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美国疫苗接种,承受了太多不切实际的期望?

美国疫苗接种,承受了太多不切实际的期望?

Jeremy Kahn 2021年01月19日
专家认为,目前的接种数字“绝对不是灾难”。

《纽约》杂志(New York)称之为“灾难”。

《名利场》(Vanity Fair)称之为“一团糟”。

英国的《每日邮报》(Daily Mail)称它可能成为一个“烂摊子”。

新冠疫苗接种工作已经在美国和英国全面铺开。在辉瑞(Pfizer)的首支RNA疫苗获批后不到两个月,英美又相继上市多支疫苗。到目前为止,美国已经有900多万人接种,英国的接种者也达到了245万人,两国的接种率分别达到了各自总人口的2.8%和4%。

从比例看,这两个数字当然小得可怜。这是否说明靠疫苗终结疫情将遥遥无期?此次疫苗接种工作与历史上的大规模疫苗接种运动相比,又处在一个什么水平?

耶鲁大学(Yale University)的公共卫生和医学史教授杰森•施瓦茨说:“美国的现实情况是,联邦政府显然对疫苗的接种速度寄予了不切实际的期望。”

他表示,目前的接种数字“绝对不是灾难”。如果说有些观察人士认为英美国家的接种工作做得很失败,那在很大程度上是因为美国政府出于政治动机而做出了愚蠢的预测——美国政府曾经预测称,到2020年12月底,美国将有2000万人接种新冠疫苗。

此次疫苗接种的目的,是给几乎全部人口都接种疫苗。更重要的是,接种工作是在疫情蔓延的过程中开展的。“这确实是一件史无前例的事情。”费城儿童医院(Children’s Hospital of Philadelphia)的儿科医生、疫苗研究员保罗•奥菲特说。不过在历史上,也有几个可以对照的例子。

距离当代最近的,就是20世纪50年代中期推广脊髓灰质炎疫苗的运动。脊髓灰质炎就是俗称的小儿麻痹症。和新冠疫苗一样,全球老百姓也曾经热切关注过世界上第一支脊髓灰质炎疫苗的研发。这支疫苗是由美国病毒学家乔纳斯•索尔克研发的,研发资金来自一家私人慈善机构——国家小儿麻痹症基金会(National Foundation for Infantile Paralysis,又称美国缺陷儿童基金会,March of Dimes)的善款。美国政府在1955年4月批准了索尔克研发的脊髓灰质炎疫苗的使用。到当年8月,全美已经注射了400万剂疫苗,足以使美国10%的12岁以下儿童产生免疫,这个年龄段也是脊髓灰质炎的主要易感人群。

在大范围接种后,美国的小儿麻痹症确诊病例数在一年内急剧下降,从1955年的14647例,骤降至1956年的5894例,到1959年已经降至900例左右。又过了十余年,等到阿尔伯特•萨宾的口服疫苗问世后,美国才进一步扩大接种人群,这时不光是在校的小学生,连青少年和成年人也接种了脊髓灰质炎疫苗。1962年萨宾研发的口服脊髓灰质炎疫苗在美国获批后,在接下来的三年里,美国约有1亿人接种了这支疫苗,约占当时美国总人口的56%。不过直到1979年,美国才宣布彻底根除小儿麻痹症。

当时英国的情况更糟。据熟悉英国疫苗史的华威大学(University of Warwick)的历史学家加雷思•米尔沃德介绍,当时,索尔克研发的一批疫苗在美国出现了严重的安全问题,英国由此认为不能依赖美国生产的疫苗,于是英国政府紧急启动了一个疫苗国产化项目。不过参加该项目的葛兰素史克(Glaxo)和宝来惠康(Burroughs Wellcome)公司都遭遇了产能问题,后者更是花了好几年时间才建成了疫苗工厂。

英国脊髓灰质炎疫苗的接种工作始于1956年,当时,英国主要依赖各地的全科诊所和家庭医生作为接种的主渠道。但供应问题严重影响了接种进度,1957年夏天,英国考文垂市爆发了一次严重的脊髓灰质炎疫情,这引起了公众的强烈不满,政府只得改弦更张,允许进口和接种外国疫苗。直到1961年,英国的大多数儿童才接种到了疫苗。虽然1959年,年仅29岁的足球明星杰夫•霍尔因为脊髓灰质炎而不幸去世,促使很多英国成年人接种了脊髓灰质炎疫苗。但让大多数成年人接种上疫苗,则是很久以后的事情了。

