The national campaign to quash the coronavirus pandemic with what appears to be a highly safe and effective means — new vaccines — has hit more chop as the Biden Administration pushes to increase supplies, sites, and credible public information about the shots.

While the White House has worked with makers to boost the complex production of vaccines  and officials are ferreting out unused stashes, demand still exceeds supplies, and rotten weather in the central part of the country disrupted deliveries of millions of shots, causing coast-to-coast cancellations of appointments for patients hoping to get shots. This snag affected the region around Washington, D.C.

The White House has said the supply chains will be restored, pronto.

Hesitancy, resistance, and selectivity

It may take longer to overcome not only hesitancy and outright resistance to the vaccines but potentially yet another challenge — call it selectivity.

A growing body of research is painting a favorable picture for the outcomes of vaccines from the makers Moderna and Pfizer. They may provide protection from serious illness and death from the coronavirus sooner than believed, performing strongly in at least one study after only one of the two prescribed doses.

That same research also suggested that the Pfizer vaccine does fine with routine refrigeration and without the logistics challenges of super cooling.

This all may sound good, especially to a public eager for any favorable news in a health crisis that has killed ~500,000 Americans and infected ~30 million.

But the complexity and nuance of vaccine science also may, experts say, be contributing to hesitancy, resistance, and a surprising choosiness about available shots, notably a new, one-dose product from Johnson and Johnson. (Chart above from Dr. Ashish Jhan, dean of the Brown University School of Public Health, may simplify thinking about this issue for some.)

The J&J vaccine has been submitted to the federal Food and Drug Administration, which, with its experts, must decide whether to grant emergency use for this product.

The information on it, released thus far, reassures experts, because this vaccine, like the Moderna and Pfizer shots, has shown in rigorous clinical trials that it is safe and effective. It keeps patients from getting seriously ill and requiring hospitalization or dying from the coronavirus.

But this reality has been eclipsed by numbers reported on the vaccines’ effectiveness — in the mid-90s in percentages for Moderna and Pfizer, versus the mid-60s for J&J, albeit with different criteria in how these metrics were determined. The situation is complicated further, globally, due to mixed data that has emerged on yet another vaccine, the product from AstraZeneca-Oxford University.

Even some health workers are balking at the prospect of getting any vaccine except Moderna or Pfizer, though J&J is more convenient (one dose and without the required refrigeration) and equal in protecting against serious illness or death — key requirements for an optimal coronavirus shot.

If the vaccines accomplish those preventive goals, they are a major benefit and should be accepted for that, expert say, even as medical science determines if they have even more positive outcomes, such as reducing or preventing transmission and allowing a speedier return to normality.

Vaccine communications will be key

The current administration’s predecessors spent so little energy communicating to the public about the coronavirus vaccines — except to emphasize the speed with which they were developed and the importance they held to a presidential re-election campaign — that Biden officials find themselves working uphill to deal with hesitancy, resistance, and selectivity among patients about the shots. They represent a praise-worthy culmination of years of research and hard work by medical scientists, and that reality should not get lost.

These issues will become more significant concerns, perhaps in weeks, as administration efforts increase supplies and vaccinations, so they equal or exceed demand. Among health workers and first-responders hesitancy persists as an issue, as it does with military personnel. It is acute in communities of color, hard hit by infections and deaths by the disease. Administration officials have sought to address equity challenges by boosting mass vaccination sites, as well as increasing shots via mobile units, and clinics and pharmacies in communities, as well as by working with social and religious groups.

Public health experts increasingly will struggle, they say, in explaining to the vaccinated what makes sense for them to do, including, for now, maintaining many of the protective actions until medical science knows more about potential risks to and spread of the virus by the inoculated.

In the meantime, individual behaviors, seasonality, and public health measures appear to be working against the pandemic — before or with vaccination. Cases, hospitalizations, and deaths have fallen in most states, dramatically in some areas.

Experts have implored people to keep up their aggressive hygiene (especially hand washing), face covering (with better or two masks), distancing, and avoiding closed, poorly ventilated spaces, especially by staying home and mostly with members of one household.

At the same time, conditions are shifting, so the administration is pressing to get younger kids back to in-person schooling for at least part of the week. States and local governments are easing up public health restrictions, including on restaurants, bars, retail, and gyms. Bitter cold both may be keeping big numbers of people at home. Or it may be keeping them indoors (not outdoors) in risky spaces and with more people from outside their immediate households.

The race is on, medical scientists underscore, in getting enough people vaccinated or recovered from the sickness, so the nation resists increasing numbers of potentially more infectious and deadly coronavirus variants and achieves the much-desired, widespread “herd immunity” that makes it tough for the virus to rage on.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs. We also have endured months of a flood of falsehoods, anti-science denialism, and the brutal politicization of public health and medicine. Not good.

We have much work to do, individually and collectively, to end the pandemic and move the country to a better place.