America reaches milestone with COVID-19 vaccine widely available to those who want it, but hesitancy still casts a shadow – USA TODAY

As of Monday,COVID-19 vaccines are available to every American over 16 who wants a shot, but a panel of experts convened by USA TODAY remains deeply concerned about the people who say vaccines aren't needed.

Anxiety about getting a shot is normal, expected and can be resolved with education and role models, several panelists said.

"People who have questions deserve to have those questions answered. Thatsfair and thats on us," saidDr.Gregory Poland,director of theMayo Clinic's Vaccine Research Group.

What he and others worry about arethose who deny the importance of vaccination and try to convince others to forgo it.

Vaccines from Pfizer-BioNTech and Moderna have been shown to be effective preventing upward of 90% of infections, both in clinical trials and real-world studies. And they've been shown to be safe, delivered to more than 125 million Americans.

"You would have trouble finding a better vaccine," saidDr. Paul Offit,director of the Vaccine Education Center at Children's Hospital of Philadelphia.

Once a month for nearly a year, USA TODAY has examined the development and rollout of COVID-19 vaccines with an expert panel whosespecialties rangefrom virology to logistics.

We asked members to create an imaginary clock, starting at midnight, when the virus first came to public attention and ending at noon when anyone who wanted a shot could get one.

Last June, the first month of our coverage, panelists put the time at4 a.m., and estimates advanced by a fullhour most months.

Although it's still a challenge to work the computerized registration system in many states, theoreticallyhigh noon has been reached, and vaccines are available to most everyone.

We had expected to rollthe clock back at least once, as vaccine development and rollout stumbled.Though it took 11 months to advance eight hours, we never went backward, a testamentto the massive resources devoted to creating the vaccines in record time.

This month, the message from the 15 panelists was clear: Vaccines are safe, effective and a triumph of scienceessential for ending the pandemic and restoring the U.S. economy. The big challenge is getting enough people to take them.

COVID-19 hasclaimedmore than 567,000 livesin the USA and sickened millions more, yet fears remain among too many Americans about the tinysafety riskthat comes with all vaccines.

"The threat is right in front of our noses, and we look past it to worry about an overblown and theoretical risk that hasn't been supported after tens of millions of vaccinations," said Dr. Otto Yang, an infectious disease specialist at the Geffen School of Medicine at the UCLA.

In 2018, vaccine hesitancy was listed as one of the Top 10 global health threatsby the World Health Organization.

People still seem to think pathogens aren't a problem unless they're personally affected.

I hear people say things like, We didnt take it seriously until my brother died of it, and after seeing what he went through, then we changed our mind,Poland said. That means a whole lot of people have to die to convince people.

Some panelists expressed optimism that most can be convinced to get vaccinated, to protect themselves and others.

"I am amazed by how effective these vaccines are in real-world studies," saidDr.Monica Gandhi,an infectious disease expert at the University of California, San Francisco, "and am over the moon that we are so lucky to have these vaccines."

"Nothing succeeds like success," said Dr.Kelly Moore,deputy director of the nonprofit Immunization Action Coalition.

Despitehitches, the vaccine development and rollout have been incredibleaccomplishments.

The first vaccines were developed and completed large clinicaltrials less than a year after the SARS-CoV-2 virus was identified. Massive amounts of federal funding under the Trump administration assured that large-scalemanufacturing wouldn't lag too far.

Under the Biden administration, distribution of the vaccines stepped up substantially, along with production, and more than 3 million Americans roughly 1% of the total population get vaccinated every day.

The success increases the stakes for getting the majority of the population vaccinated, Moore said.

"If we fail at that, its a failure of willrather than a failure of science," she said. "And we will have no one to blame for but ourselves."

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The biggest setbacks in vaccinationshave come in recent weeks in safety and production issues aroundthe Johnson & Johnson vaccine, which was authorized for use in the USA on Feb. 27, and the AstraZeneca-Oxford vaccine, which hasn't applied for authorization herebut is used around the world.

Because the Biden administration bought enoughof the Pfizer-BioNTech and Moderna vaccines, supply by midsummer should cover every American adult who wants a shot, with more remainingfor younger teens and children, who aren't yet eligible.

