On vaccines, and their limits

The health system where I work has administered over 11,000 vaccine doses to staff and patients. I feel such relief and gratitude, alongside frustration and grief. Vaccination is a key public health strategy. mRNA technology is a lifesaving advancement. Community health systems like ours are reaching people where they are, creating community-based processes that reduce barriers to access, building on months of outreach (and years of partnership) to hold space for people to share their concerns and get answers, centering the perspectives of people who have been marginalized from too many decisions and disproportionately impacted by the pandemic. Vaccines will help us emerge from this nightmare.

And. The vaccine is not a complete solution. Wearing masks, creating safe spaces with ventilation, distancing, expanding testing, and ensuring people have the resources and support to abide by public health guidelines are still needed to prevent so much suffering. It will take months and years for people to be vaccinated globally. The vaccines are highly effective at preventing disease in people who are vaccinated. But we do not yet know how well they prevent us from being infected with the virus, and how that translates to reducing transmission at a population level, especially with incidence still terribly high. The vaccines are safe and effective, but immunity is complex.

For the U.S. to monopolize global vaccine supply is shameful. For states to list equity as a guiding principle but design processes that perpetuate the harms of structural racism, ableism, and economic inequality is unacceptable. But even if all of this were done better (and it should be), vaccination does not create the conditions that will protect people from the next virus – or the many other health harms getting far less attention. Vaccines cannot repair the harm that has already been done. We know the distribution of power and resources in society leads to systematic and unjust differences in the risks we are exposed to, the opportunities we have, and the health outcomes we experience. The next crisis will play out this same way unless we invest in prevention and resilience – in public health systems, housing, food security, living wages, paid leave, decarceration, universal health care, resourced schools, environmental justice, systems of collective care.

Vaccines are essential. I am so grateful to have received my second dose last week. But our health is a product of social and political structures. We cannot displace our collective responsibility onto scientists and healthcare workers, expecting them to be heroes in ways they should not have to be. We cannot give up on each other.

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