So, here we are, at war again.
Almost six months after President Jose Biden declared “independence from covid” in a July 4 speech at the White House, U.S. health officials are once again urging Americans to get vaccinated, wear masks and be careful if they travel over the winter holidays.
“This is a war we're at, and we've got use all our resources to fight the enemy, in this case, the virus,” the White House Chief Medical Advisor, Dr Anthony Fauci, said this week. On Tuesday, President Biden announced that 1,000 military medical personnel will be deployed to hospitals nationwide over the next two months to help treat the expected rise of new patients with the Omicron variant.
Late last year, scientists produced an almost miraculous vaccine in record time, so how is it that we continue to fight a two-year old battle against a virus that has cost 800,000 lives in the United States?
What went wrong, some public health experts are asking?
“It’s a mixed picture. We’ve won on the vaccine front but we are losing on the public health side. We didn’t create the conditions to succeed on our mass vaccine campaigns,” said Dr Eric Schneider, Senior Vice President for Policy and Research at The Commonwealth Fund, a New York-based foundation whose purpose is to promote improvements in health care.
“We will remain exposed on the battlefield and under continuous fire unless we can generate a much more successful public health response,” he added.
Schneider and others say the United States has for decades invested heavily in biotech and medical research to find the next ‘wonder-drug’, while at the same time ignoring a decentralized and woefully under-funded public healthcare system.
The world was fortunate that scientists had been researching new mRNA vaccine technology that was ready to be put to the test by Moderna and Pfizer.
What caught many public health expert by surprise was public resistance to the vaccines that has turned into a complicated cultural civil war between individual rights and the needs to protect society as a whole.
Global vaccination levels
Despite leading the world in vaccine development and distribution, only 62% of Americans are vaccinated, were below the levels in other developed countries, such as Portugal (88%), Chile (87%) South Korea (81%), Spain (80%), and Canada (78%).
Some of that can be put down to a lack of political leadership in the White House under Donald Trump, as well as disinformation sown on social media and ideologically-driven media outlets, who mostly exist outside the mainstream where professional journalists abide by ethical standards of objectivity.
“That probably is the biggest failure. It’s so ironic because the former president (Trump) could take so much credit for the stroke of luck with creating the vaccines, but also is partly responsible for this politicization of public health to the point that a large percentage of the population are not vaccinate,” said Schneider.
Fragmented public health system
Instead of a federally-run national campaign of testing, quarantine and contact tracing, adopted successfully in some countries, the United States adopted a piecemeal, state-by-state approach. The White House had its hands tied in many ways due to a political system that places health in the hands of state authorities, limiting the federal government’s ability to implement a national strategy, besides funding the vaccine research and production.
Instead, the vaccines roll out was handled at a state and county level, via pop-up tent clinics, at fairgrounds and stadiums.
“We didn’t create the capacity. We were overlooking the primary care system, which is where most people would feel comfortable getting vaccinated. We are still struggling with the legacy of that,” said Schneider.
The two-year battle has so far killed 800,000 people in the United States and continues to disrupt the economy, from worker shortages to travel restrictions and cancellation of sporting events and concerts.
Even so, many lives were saved. In the absence of a vaccination program, there would have been approximately 1.1 million additional covid-19 deaths and more than 10.3 million additional covid-19 hospitalizations in the U.S. by November 2021, according to a statistical model developed by researchers at Yale University and The Commonwealth Fund.
On the other hand, more than 400,000 people were allowed to die after the vaccines became available.
To be fair, covid-19, has proven to be a formidable foe, making it difficult to get the answer right and forcing politicians to make difficult choices between locking down economies to stop the virus spreading, and allowing businesses to reopen to save jobs.
It’s still too early to say how severe the Omicron outbreak will be. Hospitals in some parts of the country are already becoming strained by covid-19 patients, health officials say, as Omicron has rapidly taken over as the dominant virus strain in the United States.