相比之下,今天新冠疫苗的接种速度已经是异乎寻常地快了。连美国疫苗开发资助项目都取名叫“曲速行动”(warp speed),这足以彰显美国在普及疫苗上的决心。曾经研究过美国疫苗接种史的英国布里斯托大学(University of Bristol)的历史学教授斯蒂芬•莫德斯利认为:“总的来说,我认为这一次的速度要比脊髓灰质炎疫苗的时期快得多,确实令人印象深刻。”

据一些医学史专家和卫生专家称,从很多方面看,对于公共卫生机构来说,当年普及脊髓灰质炎疫苗要比今天普及新冠疫苗容易一些。首先,学校是一个很理想的场所,能够便捷地给大多数儿童接种疫苗。其次,家长们也很害怕孩子们患上小儿麻痹症,所以他们会给孩子积极报名接种。而这一次,新冠疫苗在接种了一线医护人员和养老院的老人等重点人群后,接种的优先群体就要转移到下一层级,这个层级主要是按照年龄段划分的。在这个阶段,要想找到理想的接种场所就不太容易了。费城儿童医院的儿科医生、疫苗研究员保罗•奥菲特说:“美国还没有适合大规模接种疫苗的公共卫生基础设施,我们现在正努力整合资源。”

奥菲特介绍道,1976年,为了防止猪流感的潜在大流行,美国在各地的会议中心、市政厅等地设置了大规模的流感疫苗接种中心,在短短几个月时间里就接种了4000万剂疫苗——不过那一次,猪流感疫情并未给美国造成什么威胁。但现在美国或许可以从那次防疫工作中吸取一些经验。有些美国城市已经开放了一些大型公共场所作为大规模接种点,英国已经设立了7个这样的接种点,并表示将组建由50个接种点构成的接种网络。不过当前疫情远未结束,人们在接种点排队时,还是得小心地保持社交距离。“你肯定不希望疫苗接种点成为新的超级传染源。”耶鲁大学的公共卫生和医学史教授杰森•施瓦茨说。

此次疫苗接种工作还面临着另一个以前没有的难题:在很多地方,医护人员为了照顾住院的新冠患者,可以说是夜以继日地超负荷运转。但要给老百姓注射新冠疫苗,还是得靠这些医护人员。奥菲特表示,1976年那次,流感疫苗使用的是气枪式注射器,而不是传统的针头式注射器。这样一来,任何人只要经过少量培训,都能够安全轻松地承担疫苗接种工作。

不过,目前的新冠疫苗都没有采用这种注射方式。出于安全考虑,世界卫生组织(World Health Organization)已经不再建议采用这种无针注射器接种疫苗。但要想加快接种速度,可能还是要想办法让那些没有接受过医学培训的非专业人员也参与进来,在接种点承担疫苗接种工作。目前,英国政府已经开始在老百姓中招募志愿者,他们会接受基本的疫苗注射训练,然后在接种点服务,以避免给医护人员带来更多负担。另外,施瓦茨表示,美国的疫苗接种计划很可能会严重依赖私营药店,特别是沃尔格林(Walgreens)和CVS旗下的药店,因为它们在全美拥有2万多家分店。而在英国,私营药店也是提供季节性流感疫苗注射服务的主力军。这些药店也向政府表示,他们愿意充当新冠疫苗的接种点。而且药店也具备接种疫苗的一些技术条件,比如电子数据库和自动短信服务等等,可以提醒人们什么时候来接种下一针。这也是一个很重要的问题,之前的经验表明,在需要注射多针疫苗的时候,多达四分之一的成年人只打了一针,就不来打下一针了。

另外,此次疫情的社会环境也跟之前几次疫情有所不同,特别是在社会对疫苗的焦虑度上。据调查显示,只有60%左右的美国人打算接种新冠疫苗,还有很多人因为担心安全问题而下不了决心。

