How Quickly We Need To Ramp Up Vaccinations To Get To Herd Immunity

Debate about how many vaccinations are needed by when has been in the news. Drew Altman lays it out in his latest column.

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We Need a Better Way Of Distributing the COVID-19 Vaccine. Here’s How To Do It.

In an op-ed for The Washington Post, KFF President Drew Altman calls for a simplification of the troubled COVID-19 vaccine distribution system.

Op-Ed Read Post

The Challenge Of Vaccine Hesitancy In Rural America

In his latest Axios column, Drew Altman looks at the challenge of vaccine hesitancy in rural America and its implications. One of them: a highly tailored outreach campaign is needed. “Addressing this hesitancy will require convincing rural Americans about the seriousness of the pandemic, and then that the vaccine is a way to protect them, their families and their way of life,” he said.

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Joe Biden’s New Health Care Agenda (and CMS’s Big Role In It)

With the Georgia runoff elections giving Democrats control of the U.S. Senate, Drew Altman discusses President-elect Biden’s potential health care agenda and suggests that the Centers for Medicare & Medicaid Services could have an expanded role and that it may be time to rename it and elevate it to a cabinet agency.

Policy Watch Read Post

Real Progress Is Possible On Vaccine Hesitancy

Drew Altman’s Axios column draws on data from the new KFF COVID-19 Vaccine Monitor to assess where the country stands on vaccine hesitancy.

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COVID-19 Is Causing Health Spending To Go Down

New analysis from Drew Altman in his latest Axios column on the impact of the coronavirus pandemic on national health spending.