“The transmission rate of Omicron, which is kind of astronomical, is kind of like your science fiction novel, it is doubling every two to three days,” said Dr Vikas Saini, president of the Lown Institute, a Boston-based healthcare non-profit.
“We're probably going to burn through the unvaccinated population over the next month or two,” he added.
For many public health experts, and frustrated, fully vaccinated members of the public, the question remains how do you take on the vaccine resisters?
Biden's latest strategy, announced Tuesday night, is to focus instead of increased testing, to avoid having to go through another shut down of the economy. The White House is making 500 million free test kits available to the public by mail order, though critics say that’s only a drop in the bucket for a country of 330 million people.
Biden’s decision not to go back to lockdowns and mandates is broadly accepted across the spectrum of vaccine advocates and deniers.
“Vaccinated people have gone through so much during this pandemic. There are millions of Americans who have done the right thing all along, and they should no longer have to pay the price because there are people choosing to remain unvaccinated,” Dr Leana Wen, professor of health policy and management at George Washington University, told CNN.
Some public health experts say the president could go further by adopting punitive measures on the unvaccinated.
“I wish President Biden had gone into all the things that should be done to restrict the activities of the unvaccinated. They are the ones who are predominantly getting sick, overwhelming our hospitals, spreading coronavirus … causing the prolonging of this pandemic for all of us,” she said.
Wen suggested requirements for vaccination for domestic travel, vaccination for indoor dining and gyms, as is the case in some large cities such as Los Angeles, New York and Boston.
"War of attrition"
“It's really been a war of attrition. We've had a hard time really combating [the virus] with all of our forces for a long time. So, after two years there quite a bit of indifference and apathy among large segments of the US population,” said Josh Michaud, a director for Global Health Policy at the Kaiser family Foundation.
That coupled with the individual liberty mindset of some who for political or psychological reasons demand the freedom to choose what goes into their body, has ground the covid war to a virtual stalemate.
"Maybe we underinvested in research on human behavior. I never imagined a year ago ... that we would still have 60 million people" not get vaccinated, Dr. Francis Collins, director of the National Institutes of Health (NIH) told PBS this week.
Polling by the Kaiser foundation shows little recent progress in persuading more people to vaccinate, with the odd exception. “There is just a hardcore group of 14 to 16 percent of the U.S. adult population who just absolutely refuses to get the vaccine. And I don't know that there's any public policy that can make a dent in that,” he said.
Over time, some more people might change their minds as they see the effectiveness of the vaccines. “All hope is not lost for everybody,” said Michaud, who said he has a friend who recently decided to get vaccinated after months of resisting.
That resistance has created a moral, ethical and political dilemma. “ There's a tussle about autonomy, about who owns my body. What do you do when huge chunks of your society really aren’t going to make the right choice individually, can you force them or should you force them?” said Saini.
“You don't want the government knocking on your door and say, Here, take this pill or else. Right? So, I'm sympathetic to that point of view, and I think the solutions have got to be kind of more elegant and smarter,” he added.
The Biden administration has tried to impose vaccine mandates for federal workers, healthcare facilities supported by federal programs such as Medicare or Medicaid, as well as private companies with more than 100 employees. But those mandates are currently blocked in the courts, with the Supreme Court expected to rule early next year.
That leaves some experts predicting that covid may never be vanquished and could eventually become endemic, a permanent health issue, much like flu, that we will have to learn to live with.
This may be “the last gasp of the pandemic,” says Michaud, searching for reasons to be optimistic. “The combination of vaccine immunity and infection-induced immunity is going to be the barrier wall that prevents massive waves and hospitalizations and deaths going forward,” he said.
But he worries about the legacy of covid-19 and the political weaknesses in the public health system that were exposed over the last two years. “If we have another [virus] which comes along, which is even worse in terms of severity or transmissibility than this virus, we're in a weaker position than we were in the United States,” he said.