Properly defining communities is paramount in protecting them

After falling short in reaching President Biden’s goal of having 70% of adults in the U.S. receive at least one dose of a COVID-19 vaccine by the Fourth of July, it is clear more work needs to be done. While much progress has been made since COVID immunizations first became available, there are still communities around the country where protection doesn’t run as deep as we need it to be. How we define community matters. As we look toward reaching 70%, we need to think about how we’ll get there together.

Nationally, according to the Centers for Disease Control and Prevention as of July 7, 67% of Americans 18 and older have received at least one dose of the COVID-19 vaccine and 58% are fully immunized; it’s 88% of the age 65+ population and 64% of the 12+ population. Racial disparities among vaccinated communities persist with Blacks and Latinos lagging behind whites and Asians, with 37% of vaccination data still missing race and ethnicity identification for those fully vaccinated. Similar diverging trends are seen at the state level, with only a dozen states at the 70% threshold while the rest fall short.

We all want to free ourselves from “lockdown.” But when we have communities with wavering vaccination coverage, it affects all of us. This includes my home state of New York, where virtually all COVID-related protections have been lifted because, at the state level, 70% of people have been vaccinated. However, Brooklyn, the most populous borough with roughly 2 million people 18 and older, only 59% have at least one dose and 52% are considered fully vaccinated. The percentages are even lower when you include children 12 and up.

A basic tenet of public health is that overall numbers rarely tell the full story. This was a lesson hard learned in NYC during the 2018-2019 measles outbreak. Even though year after year our citywide vaccination rates for school-aged children hover above 95%, there are schools clustered in parts of the city where the measles vaccination rate is in the low 70s, and our surveillance systems were ill equipped to monitor. This then became the feeding ground for measles to spread among the unvaccinated–including adults whose immunity to measles had waned or who were otherwise immunocompromised. Places seeded by measles told us a lot about where communities mix–churches, synagogues, supermarkets, schools, medical offices, and also where work happens–communities that supply day laborers for households affected by measles then brought measles back to their own communities.

So in addition to having vaccination rates by geography, age and race, we need situational awareness of communities defined by common function such as first responders and essential workers. Knowing the percentage vaccinated status of teachers, police and firefighters, sanitation workers and hospital staff acknowledges the risk and opportunities for protection at the intersection of our lives as defined by geography, race-ethnicity and occupation; it keeps all of us safe. This community information is necessary to plan for augmented surveillance and contingency planning when clusters arise in these micro-communities that could have been prevented through vaccinations. Admittedly, occupation was one of the most challenging data points to assess early in the pandemic because it is typically not collected during the course of routine medical encounters and certainly isn’t recorded with lab results.

We should take advantage of this summer lull in transmission to build that situational awareness and make contingency plans as needed that will serve our cities, states and country in the fall and for future events.

Similarly, we need to take this same lull as an opportunity to acculturate the public to recurring “mask alert weeks” come the anticipated fall recurrence of COVID transmission. It would be a huge loss to our disease control armamentarium if we didn’t seize this opportunity to normalize mask use for communicable disease events. Normalizing mask use into our routine preventive public health messaging infrastructure will protect our communities against ongoing COVID, but also influenza and other viruses with potential to cause serious illness and death.

Making decisions that affect the public’s health using aggregate numbers is always challenging. While “at least 70% with one dose” makes messaging easier, linking it to, “We are open for business” runs the risk of instilling a false sense of security because we are using information that doesn’t tell the full story. As a way to counter that risk in the face of ongoing threats from COVID variants, public health and its partners need to reduce inequities in vaccine access and maximize disease surveillance and preventive messaging to guard against fall clusters.


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