疫苗安全问题并非没有先例。在20世纪50年代脊髓灰质炎疫苗刚刚诞生的前几个月,美国就发生了一起骇人听闻的“卡特事件”。当时,一批由卡特实验室(Cutter Laboratories)生产的疫苗没有被完全灭活就被投入使用,造成了4万名接种者感染,其中10名儿童死亡,200余人出现了不同程度的小儿麻痹症状。受“卡特事件”影响,英国的脊髓灰质炎疫苗接种速度大大放缓。但在美国,接种工作虽然因为事故调查而暂停了三周,但此次事件并未彻底打消人们让孩子接种疫苗的积极性,美国抗击脊髓灰质炎疫情仍然取得了胜利。施瓦茨说:“换成今天,很难想象一个疫苗项目能够在那样严重的安全问题下继续推进。然而他们在几周内就重启了接种工作。”

从抗击脊髓灰质炎疫情的往事中,我们还可以学到另一条经验,那就是清晰的公共卫生信息的重要性,以及要善于利用名人的“带头效应”,来建立公众对疫苗的信心。比如1956年,猫王就曾经在电视节目《The Ed Sullivan Show》上接种过脊髓灰质炎疫苗。英国布里斯托大学的历史学教授斯蒂芬•莫德斯利认为,随着如今的流行文化更加碎片化,公共卫生部门应该“针对不同的人口群体,确定不同的名人代言”,以起到更精准的说服效果。

另外还要记住,半个世纪以来,我们对免疫运动的成功评判标准也发生了重大变化。华威大学的历史学家加雷思•米尔沃德说:“你可能认为,我们能够给所有人接种疫苗,但这只是一个相对现代的现象。”在20世纪80年代电脑的普及和90年代手机短信的普及之前,这样的目标根本就是不切实际的。米尔沃德表示,现在75%的接种率都会被认为是失败的,而在20世纪50年代,75%就是辉煌的成功了。

因此,以历史的标准来看,今天人们对疫苗接种速度的不满似乎略显矫情。但这也是情有可原的,毕竟我们的技术能力早已有了突飞猛进的发展。(财富中文网)

译者:朴成奎

《纽约》杂志(New York)称之为“灾难”。

《名利场》(Vanity Fair)称之为“一团糟”。

英国的《每日邮报》(Daily Mail)称它可能成为一个“烂摊子”。

新冠疫苗接种工作已经在美国和英国全面铺开。在辉瑞(Pfizer)的首支RNA疫苗获批后不到两个月,英美又相继上市多支疫苗。到目前为止,美国已经有900多万人接种,英国的接种者也达到了245万人,两国的接种率分别达到了各自总人口的2.8%和4%。

从比例看,这两个数字当然小得可怜。这是否说明靠疫苗终结疫情将遥遥无期?此次疫苗接种工作与历史上的大规模疫苗接种运动相比,又处在一个什么水平?

耶鲁大学(Yale University)的公共卫生和医学史教授杰森•施瓦茨说:“美国的现实情况是,联邦政府显然对疫苗的接种速度寄予了不切实际的期望。”

他表示,目前的接种数字“绝对不是灾难”。如果说有些观察人士认为英美国家的接种工作做得很失败,那在很大程度上是因为美国政府出于政治动机而做出了愚蠢的预测——美国政府曾经预测称,到2020年12月底,美国将有2000万人接种新冠疫苗。

此次疫苗接种的目的,是给几乎全部人口都接种疫苗。更重要的是,接种工作是在疫情蔓延的过程中开展的。“这确实是一件史无前例的事情。”费城儿童医院(Children’s Hospital of Philadelphia)的儿科医生、疫苗研究员保罗•奥菲特说。不过在历史上,也有几个可以对照的例子。