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A shorter version of this column has been published by Axios. The country needs to ramp up vaccinations rapidly if we are to reach herd immunity by, say, July 4th our Independence Day, Labor Day, or even by the beginning of next year. Some basic math and assumptions paint the picture: + We need to  average 2.4 million doses a day starting now to reach the point where 70% of the population is vaccinated by July 4th (assuming two doses needed per person).  There are many estimates out there of what’s needed for herd immunity, and that’s probably the bare minimum. It’s also harder than it sounds, because kids aren’t being vaccinated right now, so we need to reach the vast majority of adults, which means overcoming hesitancy where it exists. + It's 1.9 million doses to reach it by Labor Day. + And 1.2 million doses per day if we achieve the goal by January 1, 2022. Some believe vaccination could be delayed somewhat for people who have been infected, reducing the target numbers that need to be reached immediately. Last Friday the Centers for Disease Control and Prevention (CDC) reported 1.6 million vaccinations were given across the U.S. and yesterday the Biden administration revised its goal to 1.5 million shots per day for the first 100 days.  If the administration uses that time to begin to put measures in place such as mobile vaccination clinics, mass vaccination sites, more pharmacy-based vaccination and other steps described in the Biden strategy to replace the current broken vaccination non-system with one that works, it seems reasonable to expect a  ramp up in the numbers of shots in arms after that.  Increasing to two to three million vaccinations per day by late Spring or early Summer seems doable. The most important goal to be achieved is not a single number in a hundred days or two hundred days, but a steady increase in vaccinations towards the level the country needs to ultimately reach. The experienced team appointed by the president should add to confidence the job will get done, but they will inevitably need to adapt on the fly as new problems emerge, including potentially new vaccine variants. Yes but: the limiting factor may be the supply of vaccine. That too seems somewhat hopeful with J+J/Janssen and then others from AstraZeneca and Novavax expected to come on line. And, the J&J vaccine is expected to be a single dose rather than two, so it would mean fewer overall doses are needed. Still, the biggest mystery remains what the supply of vaccine is expected to be and when new approved vaccines will be ready, even if everything breaks favorably.
[post_title] => How Quickly We Need To Ramp Up Vaccinations To Get To Herd Immunity [post_excerpt] => Debate about how many vaccinations are needed by when has been in the news. Drew Altman lays it out in his latest column. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-quickly-we-need-to-ramp-up-vaccinations-to-get-to-herd-immunity [to_ping] => [pinged] => [post_modified] => 2021-01-26 06:05:49 [post_modified_gmt] => 2021-01-26 11:05:49 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=509500 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 508078 [post_author] => 36621681 [post_date] => 2021-01-12 12:31:23 [post_date_gmt] => 2021-01-12 17:31:23 [post_content] =>
In an op-ed for The Washington Post, KFF President Drew Altman calls for a simplification of the troubled COVID-19 vaccine distribution system. He writes, “Hundreds of different distribution programs are being organized across the states and counties for front-line health workers, residents of long-term care facilities, essential workers, the elderly and the general public, all in different sequences. The system we have makes sense on paper, but it’s too complex to be effectively implemented by our fragmented, multi-layered health system.” "The country needs a distribution strategy that our fragmented, multi-layered health-care system can effectively implement. This will require more federal direction, a simpler priority structure and a different role for the states," he adds.
[post_title] => We Need a Better Way Of Distributing the COVID-19 Vaccine. Here’s How To Do It. [post_excerpt] => In an op-ed for The Washington Post, KFF President Drew Altman calls for a simplification of the troubled COVID-19 vaccine distribution system. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => we-need-a-better-way-of-distributing-the-covid-19-vaccine-heres-how-to-do-it [to_ping] => [pinged] => [post_modified] => 2021-01-12 13:00:49 [post_modified_gmt] => 2021-01-12 18:00:49 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=508078 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 507994 [post_author] => 36621681 [post_date] => 2021-01-12 05:00:43 [post_date_gmt] => 2021-01-12 10:00:43 [post_content] =>
A shorter version of this column has been published by Axios. Getting shots into arms in rural Americans, most of whom see getting the vaccine as a personal choice and not a social responsibility to protect others, is a problem that will require tailored outreach and messaging. It underscores that a cookie cutter approach to vaccine hesitancy campaigns will not work. Even as coronavirus surges in rural America rural residents are more vaccine hesitant than their suburban or urban counterparts and just as hesitant as Black Americans are, a group which has been singled out for their vaccine hesitancy. + 35% of rural Americans say they either will not or probably will not get it. That compares with 26% of urban Americans who say the same thing and is the same overall level of hesitancy we see for Blacks. People living in rural America are no less likely than people in urban or suburban areas to know someone who has tested positive or died from coronavirus, they have other reasons for their hesitancy. + They are less worried than their urban counterparts that someone in their family will get sick from the virus. + And more rural Americans say the pandemic is exaggerated compared to people in the suburbs and the cities. This isn’t just because rural residents are more likely to be Republicans and support President Trump.  