Forget Herd Immunity. Here’s How We End This Nightmare.

Peter J. Hotez
·6 min read

By the time Israel recently crossed the threshold of 60 percent of its population having received at least one dose of a coronavirus vaccine (with more than one half receiving two doses to become fully immunized), new COVID-19 cases and deaths had plummeted. Now that New Hampshire is the first in the United States to reach 60 percent single-dose immunization, we are seeing significant declines in COVID-19 suffering there, as well.

Such positive developments might make it seem like the all-elusive target of “herd immunity” is finally within reach, and the pandemic is kaput.

Yet on Monday, The New York Times skeptically explored whether it will even be possible to achieve herd immunity in the United States. In this context, herd immunity refers to the level of COVID-19 vaccination coverage required in order to reach a tipping point that results in halting coronavirus transmission.

But vaccines are working, and it’s important we don’t get distracted by a moving target that has been seized upon by the far right and which could be used to stoke vaccine hesitancy.

In fact, I’ve stopped using the term herd immunity because it has been highly politicized by conservative groups as a means to justify the premature halting of non-pharmaceutical interventions, including masks and social distancing. In some cases, coronavirus skeptics have set the bar at ridiculously low levels, such as 40 percent vaccinated or recovered from COVID-19.

There is a scientific rationale behind the concept of “herd immunity.” Some epidemiologists have suggested that virus transmission will dramatically decline or even disappear once the level of full vaccination reaches 65-70 percent, though lately that number has been raised to much higher levels, possibly even 85-90 percent. That’s partly because of the higher transmissibility of new variants of concern, including the B.1.1.7 variant now dominant in the U.S. and Israel.

Recently, the hope has been that if we can hit 75 percent, 80 percent, or 90 percent benchmarks, we might reach a point where transmission does not disappear entirely but is at such low levels that we can resume levels of activity that resemble pre-pandemic life.

Some version of that achievement is still the plan, and it is still attainable. However, reaching such levels will require many stars to align, and we face some significant hurdles.

Currently, no COVID-19 vaccine has been released for emergency use for anyone under the age of 16, although Pfizer-BioNTech has requested emergency use for 12- to 15-year-olds and reportedly may get it as soon as this month. We will need to create awareness campaigns regarding the importance of vaccinating this adolescent population, with a goal to have middle schools and high schools across the country fully immunized against COVID-19 by the fall. That would still leave the slice of the U.S. population under the age of 12, which is so far ineligible for vaccination.

Likewise, while vaccine hesitancy or refusal has declined significantly in BIPOC communities in recent months, we still face the reality that vaccinations in these groups lag behind white or Asian populations. A significant issue is ensuring vaccine access, especially in low-income communities that lack pharmacies and health-care facilities. Closing this BIPOC gap has been a priority for the Biden administration, a focus that must accelerate.

Third, the Center for Countering Digital Hate estimates that the leading anti-vaxxer groups have 58 million followers, and now at least one anti-vaxxer group has specifically targeted Black Americans in a new film documentary by drawing analogies between vaccinations and Tuskegee experimentation. Complicating this situation are revelations of concerted attacks on COVID-19 vaccinations by the Russian government. Although the Biden administration acknowledges the importance of ramping up pro-vaccine messages, so far it has not taken the essential steps to halt anti-vaccine aggression from U.S. groups or state actors like Russia. This could become an important barrier to high vaccination rates.

Meanwhile, as I have previously highlighted, we have at least four major news polls showing that over 40 percent of individuals self-identifying as Republicans exhibit vaccine hesitancy or refusal. That is why the top U.S. states in terms of vaccination coverage—achieving more than 50 percent of residents receiving a single dose—are all blue or bluish states, whereas states at the bottom with 35 percent vaccine coverage or less are all deep red.

I fear we are heading toward a deep red state versus blue state divide, in which only the blue states slow or halt virus transmission. In contrast, the coronavirus will continue to circulate and mutate across the U.S. southern and mountain states. That is a major barrier to anything resembling herd immunity for the country. We must find a path to reach conservative groups and the GOP leadership to get Republican strongholds vaccinated.

Another, perhaps less obvious move that is essential for Americans ready for this to be over already: vaccinating Canada. It makes no sense to vaccinate Detroit, Michigan, and yet ignore Windsor, Ontario, across the Detroit River. The same goes for Buffalo, New York, and Fort Erie, Ontario, connected by the legendary Peace Bridge. Yet Canada lags far behind the U.S. in vaccination coverage. Only 34 percent of Canada’s population has received a single dose of vaccine, and only 3 percent is fully vaccinated. Such numbers ensure that the virus will circulate in our northern states for many more months. With a Canadian population of 37.59 million, it is feasible for the U.S. to facilitate vaccinating Canada by expanding vaccine coverage another 11 percent. That is not a stretch, it’s the right thing to do, and in our enlightened self- interest.

Similarly, only 6 percent of the Mexican population is fully vaccinated, while only 10 percent has received a single dose. Because of its much larger population and logistics, vaccinating Mexico is more daunting than Canada, but we should at least begin this process in a more accelerated manner.

So, sure, the odds are stacked against us. The youngest Americans are unreachable with vaccines, at least as of now, and virus transmission continues to swirl around us. Most significantly, we should anticipate sustained transmission in some of the deep-red states where populations continue to defy vaccinations, especially if we fail to enact more aggressive measures against anti-vaccine disinformation.

But I believe we can achieve 80 to 85 percent vaccination coverage—and claw back normalcy—no matter what you want to call it.

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