Rates of Covid vaccines in the United States have plummeted. Now Joe Biden is imposing mandates on federal workers.

Five months ago, the United States overtook almost every country except Israel in vaccinating its people against Covid-19. Almost one in five Americans was already fully immunized; Hungary stood out as a success among European countries, but only 1 in 10 people had received a full regimen of the vaccine by April 6. Most of Europe was single digit.

The rapidity of the deployment, combined with the role of the United States in the development and production of vaccines, seemed to make vaccination a modern example of American exceptionalism, an example that struck a decisive blow against the virus that had upset life in the world during the past year.

But over the summer, the success story of America’s Covid-19 vaccine turned into a story of mediocrity and missed opportunities – as countries in Western Europe and Scandinavia caught up, then overtaken the United States in their vaccination campaigns.

Portugal is currently setting the tone in Europe, with nearly 80% of its population fully vaccinated. Spain and Belgium have reached over 70 percent of their population. France, Germany, UK, Netherlands and Norway all exceed 60%.

Meanwhile, America now looks quite mediocre among the rich countries, with 52.3% of its total population vaccinated as of Sept. 7.

Only a handful of countries in Western Europe – Switzerland, in particular, stand out – currently rank behind the United States in their vaccination campaigns. Meanwhile, in the poorest parts of the world, many people are still waiting to be vaccinated due to a lack of supplies.

President Joe Biden is currently trying to get more Americans to get vaccinated, as the delta variant is causing deaths at levels not seen since early February. The administration reportedly announced Thursday that the vast majority of federal workers and contractors will need to receive the vaccine. Biden is also urging private companies and schools to impose their own vaccine requirements.

“We were ahead, then we fell behind,” said Celine Gounder, infectious disease epidemiologist. “We quickly vaccinated half of the population who were eager to get vaccinated, but then hit a plateau. “

Our world in data

Israel, once touted as a model of effective vaccination, has also stagnated: its vaccination coverage has increased only marginally in recent months, from 56% in April to 63% in early September.

The United States is paying a heavy price for not maintaining its good start in vaccinating people against Covid-19. Cases have increased dramatically over the past two months, making it the second worst wave of the pandemic. The average number of daily deaths in the United States has fallen from less than 200 in early July to around 1,500 now. Taking into account the size of the population, America experiences more than twice as many deaths from Covid-19 every day than countries like France, Germany and Italy which have been more successful in vaccinating people against the virus.

Our world in data

Why the US Covid-19 vaccination campaign is lagging behind much of Europe

The United States began its vaccination campaign with a structural advantage. It had the most generous supply of Covid vaccines, along with Israel, thanks to investments made to procure doses before the vaccines were approved for emergency use by the United States Food and Drug Administration.

Europe, meanwhile, has struggled to acquire and distribute vaccine doses out of the gate, as Politico Europe covered in a January survey. This gave the US and Israel a hot start as the EU had to catch up as vaccine supplies improved in the spring and summer. (It also meant that the latter had more room to develop than the United States, which had previously been shot in the arms of its more willing citizens.)

Demographics can also hold back the United States to some extent. America has more young people than most Western European countries: around 16% of Germany’s population is under 18 compared to around 22% of the United States, to name just one example. Children under 12 are still not eligible for vaccines in the United States (or elsewhere), which may partially reduce its share of immunization.

But there’s more to the story than the oddities of the offer or demographic trends.

Compared to a country like Portugal, now the world leader in Covid vaccinations, the US vaccination rates for its eligible population are not particularly high either. In Portugal, 99 percent of people over 65 are fully vaccinated; in the United States, the share is closer to 80 percent. These disparities persist in younger age cohorts: 85% of Portuguese aged 25 to 49 are fully vaccinated compared to less than 70% of Americans in the same age group.

Another big difference that explains this divergence is that of culture and politics. Vaccinations against Covid have become, like much of the US pandemic response, polarized along political lines. In July, 86 percent of Democrats said they were vaccinated, according to a Kaiser Family Foundation poll, while only 54 percent of Republicans said the same. One in five Republican people said they “definitely will not” get the vaccine.

“This political divide on vaccines has contributed to the US lag behind European countries in coverage levels,” Josh Michaud, associate director of global health policy at the Kaiser Family Foundation, told me. .