距离当代最近的,就是20世纪50年代中期推广脊髓灰质炎疫苗的运动。脊髓灰质炎就是俗称的小儿麻痹症。和新冠疫苗一样,全球老百姓也曾经热切关注过世界上第一支脊髓灰质炎疫苗的研发。这支疫苗是由美国病毒学家乔纳斯•索尔克研发的,研发资金来自一家私人慈善机构——国家小儿麻痹症基金会(National Foundation for Infantile Paralysis,又称美国缺陷儿童基金会,March of Dimes)的善款。美国政府在1955年4月批准了索尔克研发的脊髓灰质炎疫苗的使用。到当年8月,全美已经注射了400万剂疫苗,足以使美国10%的12岁以下儿童产生免疫,这个年龄段也是脊髓灰质炎的主要易感人群。

在大范围接种后,美国的小儿麻痹症确诊病例数在一年内急剧下降,从1955年的14647例,骤降至1956年的5894例,到1959年已经降至900例左右。又过了十余年,等到阿尔伯特•萨宾的口服疫苗问世后,美国才进一步扩大接种人群,这时不光是在校的小学生,连青少年和成年人也接种了脊髓灰质炎疫苗。1962年萨宾研发的口服脊髓灰质炎疫苗在美国获批后,在接下来的三年里,美国约有1亿人接种了这支疫苗,约占当时美国总人口的56%。不过直到1979年,美国才宣布彻底根除小儿麻痹症。

当时英国的情况更糟。据熟悉英国疫苗史的华威大学(University of Warwick)的历史学家加雷思•米尔沃德介绍,当时,索尔克研发的一批疫苗在美国出现了严重的安全问题,英国由此认为不能依赖美国生产的疫苗,于是英国政府紧急启动了一个疫苗国产化项目。不过参加该项目的葛兰素史克(Glaxo)和宝来惠康(Burroughs Wellcome)公司都遭遇了产能问题,后者更是花了好几年时间才建成了疫苗工厂。

英国脊髓灰质炎疫苗的接种工作始于1956年,当时,英国主要依赖各地的全科诊所和家庭医生作为接种的主渠道。但供应问题严重影响了接种进度,1957年夏天,英国考文垂市爆发了一次严重的脊髓灰质炎疫情,这引起了公众的强烈不满,政府只得改弦更张,允许进口和接种外国疫苗。直到1961年,英国的大多数儿童才接种到了疫苗。虽然1959年,年仅29岁的足球明星杰夫•霍尔因为脊髓灰质炎而不幸去世,促使很多英国成年人接种了脊髓灰质炎疫苗。但让大多数成年人接种上疫苗,则是很久以后的事情了。

相比之下,今天新冠疫苗的接种速度已经是异乎寻常地快了。连美国疫苗开发资助项目都取名叫“曲速行动”(warp speed),这足以彰显美国在普及疫苗上的决心。曾经研究过美国疫苗接种史的英国布里斯托大学(University of Bristol)的历史学教授斯蒂芬•莫德斯利认为:“总的来说,我认为这一次的速度要比脊髓灰质炎疫苗的时期快得多,确实令人印象深刻。”

据一些医学史专家和卫生专家称,从很多方面看,对于公共卫生机构来说,当年普及脊髓灰质炎疫苗要比今天普及新冠疫苗容易一些。首先,学校是一个很理想的场所,能够便捷地给大多数儿童接种疫苗。其次,家长们也很害怕孩子们患上小儿麻痹症,所以他们会给孩子积极报名接种。而这一次,新冠疫苗在接种了一线医护人员和养老院的老人等重点人群后,接种的优先群体就要转移到下一层级,这个层级主要是按照年龄段划分的。在这个阶段,要想找到理想的接种场所就不太容易了。费城儿童医院的儿科医生、疫苗研究员保罗•奥菲特说:“美国还没有适合大规模接种疫苗的公共卫生基础设施,我们现在正努力整合资源。”

奥菲特介绍道,1976年,为了防止猪流感的潜在大流行,美国在各地的会议中心、市政厅等地设置了大规模的流感疫苗接种中心,在短短几个月时间里就接种了4000万剂疫苗——不过那一次,猪流感疫情并未给美国造成什么威胁。但现在美国或许可以从那次防疫工作中吸取一些经验。有些美国城市已经开放了一些大型公共场所作为大规模接种点,英国已经设立了7个这样的接种点,并表示将组建由50个接种点构成的接种网络。不过当前疫情远未结束,人们在接种点排队时,还是得小心地保持社交距离。“你肯定不希望疫苗接种点成为新的超级传染源。”耶鲁大学的公共卫生和医学史教授杰森•施瓦茨说。

