Between the United States' painfully slow vaccination rollout and some introducing half-baked ideas like moving to single or half doses, it was only a matter of time before public confidence began to wane. A research letter published in JAMAconfirms that public acceptance of a vaccine has declined. The Understanding America Study included approximately 9,000 Americans surveyed biweekly about covid-19 on a rolling basis. Participants were asked how likely they were to get vaccinated once a vaccine became publicly available. 

Early in the pandemic, confidence in vaccination was at its highest, at 74 percent. By the end of 2020 the figure had dropped to 56 percent. A decline was found even after adjusting for gender, age, race/ethnicity and education. There were starks differences among White, Black, Hispanic, and Asian individuals. Asian persons had the highest vaccine confidence at both time points (though the rate fell from 90 percent in April to 80 percent in December). In December, vaccine confidence rates were 59 percent among White individuals, 53 percent among Hispanic individuals, and 38 percent among Black individuals.  

In addition, level of education appears to play a role in vaccine confidence. Confidence among those with bachelor's degrees fell from 85 to 70 percent from April to December, and among those with high school education or less, the number fell by an even larger amount, dropping from 67 to 48 percent. 

The most concerning aspect of this measured decline is the fact that an abundance of encouraging information has been released about the safety and extremely high efficacy of the two vaccines currently authorized for use in the United States. In order to help bolster trust, state and national leadership must engage the public. A massive public health campaign must be carried out. Issues such as distrust—whether a result of structural racism or other causes such as recent attacks on science and scientists—must be addressed in order to move this country closer to ending the pandemic. Public outreach also must take into account various levels of health literacy and language preferences. If vaccination support continues to decline, the one tool available to control this pandemic safely—true herd immunity through scientific innovation—will be hampered, and more will needlessly die.

Back in November, Brief19 covered the National Academies of Sciences, Engineering, and Medicine's recommendations regarding "decarceration," a concept referring to decreasing the overall size of the prison population through a series of steps coordinated by the penal and healthcare systems. The idea was that in such facilities, covid-19 outbreaks are difficult to control and that people who would otherwise be able to avoid infection simply are unable to avoid it in many circumstances. At the time, the total number of incarcerated individuals was down 10 and 22 percent in jails and federal institutions, respectively, so the problem did not seem immediate. 

Now, however, many local jails and state prisons are facing closures due to unrelenting waves of covid-19 infections among staff, making it nearly untenable to adequately operate these facilities. As a result, detainees and inmates are being transferred to alternative centers that remain open, once again causing overcrowding in a population with more comorbidities and less access to healthcare—in short, creating the perfect storm for case resurgence. 

According to a New York Times database, there have been 480,000 infections and at least 2,100 deaths in correctional facility settings. Further compounding the situation are data showing that jail populations have returned to pre-pandemic levels. As politically unpalatable as decarceration efforts have been to some, increased crowding of at-risk individuals is only asking for trouble. Being put in jail or prison should not be akin to a death sentence. And yet, if action is not taken, that is precisely the outcome in many cases. Various.