Even if J&J and AstraZeneca are never usedhere, a fifth vaccine, from Novavax, may win authorization.

Vaccines won't be the total solution mask-wearingand avoiding crowds also matter, Yang said. Too often during the pandemic, leaders have stepped back from these measures when they should have encouraged people to keep going.

"As soon as numbers fall, they start relaxing containment measures," Yangsaid, comparing it to firefighters leaving the scene of a fire as soon as they begin to gain control. "When the flames are low, that is the time to redouble and intensify efforts, because that is when you have a chance to put out the fire."

Because it's too hard to control the virus with behaviors, vaccines have become the only way to stop this crisis, panelists said.

"Solving for vaccine hesitancy will be absolutely critical to ending this pandemic and revitalizing local economies across the country," saidDr.Michelle McMurry-Heath,president and CEO of Biotechnology Innovation Organization, a trade group.

They offeredsome creative ideas for encouraging more people to get vaccinated.

Pamela Bjorkman,a structural biologist at the California Institute of Technology, harkened back to the days of the polio vaccine rollout, when role models were publicly vaccinated to encourage peopleto get their shots.

"The Elviseffect," as she called it,"resulted in a lot more people getting poliovirus vaccinations." Elvis Presley famously got the polio vaccine on television before performing on "The Ed Sullivan Show" in 1956.

"We need a series of Elvises to promote vaccination for COVID-19 protection," Bjorkman said.

University of Missouri law professor Sam Halabi would like to see more well-known figures, such asLALaker LeBron James,get publicly vaccinated.

Former Presidents Jimmy Carter, Bill Clinton, George W. Bush, Barack Obama and their first ladies all werepart of a television advertising campaign to get vaccinated. Former President Donald Trump and first lady Melania Trump werevaccinated but less publicly.

Communicationexpert Peter Pitts sees a role foreach vaccinated person to "sell" the idea of vaccination to others.

"While targeted public relations and advertising campaigns are important, what will really move the needle (both literally and figuratively) are neighbors talking with friends, neighbors and relatives about their positive experiences and the feeling of freedom" after vaccination, said Pitts, president and co-founder of the Center for Medicine in the Public Interest.

"Peer pressure is a potent tool in the battle against vaccine skepticism," he said.

Yang agreed that personal connections will be key, because too few Americans put their trust in experts or the news media.

"They need to hear the information from someone they personally know and believe," Yang said. "Politics and disinformation have so polluted the public psyche that many people just won't believe anything from even the most reputable sources, or worse yet, believe disinformation based on their political alignment."

People need to be reminded that when they get vaccinated, they help not just themselvesbut people who can't get full protection because they're immunocompromised, have allergies to the shots or are particularly frail,Offit said.

He recalled when California lawmakers were trying to decide whether to allow parents to exempt their kids from routine childhood vaccinations. The tide turned in favor of vaccination when a5-year-old boy named Luke, who couldn't get shots because he was being treated for leukemia, got up in front of the state Legislature.

Standing on a stool to reach the microphone, he said, What about me? I depend on you to protect me,Offit remembered.

"Ultimately, the real carrot is watching vaccinated people get back to their normal lives over time," saidVivian Riefberg,professor of practice at the Darden School of Business at the University of Virginia, "and the real stick might unfortunately be with continued sickness and unnecessary death."

For our final question to panelists, we asked what surprised them the most about thevaccine development and distribution.

Most cited the speed by which effective vaccines have been made widely available.

"I am astonished, but not surprised, by the global scientific brilliance and collaborative spirit that has produced a profusion of useful vaccines," said Arti Rai,law professor and health law expert at Duke University Law School."Most surprising to me has been the ability of the U.S. public health care system, challenged as it is in so many ways, to do a reasonablejob on the delivery end."

"I am amazed to see how effective the vaccine has been in preventing hospitalization and death," said Prakash Nagarkatti, vice president for research at theUniversity of South Carolina.

"Without the vaccines, we would be thinking not just about wave four but also waves five, six, etc.,right now," Riefberg said.