此次疫苗接种工作还面临着另一个以前没有的难题:在很多地方,医护人员为了照顾住院的新冠患者,可以说是夜以继日地超负荷运转。但要给老百姓注射新冠疫苗,还是得靠这些医护人员。奥菲特表示,1976年那次,流感疫苗使用的是气枪式注射器,而不是传统的针头式注射器。这样一来,任何人只要经过少量培训,都能够安全轻松地承担疫苗接种工作。

不过,目前的新冠疫苗都没有采用这种注射方式。出于安全考虑,世界卫生组织(World Health Organization)已经不再建议采用这种无针注射器接种疫苗。但要想加快接种速度,可能还是要想办法让那些没有接受过医学培训的非专业人员也参与进来,在接种点承担疫苗接种工作。目前,英国政府已经开始在老百姓中招募志愿者,他们会接受基本的疫苗注射训练,然后在接种点服务,以避免给医护人员带来更多负担。另外,施瓦茨表示,美国的疫苗接种计划很可能会严重依赖私营药店,特别是沃尔格林(Walgreens)和CVS旗下的药店,因为它们在全美拥有2万多家分店。而在英国,私营药店也是提供季节性流感疫苗注射服务的主力军。这些药店也向政府表示,他们愿意充当新冠疫苗的接种点。而且药店也具备接种疫苗的一些技术条件,比如电子数据库和自动短信服务等等,可以提醒人们什么时候来接种下一针。这也是一个很重要的问题,之前的经验表明,在需要注射多针疫苗的时候,多达四分之一的成年人只打了一针,就不来打下一针了。

另外,此次疫情的社会环境也跟之前几次疫情有所不同,特别是在社会对疫苗的焦虑度上。据调查显示,只有60%左右的美国人打算接种新冠疫苗,还有很多人因为担心安全问题而下不了决心。

疫苗安全问题并非没有先例。在20世纪50年代脊髓灰质炎疫苗刚刚诞生的前几个月,美国就发生了一起骇人听闻的“卡特事件”。当时,一批由卡特实验室(Cutter Laboratories)生产的疫苗没有被完全灭活就被投入使用,造成了4万名接种者感染,其中10名儿童死亡,200余人出现了不同程度的小儿麻痹症状。受“卡特事件”影响,英国的脊髓灰质炎疫苗接种速度大大放缓。但在美国,接种工作虽然因为事故调查而暂停了三周,但此次事件并未彻底打消人们让孩子接种疫苗的积极性,美国抗击脊髓灰质炎疫情仍然取得了胜利。施瓦茨说:“换成今天,很难想象一个疫苗项目能够在那样严重的安全问题下继续推进。然而他们在几周内就重启了接种工作。”

从抗击脊髓灰质炎疫情的往事中,我们还可以学到另一条经验,那就是清晰的公共卫生信息的重要性,以及要善于利用名人的“带头效应”,来建立公众对疫苗的信心。比如1956年,猫王就曾经在电视节目《The Ed Sullivan Show》上接种过脊髓灰质炎疫苗。英国布里斯托大学的历史学教授斯蒂芬•莫德斯利认为,随着如今的流行文化更加碎片化,公共卫生部门应该“针对不同的人口群体,确定不同的名人代言”,以起到更精准的说服效果。

另外还要记住,半个世纪以来,我们对免疫运动的成功评判标准也发生了重大变化。华威大学的历史学家加雷思•米尔沃德说:“你可能认为,我们能够给所有人接种疫苗,但这只是一个相对现代的现象。”在20世纪80年代电脑的普及和90年代手机短信的普及之前,这样的目标根本就是不切实际的。米尔沃德表示,现在75%的接种率都会被认为是失败的,而在20世纪50年代,75%就是辉煌的成功了。

因此,以历史的标准来看,今天人们对疫苗接种速度的不满似乎略显矫情。但这也是情有可原的,毕竟我们的技术能力早已有了突飞猛进的发展。(财富中文网)

译者:朴成奎

New York magazine calls it “a disaster.”

