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Don’t Alienate the Willing

Being responsible isn't easy right now.

By Charlie Warzel
Spencer Platt / Getty

I try not to get mad online. But a few weeks ago this tweet activated something strangely primal in me.

I wasn’t upset at Dr. Topol, whose explanatory work during the pandemic has been extremely valuable. What set me off was the tone: the sense of a sudden, Omicron-induced shift in messaging around boosters. If you are not boosted, you are not fully vaccinated. I realize this statement was and is accurate. I realize that the Omicron variant’s sudden arrival prompted a new push for people to get a third shot and that the messaging needed to be more urgent. I wasn’t frustrated because I disagreed with the tweet or with the numerous people in my feeds and on TV imploring us to get boosted. I was frustrated because I very much wanted to get boosted and could not, for the life of me, secure a timely appointment for myself and my family.

Aside: I worry about sounding gross and privileged here. The fact that there’s a 20-day waiting period to get an appointment for a third dose of a lifesaving vaccine is hardly a problem, in a global sense. The monumental logistical and moral failure of vaccine inequity is the real and glaring problem. The fact that the countries and regions with the highest incomes are “getting vaccinated more than 10 times faster than those with the lowest” is not surprising, but it is upsetting. So are reports that experts believe it would only cost $50 billion to vaccinate the world and yet, according to the Organization for Economic Cooperation and Development, low-income countries have an average of only 7.6 vaccine doses administered per 100 people (in high-income countries the figure is 147.1 doses per 100 people).

This grim reality makes me feel guilty even talking about third doses (and was a reason that the booster conversation in the U.S. was contentious in the summer and early fall). But I think it is still worth discussing in the context of the American pandemic response.

One reason why the sudden tonal shift around boosters bothered me is that it wasn’t the American public that dragged its feet on third shots—it was key public-health officials. Ryan Cooper has a great piece in The Week detailing how the Biden administration was concerned about waning vaccine efficacy this summer, and that FDA officials argued they didn’t have enough science to back boosters yet. As Cooper notes, this was a “noble lie” designed to get more vaccines to poorer countries. He writes:

Fudging the science did not, in fact, help poorer countries get more doses—but it certainly delayed booster distribution here. After weeks of argument and pressure, the CDC finally approved boosters for all adults in late November, yet it only recommended them for people over 50, ignoring research which recommends their universal use.

I’m in a COVID-news-saturation bubble, and so I felt confident mid-fall that boosters would ultimately be approved for my age group. I had a lot of people under 50 tell me they went and got boosters before the government recommended it. They checked boxes saying they had a reason (working in a high-risk environment, having a preexisting condition, etc.) in order to get a booster on their own timeline. No judgment here, truly! Personally, I didn’t feel comfortable fudging any forms so I waited until the recommendation for the general public, which came right around the arrival of Omicron. By then availability in my area was extremely scarce. I live just outside a midsize city in western Washington State near the Canadian border (population: roughly 90,000). It’s a pretty COVID-compliant area—the type of place you’d expect to see solid demand for boosters, but also decent supply.

I spent days looking for an appointment that might get myself and my partner fully vaccinated before the holidays, and I struggled mightily. I drove to pharmacies to inquire personally and, each time, the exhausted workers behind the counter sighed. Many pharmacies only did walk-in booster shots one hour per day, but only if they weren’t inundated and short-staffed, a rarity these days. I called the Walgreens vaccine hotline and spoke to a staffer who couldn’t find me an appointment within 60 miles. She apologized to me as if this were somehow her fault. She said it had been dispiriting turning people away, which she was having to do a lot.

I’ve been thinking about those other people she couldn’t help and wondering how many of them were able to find what they were looking for. After spending an inordinate amount of time hunting for a booster appointment, I eventually found one, thanks to a last-minute cancellation. But most people don’t have my time, my schedule flexibility, or the patience to navigate vaccine-scheduling systems that require you to constantly reenter the dates of your past vaccinations just to see if there’s availability in your area. An acquaintance of mine who has been volunteering to book booster appointments for others told me that CVS’s vaccine scheduler “not only asked for insurance info, but also a driver’s license number and physical address.” She ended up driving 120 miles round trip to help get somebody a booster because the only appointments in their area required them to miss work, which was not possible for them. The system, for many, is a slog.

An a cappella group telling people that they should make like a rocket ship and get a boost does very little for them when the logistics make jabs very difficult.

Booster availability has been scarce even in large metropolitan areas. A recent dispatch from WHYY in Philadelphia suggested that local areas are getting swamped:

“At Penn Presbyterian, we have 200 appointments a day. Last week, we saw an increase of 150% in terms of overbooking our appointments,” she said. “We’re starting to see that access everywhere is becoming really tight.”

One of the reasons appointments have been hard to find is because, like other health-care workers, pharmacists have been overwhelmed, working in stressful, frequently high-risk settings. Administering COVID vaccines is just another responsibility for them, on top of filling prescriptions and everything else they must do. Plus, according to the Associated Press, pharmacists are also dealing with an influx of callers asking about vaccines or the availability of COVID tests:

“We’re all working a lot harder than we did before, but we’re doing everything we can to take care of people,” Wilson said, adding that he has not had to temporarily close any of his pharmacies or limit hours so far.
Tolle said she was lucky to hire a pharmacy resident just before the delta surge arrived. The new employee was supposed to focus mostly on diabetes programs but has largely been relegated to vaccine duty. Tolle said her Bay Street Pharmacy is now giving about 80 COVID-19 vaccines a day, up from 20 before the delta wave.

