be paired with those other resources to make sure the doses actually get used.
Experts emphasized that this should be done not just at the state but the local level too. So far, Michigan’s COVID-19 outbreak in the middle of widespread vaccination efforts seems unique — and experts expect truly statewide outbreaks to happen less often, if at all, over time. But there are still going to be outbreaks at the local level, and vaccine surges could help in such settings.
One concern about this concept is more political: Some states may feel like they’re losing or giving up vaccine supply to help contain outbreaks in other places. Even worse, some states may feel like they’re essentially being punished for containing the coronavirus — if they’re getting fewer doses because they have fewer coronavirus cases.
When I asked experts about this, they acknowledged it doesn’t necessarily feel fair. But they pushed back on framing a vaccine surge around such rigid questions of fairness.
First, there’s the practical consideration. The vaccine effort is mainly about saving lives. A place with more Covid-19 cases is obviously at greater risk of the coronavirus. So getting a vaccine to those places would save more lives.
Second, there are selfish reasons for other states to want COVID-19 hot spots to get more vaccines. A coronavirus wave in one state could easily spill over to another. And if a surge system is put in place now, it could come to benefit the same states that feel they’re giving up doses today, given the above-zero chance of any state getting hit by COVID-19 in the future.
“We live in a society,” Gandhi said. “We’re all connected.”
There also may be a way to get around concerns about fairness: Instead of yanking supply that was meant for one state and giving it to another, the federal government could always set aside a portion of its vaccines to go to hot spots. The National Academies of Sciences, Engineering, and Medicine suggested setting aside a portion of vaccine doses — perhaps 10 percent — for this kind of purpose.
If those vaccines were never directed at a particular state, it’s going to be harder for that state to feel like it lost something.
In some cases, a vaccine surge may not even necessarily involve extra doses. Take a state like Alabama, which is currently administering a little more than 60 percent of the doses it’s getting — the worst rate in the country. If Alabama became a COVID-19 hot spot, arguably the biggest help it would need is not more doses but help in using the doses that it already has. In that context, a vaccine surge may need to focus on the other resources above and beyond more doses. Particularly in Republican strongholds, where people are more likely to be vaccine-hesitant, a surge could come down to concentrated education and outreach efforts.
Places with surges can’t ease up on other restrictions yet
One point experts repeatedly emphasized: A vaccine surge doesn’t mean other precautions against Covid-19, from masking to social distancing, should be prematurely discarded.
Vaccines are the way toward getting life back to normal. Israel’s experience is real-world evidence of that.
But until COVID-19 cases are sufficiently suppressed nationwide, and until the US surpasses the inflection point for vaccines, there’s always going to be a risk of a coronavirus outbreak. The other precautions — the ones we’ve heard so much about in the previous year — add an extra layer of security until that point.
Michigan’s current COVID-19 wave came as it eased restrictions related to the coronavirus. And Gov. Whitmer, dealing with restraints imposed by politics, the public, the legislature, and the courts, has resisted reimposing the restrictions. Paired with a new, more infectious coronavirus variant that first surfaced in the UK, the relaxed rules allowed Covid-19 to take off in the state.
Some critics have argued that Michigan should have focused on the other precautions instead of calling for a vaccine surge. Anthony Fauci, the White House’s chief medical adviser, claimed that in outbreaks like Michigan’s, “the best thing to do is try to contain” the virus and “really to shut down things much more so.”
But it doesn’t have to be either-or. Michigan and other parts of the US could continue with the precautions we’ve all heard about over the past year, while vaccine surges could help further in hot spots as they pop up. That applies even to hot spots with coronavirus variants, which the vaccines work against.
The measures likely won’t even be needed that much longer. At current rates, the US is on its way to vaccinating every adult by midsummer. If that holds true, we’ll be able to meet people unmasked, indoors, and do all those things that were considered too risky just months prior.
Until then, America should deploy every tool it has to get to the end quicker and with more people alive. That includes vaccine surges.