Vanity Fair says it is “an absolute mess.”

A potential “shambles,” warns the U.K.’s Daily Mail.

That’s the prevailing take on the COVID-19 vaccine rollout so far in the U.S. and Britain. Less than two months after the first vaccine—Pfizer’s messenger RNA–based inoculation—received the first regulatory approval, more than 9 million doses of various COVID-19 vaccines have been administered in the U.S. and 2.45 million in the U.K. That’s enough to cover 2.8% and 4% of each country’s respective population.

Do these numbers really indicate a hopelessly bungled vaccination effort? And how does this compare with historical mass vaccination drives?

“What we’ve seen in the U.S. is an expectations game gone awry,” says Jason Schwartz, a professor of public health and the history of medicine at Yale University. “There were off the chart expectations from federal government about the pace of vaccinations.”

He said the current numbers were “absolutely not a disaster.” If they looked like one to some observers, he says, it is largely because the U.S. government foolishly predicted, in an attempt to bolster political support, that 20 million people would be vaccinated by the end of December 2020.

There are a few parallels for the current vaccination effort, which is aimed at inoculating almost the entire population and is taking place in the midst of a deadly pandemic. “This really is unprecedented,” says Paul Offit, a pediatrician and vaccine researcher at the Children’s Hospital of Philadelphia.

The closest historical analogy to the current challenge is the campaign to combat polio in the mid-1950s. As with COVID-19, the public had eagerly anticipated and tracked development of the first polio vaccine, developed by Jonas Salk with funding from a private charity—the National Foundation for Infantile Paralysis, better known as the March of Dimes, Schwartz says. The U.S. government approved wide-scale use of Salk’s vaccine in April 1955. By August, some 4 million doses had been administered, enough to have immunized about 10% of U.S. children under the age of 12, who were the main target population for the vaccine.

Cases of polio infection dropped dramatically within a year, from 14,647 in 1955 to 5,894 in 1956 and then to about 900 in 1959. But it would take almost a decade more—and the advent of Albert Sabin’s oral vaccine—to expand immunizations to cover not only elementary school children, but teenagers and adults too. Once Sabin’s vaccine was authorized for use in the U.S. in 1962, it is estimated about 100 million people, or about 56% of the American population at the time, received the oral vaccine over the next three years. Even then, polio was not declared eradicated in the U.S. until 1979.

The situation in the U.K. was even worse. When a serious safety issue arose with a batch of Salk’s vaccine in the U.S. (more on that in a moment), Britain decided it couldn’t rely on American-made supplies, and the government launched a crash program to produce doses domestically. But the British companies chosen for the task—Glaxo and Burroughs Wellcome—struggled to set up manufacturing capacity, with the latter taking years to complete its plant, says Gareth Millward, a historian at the University of Warwick who has written about the U.K. vaccination efforts.

Immunizations began in 1956, with Britain using its network of general practice, or family, doctors as the primary means of administering the inoculations. But inadequate supplies plagued the rollout, and in the summer of 1957 there was a major polio outbreak in the city of Coventry. This caused a public outcry that forced the government to reverse course and allow foreign-made vaccine doses to be imported and administered, Millward says. It then took until 1961 for most children in the country to be vaccinated. As for adults, that process took longer still, he says, although the tragic death of 29-year-old soccer star Jeff Hall from polio in 1959 spurred many adults to get immunized.

In comparison, the pace of today’s COVID-19 vaccination rollout does seem like “warp speed,” as the U.S. vaccine development funding program’s name suggests. “Overall, I think this is so much faster than the polio years; it’s really remarkable,” says Stephen Mawdsley, a history professor at the University of Bristol, in England, who has researched the U.S. polio vaccination drive.

In many ways, the polio vaccine effort was easier than what faces public health officials today, medical historians and health experts say. Schools provided an easy and convenient place to vaccinate most children, Offit says, and parents were so afraid of the ravages of polio they readily signed their kids up to be injected. With COVID-19, once immunization efforts move beyond the top priority groups of frontline health workers and nursing home residents into the next tiers, which are largely defined by age brackets, it becomes harder to identify locations that could readily serve as vaccination hubs, Offit says. “There is not a public health infrastructure for mass vaccination in the U.S., and we are trying to put that together on the run,” he says.