These types of staffing shortages are the result of a broken system that is, in turn, breaking health-care workers. If the federal government would like us all to get boosted, surely the best way to do that would be to make sure there are dedicated vaccine clinics, instead of offloading the responsibility onto strained pharmacies.

On Monday, I showed up to a local Rite Aid at 1:30 p.m.—half an hour before their scheduled walk-in time. The pharmacist told me that the first walk-in showed up at 9 a.m. By 11 a.m., the clinic’s four walk-in slots had been filled. She pointed to the waiting area, which was full of senior citizens, some of whom had been waiting patiently for five hours in order to feel safe when they gathered with friends and family over the holidays.

A few hours later, while I was visiting a pharmacy on the other side of the county, my partner went to get her booster. While she was in line, a man approached the pharmacist, desperate to find rapid tests for his wife and young son. His wife, he explained, is a teacher and they were concerned about a possible exposure and unable to schedule a PCR test. After overhearing that, my partner told him that Walmart had recently stocked some BinaxNow at-home rapid tests. (He thanked my partner, and then asked where she got her KN95 mask.) After the man left, the pharmacist told my partner that they “hardly ever have tests in stock. I’m glad I have something I can tell people now.”

These are anecdotes. But they illustrate the disjointed American response to the pandemic. In my booster-appointment booking and reporting, I didn’t encounter any anti-vaxxers or even vaccine-hesitant individuals. All the struggles I saw involved people who wanted to do the responsible thing and were met with logistical hurdles. The best example of this nationally: at-home-test kits, which are sold out across the country. The shortages mean that some people will either opt to not gather with friends and family or decide to take the risk and get people sick.

It’s not all bad. On Tuesday, the Biden administration announced a plan to make 500 million at-home COVID tests available for free. Beginning next month, the government will mail at-home COVID-test kits to any U.S. household that requests them, for free. The president also announced that, starting in January, 1,000 military service members will be available to deploy to overloaded hospitals.

Sending tests to people and building up emergency infrastructure are unequivocally good things, but the amount of time it took to get the administration here (and the fact that it will be woefully late for the holidays and the beginning of the Omicron surge) makes it hard to summon a lot of goodwill about the announcement. It was only two weeks ago, after all, that White House Press Secretary Jen Psaki scoffed at the notion of sending tests to every American household. And it was only a few months ago that government public-health officials questioned the need for boosters.

Throughout the pandemic, I’ve tried to be as mindful as possible that we are all muddling through uncertainty together. I’ve tried not to lose sight of the fact that trying to understand and give recommendations to the public to mitigate a novel virus will inevitably be fraught. Information will change rapidly. People will make mistakes. That’s normal. But plenty of well-meaning individuals making big governmental decisions in public health seem to want to appear superhuman or at the very least definitive in their guidance. Even when the information is not definitive.

A crucial part of building trust is modeling vulnerability. I’ve long appreciated this line from David De Cremer, a provost at the National University of Singapore, who studies trust inside large organizations:

First, if trust is present then it implies that the interacting parties have positive expectations about each other. One expects that the other party will act in ways that are honest, reliable and not damaging to one’s interests. Second, if such positive expectations are alive and well, then no reason exists to fear being vulnerable to the actions of the other party. Hence, no need should arise for using any control tactics.

It sounds counterintuitive but when you are vulnerable—when you state what you do and don’t know and admit your mistakes honestly—it has a mirroring effect. People believe you’re not trying to control them and they’re more likely to, well, listen to you. And to be vulnerable themselves.

As Cooper’s piece in The Week notes, the American pandemic response, no matter how well-intentioned, has too often tried to micromanage its citizens or to obscure the reality on the ground in order to coax out a specific outcome. The strategy has failed time and again because it seems to ignore how most humans behave (they like to be listened to and leveled with and they don’t like to be micromanaged). Interestingly enough, the outgoing NIH director cited a lack of understanding of human behavior as a pandemic blind spot just this week:

It may seem silly to obsess over pandemic messaging when large swaths of the country remain actively hostile to even the smallest virus-mitigation strategies. And it might seem crass to nitpick over boosters when global access to the vaccine is so unequally distributed. But in a pandemic where conditions change all the time, access to something like boosters or rapid tests or high-quality masks are the low-hanging fruit. The lack of resources and safety nets for those willing to do their part to keep themselves and their fellow Americans safe is an unforced error. The holidays are here and this is the scene in some cities:

Doesn’t inspire much trust or confidence.

We’ve spent so much energy throughout this pandemic strategizing about how to bring the unwilling along with us. That’s a crucially important task. But sometimes I think we alienate the willing in the process. For this crowd, there’s so much we can do. Free tests. Better masks. Paid sick leave and child or elder care for those dealing with side effects or taking time to get protected. We have the resources. We just need the will to deploy them—and, most importantly, trust in each other.

Charlie Warzel is a staff writer at The Atlantic and the author of its newsletter Galaxy Brain, about technology, media, and big ideas. He can be reached via email.