Analysis shows that their hesitancy and lack of worry about COVID-19 extends beyond their partisanship. Strikingly, 62% of rural residents see getting vaccinated as a personal choice compared with 36% who see it as part of their responsibility to protect the health of others in the community. Its just the opposite for people in urban areas. The data suggest that addressing hesitancy in rural America will require convincing rural Americans about the seriousness of the pandemic and then reaching them with an almost second amendment-like appeal: that the vaccine is a way to protect you, your family and your way of life. As neighbors who are not vaccine resistant are vaccinated some of the hesitancy we see in rural America may fade away. But it will require very targeted digital messaging to reach these more conservative vaccine resistant rural populations who hear regularly from conservative media that COVID-19 mitigation strategies are a way to take away they personal liberties and deny them their way to make a living. This would include targeted ad buys on Fox, Newsmax, OANN and other information channels they trust.
[post_title] => The Challenge Of Vaccine Hesitancy In Rural America [post_excerpt] => In his latest Axios column, Drew Altman looks at the challenge of vaccine hesitancy in rural America and its implications. One of them: a highly tailored outreach campaign is needed. “Addressing this hesitancy will require convincing rural Americans about the seriousness of the pandemic, and then that the vaccine is a way to protect them, their families and their way of life,” he said. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-challenge-of-vaccine-hesitancy-in-rural-america [to_ping] => [pinged] => [post_modified] => 2021-01-12 11:39:13 [post_modified_gmt] => 2021-01-12 16:39:13 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=507994 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 507896 [post_author] => 36621681 [post_date] => 2021-01-11 00:39:48 [post_date_gmt] => 2021-01-11 05:39:48 [post_content] => The details vary but the story is always the same: every candidate’s big plans for health care morph, shrink, and change after they are elected and confronted with new political and economic circumstances. That will be true in spades for President-elect Biden. Very narrow margins in both houses of Congress means two of the big ideas he campaigned on may get a hearing but are highly unlikely to pass, the public option and early eligibility for Medicare. But Democratic control of the Senate opens up different if more modest opportunities for legislation to expand access and make health care more affordable, while narrow margins provide the political benefit of lowered expectations for big health legislation to go with it. And there is a long list of actions the president-elect can take with executive and administrative authority that cumulatively could really make a difference. With Democratic control of the Senate, President-elect Biden can pick anyone he wants for two key unfilled health posts, Centers for Medicare & Medicaid Services (CMS) and Food and Drug Administration (FDA). He may also be able to find support for legislation to nullify the suit against the Affordable Care Act (ACA) before the Supreme Court or pass expanded ACA premium tax credits through the budget reconciliation process with a simple majority vote.  Another example: he may be able to garner support for legislation incentivizing states that have not done so to expand Medicaid, including the big hold outs: Texas, Florida, and Georgia, where the Democratic senators who just claimed victory campaigned on the issue. Then there are over fifty actions the Biden administration can take by executive and administrative action that can add up to significant change in health care. Together they would affect virtually every dimension of the health care system: COVID-19, the ACA, Medicaid, Medicare, mental health, reproductive health, LBGTQ health, long-term care, immigration, behavioral health, and HIV. Some actions can happen fairly quickly, such as reopening ACA enrollment, disallowing state waivers for policies such as Medicaid work requirements, rescinding the Mexico City Policy on family planning funding, re-entering WHO, and participating in the global vaccine agreement. Other actions require going back through the regulatory process and will take a little longer, such as repealing restrictions on immigration like the public charge rule, or removing limits on funding for Planned Parenthood clinics, or making skimpy short term insurance plans extended by the Trump administration short term again. It will also take time to reinstate funding for ACA outreach. Most of the changes dealing with health financing and access will be carried out by CMS, the agency with responsibility for Medicare, Medicaid and the ACA and more than a trillion dollar budget, which will be called on to play a much more proactive role harkening back to its formative days in the Carter administration when it was called the Health Care Financing Administration (HCFA). Then HCFA viewed its mission as using its purchasing power to drive change throughout the health care system. Its name was changed to CMS in 2001 by Republican Health and Human Services (HHS) Secretary Tommy Thompson to signal that the agency would be less aggressive and more responsive to states and providers, in keeping with a more conservative view of the role of the federal government. (Disclosure: I am a bit of a CMS booster. I worked there in the HCFA’s formative days, and was asked to run HCFA by first President Bush but withdrew my nomination after a disagreement with his Chief of Staff about my independence). CMS will likely be asked to use demonstration and waiver authorities to accomplish on a smaller scale what cannot be accomplished in Congress, working with interested states to test out ideas like the public option or a broad range of approaches to addressing the underlying social causes of poor health and racial disparities in health care. Under the Biden administration we could see the most proactive use of waivers yet from CMS. I have received waivers in state government, helped to give them in HCFA, and studied them at KFF.  