In an effort to head off a potential swine flu epidemic in 1976—which turned out to be much less of a threat than initially feared—the U.S. opened mass flu vaccination centers in convention centers and town halls and managed to immunize 40 million Americans in a matter of months, Offit says. There may be lessons to draw from here. Several U.S. cities are beginning to open up big public venues to serve as similar large-scale vaccination locations, and the U.K. has opened seven such centers and is promising a network of up to 50. But the problem with mass vaccination centers in the midst of a raging pandemic is that social distancing must be carefully maintained while people are waiting in line for their shots. “You don’t want the vaccination centers to become superspreader sites,” Schwartz says.

Another problem weighing on the vaccination drive this time that wasn’t a factor in the past: In many places, doctors and nurses are already working around-the-clock caring for hospitalized COVID-19 patients. They can’t easily be spared to give inoculations. In 1976, the flu vaccine was administered using a pneumatic gun, rather than a conventional needle and syringe. This allowed anyone, with a minimal amount of training, to safely and easily serve as vaccinators, Offit says.

Such technology is not currently being considered for the COVID-19 vaccines—in fact, the World Health Organization no longer recommends such jet injectors be used for vaccines because of safety risks—but figuring out ways to allow people without medical training to administer the vaccine may be crucial to increasing the speed of the immunization effort. In Britain, the government has begun recruiting volunteers from the general public who will be trained to give injections in the new mass vaccination centers to avoid further straining doctors and nurses. The U.S. plans to rely heavily on private pharmacies, particularly those owned by Walgreens and CVS, which between them represent some 20,000 sites around the U.S., Schwartz says. In the U.K., private pharmacies, which are already accustomed to providing seasonal flu jabs, have also told the government they could serve as vaccination hubs. Pharmacies also already have in place the kinds of technology—electronic databases and automatic text messaging—needed to help remind people to get their second doses of the vaccine at the right time, a significant concern given that experience with previous multi-dose inoculations in adults has shown that as many as a quarter of people fail to get their second jabs, Offit says.

Previous vaccination drives also took place amid a very different environment in terms of public anxiety around vaccinations. Surveys have shown that only about 60% of Americans intend to get a coronavirus vaccine, with many of those who are reluctant citing safety concerns as the reason for their hesitancy.

In contrast, the 1950s battle against polio succeeded despite a catastrophic safety problem in the first months of the immunization drive: Known as the Cutter Incident, it involved a batch of the vaccine, made by Cutter Laboratories, in which the live polio virus had not been properly inactivated. The vaccine resulted in about 40,000 cases of polio, including the deaths of 10 children and 200 others left with varying degrees of paralysis. Alarm over the debacle is what severely slowed the U.K. vaccination drive. But in the U.S., while vaccinations were suspended for three weeks while the March of Dimes and the U.S. government investigated and put new safeguards in place, the disaster had almost no discernible effect on people’s willingness to have their children immunized. “It is hard to imagine a vaccination program today surviving a safety lapse as bad as that,” Schwartz says. “Yet they got back on their feet within weeks.”

Another lesson from the polio eradication efforts was the importance of clear public health messages, and the use of celebrities, such as Elvis, who was vaccinated live on The Ed Sullivan Show in 1956, to build public confidence in the inoculations, Mawdsley says. But in today’s more fragmented popular culture, he says, public health officials should be “trying to identify different celebrities for different demographic groups” who can help promote vaccination.

It is also important to remember that our perceptions about what constitutes a successful immunization drive has changed significantly in the past half-century. “The idea that you can vaccinate everybody is a relatively modern phenomenon,” Millward says, noting that before the widespread use of computerized records in the 1980s and text messaging to mobile phones in the 1990s, such a goal would have been impractical. Today, he says, a 75% vaccination rate is seen as an abject failure, whereas in the 1950s it was seen as a brilliant success.

So today’s exasperation with the pace of the vaccine drive may seem misplaced by historical standards. But our impatience seems to grow in proportion to our technological capabilities.

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