She praised the public-private collaboration that gotthe vaccines produced in record time, as well as the effective use of government funding to support vaccine developmentand rescue the economy.

"Imagine if there were no vaccines and outright economic collapse," she said. "This time last year, that was a distinct possibility."

On the negative side of the ledger, several panelists expressed dismay about the fragmentation of the health care system, particularly under the Trump administration, in which every state operated on its ownunderlittle direction from Washington.

"I was surprised how ill-prepared we were for this in general," said Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai in New York City. "Many lives could have been saved if we had responded properly from the beginning."

Dr. William Schaffner,a professor and infectious disease expert at the Vanderbilt University School of Medicine in Nashville, Tennessee, said he was discouraged that it took so long to roll out vaccines at the local level."Also, how much variation in vaccination prioritization occurred among the states," he said.

That slow start turned into a breakneck paceand will hopefully serve as a role model for fixing other problems, several panelists said.

"It creates confidence in government capacity to deliver at scale quickly," said Prashant Yadav, a medical supply chain expert andsenior fellow at the Center for Global Development. "Lets hope this confidence is contagious to other fields if we have been able to do it in public health, can we also do it for health care more comprehensively?"

Several panelists pointed out that the virus highlightedchallengesin America's health care system and the need to prioritize global health.

"While this is not a surprise, the pandemic has laid bare the stark inequities in health care/society that need to be addressed," Riefberg said.

She and others said they were shockedbythe widespread rejection of science and the politicization of basic health measures such as mask-wearing, vaccines and vaccine passports to prove inoculation.

Riefberg said she's disappointedthat therearen't many good treatments to fight COVID-19. "After a year and about 1,000 clinical trials, all we have is remdesivir (maybe), monoclonal antibodies (less effective by the day because ofvariants)and steroids," she said.

Panelists said their concerns couldn't dim their overall enthusiasm about the vaccines and thepotential they have to make a real difference in the pandemic saving lives and allowing people to bounce back from the incredibly difficult past year

"The resiliency of the average American is astounding," Pitts said.

USA TODAY asked scientists, researchers and other expertshow far they think the vaccine development effort has progressed since Jan. 1, 2020 when the virus was firstrecognized. Fifteenresponded this month. We are grateful for the time they have devoted to this project.

Pamela Bjorkman,structural biologist at the California Institute of Technology

Dr.Monica Gandhi,an infectious disease expert at the University of California, San Francisco

Sam Halabi,professor of law, University of Missouri; scholar at the ONeill Institute for National and Global Health Law at Georgetown University

Florian Krammer,virologist at the Icahn School of Medicine at Mount Sinai in New York City

Dr.Michelle McMurry-Heath,president and CEO of Biotechnology Innovation Organization

Dr.Kelly Moore,deputy director of the nonprofit Immunization Action Coalition; former member of the CDC Advisory Committee on Immunization Practices

Prakash Nagarkatti,immunologist and vice president for research, University of South Carolina

Dr. Paul Offit,director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children's Hospital of Philadelphiaand a professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania

Peter Pitts,president and co-founder of the Center for Medicine in the Public Interestand a former FDA Associate Commissioner for External Relations

Dr.Gregory Poland,director, Mayo Clinic's Vaccine Research Group, and editor-in-chief, Vaccine

Arti Rai,law professor and health law expert at Duke University Law School

Vivian Riefberg,professor of practice at the Darden School of Business at the University of Virginia, director emeritus and senior adviser withMcKinseyanda board member of Johns Hopkins Medicine, PBSand Signify Health, a company working totransformhow care is paid for and deliveredat home

Dr. William Schaffner,a professor and infectious disease expert at the Vanderbilt University School of Medicine in Nashville, Tennessee

Prashant Yadav,senior fellow, Center for Global Development, medical supply chain expert

Dr.Otto Yang,professor of medicine and associate chief of infectious disease at the David Geffen School of Medicine at UCLA

Contact Karen Weintraub at kweintraub@usatoday.com and Elizabeth Weise at eweise@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

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America reaches milestone with COVID-19 vaccine widely available to those who want it, but hesitancy still casts a shadow - USA TODAY