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With more than 100 years of medical and scientific progress since the great influenza of 1918, the U.S. was expected to perform better against the next major pandemic than the rest of the world and certainly better than we performed compared with the world in 1918. In actuality, we did dramatically worse.
From 1918 to 1920, U.S. influenza deaths were 1.4 percent of the worldwide total. Today, the U.S. has surpassed 1 million COVID-19 deaths — accounting for 16 percent of the global toll.
Can we learn from mistakes we have made in our response to COVID-19 in an effort to save lives throughout the remainder of the pandemic and in future pandemics?
In some critical ways, we actually have done extremely well. We developed highly effective vaccines that dramatically reduce the chance of death (or serious illness or hospitalization) from COVID, in record time, and they have been distributed across the country, free of charge. So, it is deeply troubling that we also have not adequately risen to the challenge. Tens of thousands of our fellow citizens whom we lost, mostly those who chose not to get vaccinated, did not have to die.
From the outset, there has been a widespread unwillingness to properly mask, distance and isolate. An anemic testing regime further weakened the U.S. effort. But the biggest barrier to success was the failure of a large segment of the population to get vaccinated and boosted.
Numerous countries have been far more successful in containing the pandemic than the United States. In comparison to Australia’s response, a recent New York Times investigation calculates that if the United States had taken the same COVID-19 measures, “about 900,000 lives would have been saved.” Australia’s approach was strict, with numerous mandates and fines for violating restrictions. Australians are at least as independent and devoted to individual freedoms as Americans, but their suite of restrictions was still effective because, despite their discomfort, the vast majority of Australians committed to and stayed with the program. According to the New York Times, that success against COVID-19 is based on trust — trust that others will do the right thing for the greater good, trust in science, in government, in responsible media. Additionally, like most wealthy democracies, Australia has a simpler, centralized, coordinated and more equitable health care system than ours in the United States.
But mandates alone are not the whole answer. China’s stringent zero-tolerance COVID-19 policy, for example, has backfired in areas like Shanghai. Other potent tools also exist for shaping human behavior to promote health and wellness. Early in the pandemic, the Australian government used incentives, paying people who had COVID-19 or had been exposed to COVID-19 to stay home.
In their book “Nudge,” Richard Thaler and Cass Sunstein make a strong case for “nudging” people into optimum behaviors by reshaping the environment in which they live and make decisions. Put carrots first in the school line, and kids select and eat more carrots. Thus, vaccination sites could be located where people already go, at convenient times. Houses of worship could offer vaccinations following services. Primary care physicians should have COVID-19 vaccines available. Accessible free masks could be placed at the entrances to shops and other venues.
Clearly, government and public health officials can do a better job of communicating and explaining what is known about COVID-19 and the ways to prevent it. Improved messaging is particularly critical in a time when so many are inundated by an incessant flood of conspiracy theories and misinformation.
As we pass 1 million COVID-19 deaths, with the disease surging once again, it seems almost harder now than at the beginning to up our game. Everyone feels COVID-19 fatigue. We all want the pandemic to be over, but while in Australia 95 percent of adults are fully vaccinated, in the U.S. we are at an inadequate 66 percent.
Our response does not have to be — shouldn’t be — partisan. Australia’s pandemic success resulted from thoughtful, bipartisan discussion at the highest levels of their government. The widely praised U.S. pandemic preparedness plan was initially developed in 2006 under George W. Bush, then followed up, with bipartisan collaboration in the Obama administration. Unfortunately, when the pandemic emerged in 2019, it seems nobody in charge opened the binders of the plan, choosing, instead, to ignore and dismiss its recommendations.
Our biggest challenge now appears to be willful ignorance and the volume of misinformation about the vaccines despite the reality that the modern mRNA COVID-19 vaccines are extremely safe and highly effective in preventing serious illness and death, safe enough to be approved for children 6 months and up. The rightwing politicians and newscasters, who encourage vaccine hesitancy and mask resistance, likely know this, and for the most part they make sure that they and their families are vaccinated.
It is heartbreaking and truly tragic that anti-vaccine folks who do finally manage to give up their uninformed and illogical opposition to a life-saving option are those who are seriously ill or on their deathbeds, telling spouses, parents and children — often by text since they have to be isolated from loved ones, “I should have just gotten the damn shot.”
Peter Katona, MD, is a clinical professor of medicine at the UCLA David Geffen School of Medicine and an adjunct professor of public health at the UCLA Fielding School of Public Health. He chairs the UCLA COVID-19 Infection Control Working Group.
Kavita Patel, MD, MS, served in the Obama administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement. She is currently a primary care physician at Mary’s Center in Washington, D.C.
Seth Freeman, MPH, is an Emmy-winning writer and producer for television, a playwright and a journalist, who writes about technology, policy and public health.