COVID-19 immunity is too far off

By John Hood

Raleigh, NC – As of January 18, North Carolina had received about a million doses of COVID-19 vaccines. Nearly 330,000 of those doses had been injected into the arms of North Carolinians.

That may sound like a big number. But it’s not nearly big enough. Our state has 10.5 million residents. We aren’t moving as rapidly as we must to suppress the pandemic — and to restore the economic, educational, and social institutions it has so ruthlessly disrupted.

This is not just a North Carolina problem. Many other places are struggling with practical and logistical difficulties, particularly given the fragility and brief shelf-life of our early vaccines.

In the District of Columbia, a healthy 30-year-old man was immunized because he happened to be in a grocery store buying a snack when the pharmacy manager came on the loudspeaker to offer unused vaccine doses that were about to go bad. In France, preexisting skepticism about vaccination in general has deterred even frontline health workers from getting their shots. In many states, phone banks and online systems have proved inadequate to handle public requests, sometimes shutting down entirely.

But North Carolina’s rate of vaccination is low even by these standards. Again as of January 18, our state had administered only 33% of doses received. Among the 50 states, only Hawaii had a lower rate. The national average was 47%. Southern states such as Mississippi (49%), Tennessee (50%), Florida (54%), Louisiana (54%), Kentucky (63%), Texas (61%), and West Virginia (75%) have managed to beat that average.

To their credit, Gov. Roy Cooper and his top officials have acknowledged the seriousness of the problem and taken some steps to rectify it. Perhaps most importantly, they’ve abandoned their original phase-in approach, which was too complicated and prescriptive, in favor of the current, simpler standard: if you work in health care or are aged 65 or over, you’re eligible.

This change angered some North Carolinians, such as teachers. It has confused other North Carolinians who fail to see how expanding eligibility makes sense given long lines at vaccination sites. But it was the right call.

First and most importantly, it reflects a realistic assessment of risk. Even with our current high level of community spread and daily deaths, the distribution of COVID deaths has changed very little since the start of the pandemic. About three-quarters of all North Carolinians killed by the virus are elderly. Fatal infections among the non-elderly, attributable to transmission in schools, stores, or random interactions, remain quite rare.

Second, a simpler eligibility standard is easier to communicate and administer. While significant documentation was always necessary for a vaccine that was being administered twice, the need to receive and evaluate a patchwork of eligibility classes and definitions has proved to be an unwelcome barrier to getting needles stuck in arms.

North Carolina will have to go further, faster, to achieve large-scale immunization. We need to mobilize a larger network of nurses and aides, including retirees willing to volunteer or work temporarily. We need scores of dedicated vaccination sites — in parking lots or other easily accessible places — that can operate in large daily volumes. If county health departments and other local providers need state dollars to expand their workforce, physical capacity, and online networks to handle the load, Cooper and the General Assembly should respond quickly to supply it. This emergency is precisely the kind of event for which the state builds cash reserves.

I’m open to more-aggressive measures, too. For example, government regulators could allow providers to delay the administration of second doses, allowing us to administer first doses to a far-larger population. The resulting immunity may not be as high as the two-dose version, but for this purpose scope is likely to be far more important than maximizing potency.

I don’t pretend to know all the answers, of course, or even all the questions. But I know this for sure: there is no good reason for North Carolina to rank near the bottom in vaccination. Let’s get on with it.

John Hood is chairman of the John Locke Foundation and author of the forthcoming novel Mountain Folk, a historical fantasy set during the American Revolution.