Monday, September 27, 2021

How the US vaccine effort derailed and why we shouldn’t be surprised


Jessica Glenza
Mon 27 Sep 2021 02.00 EDT


The story is one example of how the United States purchased enough vaccines to inoculate its entire population, and even potentially embark on a round of booster shots, but health professionals found lacking another essential element essential to a successful vaccination campaign: trust.

That lack of confidence garnered the United States an unenviable distinction – in mid-September it became the least vaccinated member of the world’s seven most populous and wealthy democracies, or “G7,” which includes Britain, Canada, France, Germany, Italy and Japan.

Now, a surge of the Delta Covid-19 variant has killed on average more than 2,000 Americans per day and forced the US death toll past the symbolic milestone of 675,000 deaths, the estimated number of Americans who perished in the 1918 influenza pandemic, even as hospitalization and death from Covid-19 are largely preventable.


“When I look at this I do see a very familiar pattern,” said Dr Steven Woolf, a prominent population health researcher at Virginia Commonwealth University. “When Operation Warp Speed came out I thought I was just seeing a modern example of this old problem where the scientific community developed the vaccine at ‘warp speed,’ but the implementation system for getting it out into the community was inadequate.”

Woolf calls this “breakthrough without follow-through”. In that light, the plodding vaccination campaign could be seen as one more aspect of the American “health disadvantage”.

The phrase describes a paradox: the US houses among the most advanced medical and research centers in the world, but performs poorly in basic health metrics such as maternal mortality and infant mortality; accidental injury, death and disability; and chronic and infectious disease.


An important piece of research in this area is a 2013 report by a panel chaired by Woolf, directed by Aron, and funded by the National Institutes of Health. Called US Health in International Perspective: Shorter Lives, Poorer Health, the report describes how Americans spend more than double per person on healthcare compared with 17 peer nations, but rank near the bottom in health outcomes.

The phenomenon is described as “pervasive”, affecting all age groups up to 75, with life expectancy declining especially for women. In just a few examples, Americans have the highest infant mortality, children are less likely to live to age five, and the US has the worst rates of Aids among peer nations.

The US also has the highest or among the highest rates of cardiovascular disease, obesity, chronic lung disease and disability. Together, these risk factors culminate in Americans having the worst or second worst probability of living to age 50.

Americans know intuitively that their healthcare is expensive, frustrating and often unfair. Remarkably, even amid the pandemic, roughly 30 million Americans went without health insurance, exposing them to potentially ruinous medical debt. [Many can't afford health insurance.]


Even people relatively well insulated from societal ills live shorter, sicker lives than their counterparts in Europe.

“That is, Americans with healthy behaviors or those who are white, insured, college-educated, or in upper-income groups appear to be in worse health than similar groups in comparison countries,” the 2013 report found.

Research since this report was published has elaborated on these findings, notably recent research showing that American life expectancy has declined while peer nations saw continued gains.

“To some extent, we feel that reflects the tendency of Americans to reflect the role of government, and insist on their freedoms,” said Woolf. However, it is an attitude that can be taken to extremes, “and there’s no better example than Covid-19”.



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