The US vaccination campaign is facing a fundamental challenge: getting the vaccine where it’s needed most. Millions of Americans are still unprotected, many of them at high risk of severe illness. Our 4th surge is beginning. Lives are at stake. 1 of thread/

1 in 3 people in the US have gotten at least one dose of vaccine—but that means 2 in 3 haven’t. Millions of people age 50-64 and 65+ who haven’t yet been vaccinated can still get Covid and are at much higher risk of severe illness or death, especially with the new variants. 2/

Some states are doing much better than others reaching older people: NH, VT, ME, RI, CT, MA, SD have given >1 dose to more than 85% of residents 65+ years old. In TN, WV, MS, Alabama, HI, and PR that proportion is less than 70%. 3/

There are still 12 million people 65+ unvaccinated. Nearly half of 50-64 are vaccinated, but that leaves 34 million in that group unvaccinated. Those not yet vaccinated are disproportionately Black and Latinx. We must do better. 4/

The most prevalent strain of Covid in the US now is B117. This variant is more contagious and likely more deadly. How bad it gets depends more on us than on the virus. New variant, same response needed: vaccinate, mask, distance. Patience, discipline, solidarity. 5/

In the coming weeks, we need to shift our strategy. It’s not enough for everyone to be eligible for vaccination, we have to make sure people actually get vaccinated. That means reaching people at highest risk of severe illness and death, in the places with most spread. 6/

I explained last week how a single well-targeted vaccination could save 10 times more lives, and prevent 100 times more cases, than vaccinating a low-risk person in a low-risk community. https://bit.ly/3uDUg1w  7/

If we optimize vaccine distribution we can save the most lives. The number needed to vaccinate to save one life shows impact of vaccines in high- vs low-risk groups. Vaccinating anyone helps, but for the next 1-2 months, focus can save many lives. Aim our shots better. 8/

There have been ~560K Covid deaths in the US: 1 of 586 Americans. To prevent one death we need to vaccinate ~586 people/year. Vaccinating 100 million people will save >170K lives from Covid this year (more when secondary cases prevented are included in the calculation). 9/

This is even more dramatic when we look at nursing homes. ~220K nursing home residents have died from Covid. To prevent one death, we need to vaccinate ~7 nursing home residents, so vaccinating 1 million in this population alone will save 140K lives (!). 10/

But focusing on age alone isn’t enough—we have to improve vaccine equity by race/ethnicity also. @KFF data shows a consistent pattern: Black & Latinx people are less likely to be vaccinated even though they’re more likely to get Covid and die from it. https://bit.ly/3wK4QGk  11/

A preprint study showed we can save more lives if we prioritize high-risk areas. https://www.medrxiv.org/content/10.1101/2021.03.25.21254272v1 12/

Right now, Michigan is being hit hard. Other states may follow. As hotspots emerge, we should flood the zone with vaccines. We also need to mask up and take other measures, such as closing bars and limiting restaurants until vaccine coverage increases or cases decrease. 13/

There’s a lot more we can do to improve equity and overcome vaccine hesitancy. Make it easy to get vaccinated. Convenience overcomes reluctance. 14/

Instead of requiring appointments, let people walk in—esp those at high risk of severe illness & in places with extensive spread. Offer extended hours, allow time off from work & provide transportation to vaccination sites. Make vaccines widely available at doctors’ offices. 15/

Reach people where they are. That means getting creative with mobile and non-traditional vaccination sites such as churches, schools, corner stores, bars & pop-ups at community events. Use the right messages and the right messengers. Partner with community orgs and leaders. 16/

Ask our friends, family and neighbors if they've been vaccinated. If not, ask if you can help them sign up or support them to get vaccinated. Listen and acknowledge concerns, address with facts, and tell real stories of real people harmed by Covid and protected by vaccine. 17/

We must do better with focused, rapid vaccination in the US. And we must recognize that global vaccine equity is an urgent crisis. Increasing manufacturing is the only way forward. Uncontrolled spread anywhere is a threat everywhere. 18/end