This conversation about protecting hospitals, back in the era when New Yorkers were still being encouraged to go to restaurants, well before the coasts’ contagion began closing in on the Midwest in earnest, helped define what became, by some measures, one of the most effective and balanced Covid responses in the United States. Ricketts is a mandate-shunning Republican who runs a heavily Republican and rural state with a middling vaccination rate — factors that have been linked to worse pandemic health outcomes in other states. He never ordered a statewide shutdown when 43 other governors, Democrats and Republicans, did so; he has stood against, or even supported lawsuits over, local mask requirements; he has told state agencies not to comply with federal vaccine mandates and gotten scolded by the U.S. secretary of defense for objecting to such requirements for the National Guard. And yet by the fall of last year, when POLITICO crunched the data of state pandemic responses on a combination of health, economic, social and educational factors, one state came out with the best average: Nebraska.
The state had the best economic performance of any in the pandemic up to that point, and its students, according to available data, appear to have suffered little to no learning loss. Whereas many states saw a trade-off between health and wealth in the pandemic — often corresponding to more-restrictive Democratic leadership and less-restrictive Republican leadership, respectively — Nebraska also scored above the national average for health outcomes POLITICO evaluated last year (20th of 50 states). Nebraska was the first state to accumulate a 120-day stockpile of PPE in the nationwide scramble for supplies; was a national leader in opening schools; and was among the quickest getting federal aid to small businesses. As of now, its cumulative pandemic death toll per capita is near the lowest of all 50 states, according to the Kaiser Family Foundation. This, however, is grading on a hideous curve in a country that hasn’t managed the pandemic well in general: More than 4,000 Nebraskans have lost their lives to Covid. Lawler of the University of Nebraska Medical Center, who helped design the state’s early Covid response but has since grown critical of Nebraska’s approach, notes that South Korea has 14 times lower per capita Covid mortality than Nebraska. “Nobody,” he told me via text, “should be patting themselves on the back for doing 14 [times] worse.”
One success story took place in Philadelphia, thanks to an effective collaboration between two health systems and Black community leaders. Recognizing that the largely online signup process was hard for older people or those without internet access, Penn Medicine and Mercy Catholic Medical Center created a text-message-based signup system as well as a 24/7 interactive voice recording option that could be used from a land line, with doctors answering patients’ questions before appointments. Working with community leaders, the program held its first clinic at a church and vaccinated 550 people.
In Alabama, for example, National Guard mobile vaccination units were set up with the ultra-cold freezers needed to transport and store mRNA-based covid-19 vaccines. “Why not, when this particular push is over, leave those freezer units with the federally qualified health centers that are already in those communities?” McClure says. “You’re starting to build the infrastructure for being able to deliver vaccination on a consistent basis.”
Five key fallacies and pitfalls have affected public-health messaging, as well as media coverage, and have played an outsize role in derailing an effective pandemic response. These problems were deepened by the ways that we—the public—developed to cope with a dreadful situation under great uncertainty. And now, even as vaccines offer brilliant hope, and even though, at least in the United States, we no longer have to deal with the problem of a misinformer in chief, some officials and media outlets are repeating many of the same mistakes in handling the vaccine rollout.
Amidst all the mistrust and the scolding, a crucial public-health concept fell by the wayside. Harm reduction is the recognition that if there is an unmet and yet crucial human need, we cannot simply wish it away; we need to advise people on how to do what they seek to do more safely. Risk can never be completely eliminated; life requires more than futile attempts to bring risk down to zero. Pretending we can will away complexities and trade-offs with absolutism is counterproductive. Consider abstinence-only education: Not letting teenagers know about ways to have safer sex results in more of them having sex with no protections.
Like public health officials everywhere, Dr. Jeffrey Duchin marvels at the miraculous production of highly effective vaccines against COVID-19 in mere months.
But Duchin, head of public health in Seattle and King County, Washington, doesn’t dwell on the only triumph of the pandemic response. Instead, he quickly pivots to the huge deficiencies plaguing the rollout of those lifesaving injections.
The lack of planning and coordination. The insufficient workforce and training. The inadequate public messaging and outreach. And the failure to create a uniform database to track inventory and equitably distribute shots.
“We’re seeing the consequences now of a complete and utter failure to ensure we have a full and robust vaccination system,” Duchin said. The chaotic execution of state and local vaccination programs is only the latest in a series of missteps by public health departments during the worst pandemic in more than a century. They include lackluster testing, contact tracing and data collection, and the failure to protect minority communities, which have borne the brunt of this disease.