I once received a waiver from the Reagan administration at 2 a.m. in the White House after an intense marathon negotiation, just hours before our New Jersey welfare reform program went live. Waivers have always occupied an arcane, semi-technical, even more political corner of health policy through which a great deal can get done. With its huge role and budget, it may be time for CMS to have a new name that signals a broader purpose, if only to instill a clearer sense of mission in the agency and help it attract the talent it will need in the future (a return to its original name would not be a bad choice, nor would Health Security Administration).  The head of the agency, one of the most important leadership positions in American health care and arguably the top position in health policy, plays a far larger role than the title “administrator” conveys. It is never worth using up too much political capital over fights about names or bureaucratic restructuring.  But, with the ability to move the health system every time it sneezes, at the right opportunity in the future it may also make sense to consider making CMS and the vast federal health financing enterprise it oversees a separate cabinet agency. [post_title] => Joe Biden’s New Health Care Agenda (and CMS’s Big Role In It) [post_excerpt] => With the Georgia runoff elections giving Democrats control of the U.S. Senate, Drew Altman discusses President-elect Biden’s potential health care agenda and suggests that the Centers for Medicare & Medicaid Services could have an expanded role and that it may be time to rename it and elevate it to a cabinet agency. 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A shorter version of this column has been published by Axios. There is a lot to be very worried about when it comes to vaccine hesitancy, but there are also reasons to be optimistic. The shares of hesitant groups that appear totally dug in are relatively modest for a new vaccine people have not seen administered safely in their communities, and many of the reasons people are reluctant to get vaccinated are remediable if they get more information from sources they trust. Four groups jump out from our new KFF COVID-19 Vaccine Monitor project as vaccine hesitant: Republicans and rural Americans – the Trump base, parroting the president’s COVID denialism; Black adults, and essential workers. In every case more members of each group says they will get the vaccine than say they will not. The shares who are currently hesitant range from 42% for Republicans to 33% for essential workers. Those are still big numbers, but it appears they can be reduced with more information. For example, 71% of Black adults who are now hesitant say it’s because they are worried about side effects. Once they learn they are mild and confirm that as people are vaccinated they may worry less. The same is true for the 50% of vaccine-hesitant Black adults who worry that they will actually get COVID from the vaccine, another top concern. 25% of Republicans currently say they will “definitely not” get the vaccine. But that leaves three quarters of Republicans who may get the vaccine under various circumstances: 28% of Republicans say they will get it “as soon as possible”; 33% want to “wait and see”; and 10% say they will get it “only if its required”. Among essential workers – a group that is a particularly important target of vaccination efforts because of their high risk of exposure to the virus – 28% say they will get the vaccine as soon as they can and 36% want to “wait and see”; another 14% say they’ll only get it if required for work or other activities, and 18% say they “definitely will not” get vaccinated. Hesitant essential workers have a variety of worries:  Half (51%) are worried about side effects, and a similar percentage don’t trust the government to make sure the vaccine is safe and effective (50%). There could be setbacks if there are adverse events that receive wide press coverage that spook already apprehensive groups and these will have to be managed well by public health leaders.  States will also need to allocate vaccine supply equitably to inner city and rural areas and assure distribution in those areas that is accessible for traditionally underserved populations. Distrust of government and institutions in communities of color will remain a real barrier. It will take effective messaging and information efforts utilizing credible messengers and digital communications techniques to reach these different groups, targeting their different worries about the vaccine. No one message or single messenger is likely to be effective. If those efforts are funded and implemented it does appear that real progress can be made to reduce hesitancy among the most resistant groups.
[post_title] => Real Progress Is Possible On Vaccine Hesitancy [post_excerpt] => Drew Altman’s Axios column draws on data from the new KFF COVID-19 Vaccine Monitor to assess where the country stands on vaccine hesitancy. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => real-progress-is-possible-on-vaccine-hesitancy [to_ping] => [pinged] => [post_modified] => 2020-12-22 14:00:22 [post_modified_gmt] => 2020-12-22 19:00:22 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=501146 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 499019 [post_author] => 36621681 [post_date] => 2020-12-02 05:00:29 [post_date_gmt] => 2020-12-02 10:00:29 [post_content] =>