There are pockets of vaccine hesitation in Europe, especially in Germany and France, but nothing on the scale of what we have seen in the United States. In Portugal, as evidenced by its exemplary vaccination rate, skeptics have a very low public profile.

“We don’t need to convince people to get vaccinated,” Gonçalo Figueiredo Augusto, who studies public health at NOVA University in Lisbon, told me on Zoom. ” People want. “

How Portugal became a world leader in vaccination

Perhaps a difficult story has, oddly enough, put Portugal on the path to success, Augusto said. The country lived under a dictatorship from 1933 to 1974, and public health efforts stalled during this time. Driven by preventable deaths from infectious diseases, the infant mortality rate in Portugal has remained significantly higher than in wealthier European countries like France, Germany and the UK. It was not until the last years of the regime, in the early 1970s, that a serious vaccination campaign began.

“People were very willing to get vaccinated because infectious diseases were a huge problem,” Augusto told me. “We were a poor country then and we learned how important vaccines were. “

As Portuguese democracy was restored and economic conditions improved, public health improved as well. In the 1990s, infant mortality had fallen at the same rate as that of these other countries.

But some of its citizens still carry memories of a time when routine vaccinations were not a given. More than 97% of Portuguese children are vaccinated against measles these days, Augusto said. But in the United States, the share is lower, closer to 90 percent, because a small but significant portion of the population continues to resist this inoculation.

Portugal also carries the most recent memories of a devastating winter wave of Covid-19, as do many countries, including the United States. After largely dodging the worst outbreaks of last spring and summer, social distancing restrictions have been relaxed. The country’s leaders wanted to allow the Christmas holidays to take place as normally as possible in 2020.

In early January, the number of cases was increasing rapidly and deaths quickly followed. For a while, Portugal had the world’s worst Covid death rate. “The idea that the virus was very close really kicked in in January,” Augusto said. “It was traumatic for the country.”

In Portugal, vaccination has become the best way out of the crisis. Initially, the country was hampered by the same supply shortages seen across Europe. But as more and more doses became available, vaccination rates increased. As older people, people with weakened immune systems, and essential workers were vaccinated, death rates began to drop. This has boosted confidence in vaccines.

The United States has seen its own deadly winter wave, and the recent delta wave appears to coincide with an increase in vaccinations. But the share of Americans vaccinated is still lower than that of the Portuguese, even considering only eligible populations.

Portugal has also adapted on the fly to a changing pandemic. When the delta variant got there in May, the national government decided to speed up the vaccine dosing schedule. The interval between the first and second dose of AstraZeneca, Pfizer and Moderna vaccines has been shortened by one week or more.

“The idea was to vaccinate the population as quickly as possible with two doses,” said Augusto. The country has benefited from a highly centralized approach, with the national government assuming responsibility for vaccine procurement, distribution and administration. The army also played a logistical role on the ground.

The aggressive deployment has paid off. Portugal saw a small spate of Covid cases and deaths in July and August, but it was much less severe than what the United States is currently experiencing.

Our world in data

The country has also explicitly linked its vaccination rates to its reopening plans. Bars and nightclubs have been closed there for months and the government said they would be allowed to reopen once 85% of the population has been vaccinated. It is expected to reach this benchmark in a few weeks.

“Don’t you want any rules?” Get vaccinated, help the country ”, this is how Augusto described the message of the heads of government to the Portuguese people.

Some American politicians and businesses feel more comfortable with the same kind of idea, either by making vaccinations mandatory or by requiring them for certain activities. The Biden administration is now aggressively pushing vaccine requirements, with the president himself announcing more in a speech Thursday. Democratic-led states and cities are taking similar action. More and more private companies are also embracing vaccine requirements.

“In the United States, we have come close to vaccinating anyone who voluntarily wishes to be vaccinated,” Michaud said. “So any further progress in immunizing many adults will likely depend on vaccine requirements and mandates. “

But these efforts meet resistance from politicians and Republican voters, who present them as non-Americans.

It’s a microcosm of why the United States has fallen behind in its attempt to vaccinate people against Covid-19 and bring the pandemic under control. The toll of this failure continues to grow.