Just as the troubling Delta variant was spreading through the US, Charis Hill got a worrying call from their doctor.
The medications Hill takes to treat their spondylitis affect their immune system, and they knew the Covid-19 vaccine might not work as well for them as it does for others. So weeks after their second shot, they got a test.
The results were shocking: “No antibodies were detected in my system,” said Hill, who lives in California. As the rest of their state celebrated a grand reopening, a jubilant lifting of social distancing rules and mask mandates, Hill went back into isolation.
Across the country, coronavirus death rates have plummeted as more and more Americans who are eligible for the vaccine get inoculated. And research from the UK, where the Delta variant was first detected, indicates that the current vaccines are effective against new variants.
But even in states like California, which has one of the highest rates of paper capita vaccination in the world, those who don’t want to get vaccinated, those who can’t, and those like Hill – for whom the vaccines don’t provide adequate protection – remain unprotected against Delta, which researchers believe to be the most infectious variant yet. Scientists are also studying whether the variant is deadlier than others, and causes more severe infections. Epidemiologists and other public health experts worry that state and federal policies are leaving the most vulnerable behind.
The vast majority of Americans now dying of Covid-19 are unvaccinated, public health officials say. And with most Americans eligible for the vaccine, “nearly every death, especially among adults, due to Covid-19, is, at this point, entirely preventable,” said Rochelle Walensky, director of the Centers for Disease Control and prevention.
As American society adjusts back to pre-pandemic normals, “you’re seeing the multiplication of vulnerabilities,” said Cecília Tomori, an anthropologist and a public-health scholar at Johns Hopkins. The issue, she said, is that the Centers for Disease Control and Prevention, as well as state and local governments, have embraced a public health strategy centered on individual responsibility.
While the CDC and local public health agencies have focused on winning over the vaccine hesitant, launching rewards programs and vaccine lotteries, offering free burgers, beers and even college scholarships – immunocompromised Americans and those who are unable to access the vaccine have gotten lost in the mix, Tomori said.
Surveys have indicated that the majority of unvaccinated Black and Hispanic adults have issues accessing vaccines, or getting time off work to get inoculated. Many disabled Americans who are homebound haven’t been able to get themselves to vaccination centers. And millions of people on immunosuppressive treatments, including people living with HIV, Crohn’s disease and other inflammatory conditions, those undergoing chemotherapy and recent recipients of organ transplants – are unlikely to derive protection from Covid-19 vaccines even if they get them.
Announcements doing away with indoor mask requirements in grocery stores and pharmacies and lifting social distancing requirements in public places send the message that those who aren’t able to get vaccinated are expendable, Tomori added. The result, she said, is a “survival of the fittest” mentality.
“We’re creating a situation where people who are immunocompromised, who are disabled, who are elderly, and who might not have mounted a strong immune response to the vaccine are unable to access public spaces out of fear,” said Rebecca Fielding-Miller, an epidemiologist at the University of California, San Diego. “And I don’t think that’s really good public health.”
Although unvaccinated people in the US are now less likely to encounter infectious people as case numbers drop, their odds now of catching Covid-19 upon crossing paths with someone who is carrying the Delta or another especially contagious variant are now higher than they were last year. And while she understands the mental health tolls of living in total isolation, and the need to return to social life and school, Fielding-Miller said she doesn’t see why officials must adhere to an all or nothing approach – lifting all restrictions. The approach has left many immunocompromised people even more isolated now than they were at the peak of the pandemic.
Denise Reich, a writer based in Los Angeles, said that as someone who has a primary immune deficiency, it’s unknown how much the Pfizer vaccine she received will protect her against infection – or if it will at all. Right before the state lifted most coronavirus restrictions, she did start to feel a bit safer – people were still wearing masks, and more and more were getting vaccinated. She walked around a garden, and browsed a store.
“But once the restrictions were lifted – the fantasy that things would start getting safer for me went out the window,” she said. Pictures of friends attending parties and visiting theme parks have made her feel left out, she said. The virtual events she relied on last year to stay connected have now mostly been cancelled in favor of in-person gatherings. “I actually feel way more alienated now than I did at the beginning of the pandemic,” she said.
“It’s probably not right to say, ‘You had cancer, and so I’m sorry you can’t participate in society anymore – the rest of us need to move on,’” Fielding-Miller said. “We need to balance our desire to get back to a normal state with consideration for who’s being left behind or harmed.”
It’s simple enough, she said, to allow the economy to reopen while keeping indoor mask requirements in place. “Masking is so easy to do – and it’s so hugely effective,” she said.
On Tuesday, health officials in Los Angeles county issued a recommendation that everyone, regardless of vaccination status, wear masks indoors. “Until we better understand how and to who the Delta variant is spreading, everyone should focus on maximum protection,” LA’s health department said.
Enacting flexible sick leave and work-from-home policies for those who are unable to get vaccinated would go a long way as well, Fielding-Miller said. Ultimately, protecting the most vulnerable will also protect society more broadly, she said. Each new infection is a new opportunity for the virus to mutate and create new, even more troubling variants – ones that could, at some point, evade existing vaccines.
For Hill, California’s reopening on 15 June was the start of a second, personal lockdown – it’s unsafe for them to go to the grocery store, or picnics in the park, or Fourth of July barbecues. “It’s really a repeat of last March, for me,” they said.