A shorter version of this column has been published by Axios. We have never seen a year in which health spending actually goes down. Now the seemingly impossible is happening, but the reason – COVID-19 – makes it both anomalous and more tragic than a cause for celebration. + Year-to-date spending on health services is down about 2% from last year. Health spending for the calendar year may end up lower than it was in 2019. + Adding spending for drugs, which are less affected by COVID-19 and have not fallen, total health spending is still down by about 0.5% from last year. + At its low point in April when the pandemic first really hit, spending on health services had fallen an eye popping 32% on an annualized basis. + This is the first time expenditures for patient care have fallen year-over-year since data became available in the 1960s. The largest drop-offs were in outpatient care as people put off elective services or doctors offices and outpatient clinics shut down. Telehealth visits increased dramatically but did not make up all of the difference. Spending and utilization have been recovering, but could fall again if the current winter spike in COVID-19 causes hospitals to fill up and defer non-COVID-19 care, and people again put off elective care. We do not know what share of the spending and utilization skipped or delayed because of COVID-19 was necessary or unnecessary. There was a decline in cancer screenings and visits to manage chronic care but we also do not know if health outcomes suffered. These data will trickle in as studies are published, and will be critical to determining how much we can safely reduce health spending in the future. Historically external shocks to the system like recessions have had a larger impact on utilization and health spending than anything we have been able to do about costs in the health system. But COVID-19 is different; it’s a double shock to health spending. The COVID-19 economy, like any big recession, depresses utilization of health services because people have less money to spend for health care. But unlike typical recessions, COVID-19 also directly attacks the health system, filling up hospitals with COVID-19 patients, closing outpatient facilities and doctors offices, and causing people to defer or skip care for fear of becoming infected. It may be a long time before we see a reduction in health spending like this again.
[post_title] => COVID-19 Is Causing Health Spending To Go Down [post_excerpt] => New analysis from Drew Altman in his latest Axios column on the impact of the coronavirus pandemic on national health spending. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => covid-19-is-causing-health-spending-to-go-down [to_ping] => [pinged] => [post_modified] => 2020-12-02 05:46:00 [post_modified_gmt] => 2020-12-02 10:46:00 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=499019 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 509500 [post_author] => 36621681 [post_date] => 2021-01-26 05:01:24 [post_date_gmt] => 2021-01-26 10:01:24 [post_content] =>
A shorter version of this column has been published by Axios. The country needs to ramp up vaccinations rapidly if we are to reach herd immunity by, say, July 4th our Independence Day, Labor Day, or even by the beginning of next year. Some basic math and assumptions paint the picture: + We need to  average 2.4 million doses a day starting now to reach the point where 70% of the population is vaccinated by July 4th (assuming two doses needed per person).  There are many estimates out there of what’s needed for herd immunity, and that’s probably the bare minimum. It’s also harder than it sounds, because kids aren’t being vaccinated right now, so we need to reach the vast majority of adults, which means overcoming hesitancy where it exists. + It's 1.9 million doses to reach it by Labor Day. + And 1.2 million doses per day if we achieve the goal by January 1, 2022. Some believe vaccination could be delayed somewhat for people who have been infected, reducing the target numbers that need to be reached immediately. Last Friday the Centers for Disease Control and Prevention (CDC) reported 1.6 million vaccinations were given across the U.S. and yesterday the Biden administration revised its goal to 1.5 million shots per day for the first 100 days.  If the administration uses that time to begin to put measures in place such as mobile vaccination clinics, mass vaccination sites, more pharmacy-based vaccination and other steps described in the Biden strategy to replace the current broken vaccination non-system with one that works, it seems reasonable to expect a  ramp up in the numbers of shots in arms after that.  Increasing to two to three million vaccinations per day by late Spring or early Summer seems doable. The most important goal to be achieved is not a single number in a hundred days or two hundred days, but a steady increase in vaccinations towards the level the country needs to ultimately reach. The experienced team appointed by the president should add to confidence the job will get done, but they will inevitably need to adapt on the fly as new problems emerge, including potentially new vaccine variants. Yes but: the limiting factor may be the supply of vaccine. That too seems somewhat hopeful with J+J/Janssen and then others from AstraZeneca and Novavax expected to come on line. And, the J&J vaccine is expected to be a single dose rather than two, so it would mean fewer overall doses are needed. Still, the biggest mystery remains what the supply of vaccine is expected to be and when new approved vaccines will be ready, even if everything breaks favorably.
[post_title] => How Quickly We Need To Ramp Up Vaccinations To Get To Herd Immunity [post_excerpt] => Debate about how many vaccinations are needed by when has been in the news. Drew Altman lays it out in his latest column. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-quickly-we-need-to-ramp-up-vaccinations-to-get-to-herd-immunity [to_ping] => [pinged] => [post_modified] => 2021-01-26 06:05:49 [post_modified_gmt] => 2021-01-26 11:05:49 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=509500 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 259 [max_num_pages] => 44 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => 1 [is_privacy_policy] => [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_favicon] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 88d143b905ecf4f36b399aedd44b1a56 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )

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