The government doesn’t seem to have a solution to the vaccine’s new last-mile problem

This is called the last-mile problem. It also applies to wide-scale vaccination efforts, in which ordering and obtaining millions of doses of vaccines (as the Trump administration did) is relatively easy compared with getting those shots in arms, as the saying goes. The Biden administration is justifiably proud of its expansion of vaccine access in the past several months. White House chief of staff Ron Klain had lamented the Obama administration’s errors in distributing a vaccine to deal with the H1N1 virus in 2009; the coronavirus vaccination program has been much bigger and much smoother.

But now there’s a new last-mile problem. How can the government complete the job of vaccinating enough adult Americans that we reach herd immunity, meaning that the virus is effectively stamped out in the United States?

On Wednesday, President Biden gave a speech in which he offered some possible solutions.

“The vaccine is free. It’s convenient and it’s increasingly available,” Biden said. But he’d also heard concerns that people couldn’t take time off work to get the vaccine. So, he said, he was “calling on every employer, large and small, in every state to give employee the time off they need with pay to get vaccinated and any time they need with pay to recover if they’re feeling under the weather after the shot.”

That is a good solution to the problem of people not having the time or flexibility to get vaccinated. But it seems increasingly clear that this is not the problem that is preventing the country from administering those last-mile vaccinations.

Since the government halted the deployment of one-dose shots from Johnson & Johnson on April 13, the daily averages of people receiving their first doses and of people newly completing their vaccination regimens have declined. On April 13, according to a Washington Post analysis of data from the Centers for Disease Control and Prevention, the seven-day average of first doses received was about 2 million. A week later, the average had fallen to 1.5 million. For completed vaccinations — meaning, in the past week, second doses of the Pfizer or Moderna vaccine — there was a similar but smaller decline.

At the same time, the gap between the number of vaccines distributed to states and the number of vaccines administered continues to grow. That suggests at least some measure of oversupply. On April 13, the seven-day average of new doses given in total was 90 percent of the total of new vaccine doses distributed. On April 20, the average of doses given was only 80 percent of those distributed.

We know one obvious reason this might be the case. There remain a lot of Americans who say they don’t plan to be vaccinated at all. In a Kaiser Family Foundation poll completed last month, older Americans and those with serious health conditions were more likely than Americans overall to both report getting the vaccine and wanting to get it. They were joined by Democrats and college graduates, more than two-thirds of whom said that they’d gotten or would soon get a dose.

At the other end of the spectrum are younger Americans, essential workers outside of the health-care field and (as you’ve no doubt heard by now) Republicans. Among Republicans and White evangelical Protestants, a third say they either won’t get the vaccine or only will if required by employers or for school.

Last week, we pointed out the correlation between support for Trump in 2020 in a state and lower rates of vaccination. Recent analysis by the New York Times showed that this correlation trickled down to the county level as well.

But there’s another important correlation at play. In Quinnipiac University polling released last week, respondents were asked if they planned to get a vaccine and if they were concerned about a new surge in coronavirus cases. Groups that were least concerned about a new surge were also least likely to get a vaccine — led by Republicans.

This isn’t surprising! If you don’t think the virus is something to worry about, why would you go out of your way to be vaccinated against it?

Sure, we could boost the number of vaccine recipients if it were mandatory, but even then only another 6 percent of Republicans say they’d get a shot. Plus there’s an emerging market in counterfeit vaccination cards that appear to be focused to at least some degree on eventual requirements from businesses or employers.

On Jan. 20, when Biden took office, the problem was getting vaccines to the people who wanted them. That problem was largely fixed, as the vaccination data show. Now, the problem is getting vaccines to the people who don’t want them, and who need to be vaccinated to get us that last mile to herd immunity.

That problem has not been fixed, and it’s not entirely clear how it will be.

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