The United States has now surpassed one million COVID-19 related deaths.
As the United States assesses what went wrong, unvaccinated Americans have received a lot of attention. President Biden warned in July 2021, “the only pandemic we have is among the unvaccinated”. And, in some ways, he was right; two-thirds of US COVID deaths since then have been among the unvaccinated.
But, President Biden was also very wrong.
Yes, it is fair to emphasise the role vaccine avoidance played in reaching the one million deaths milestone. Around a quarter of America’s COVID deaths were considered preventable with vaccination. The messaging on vaccines also implied the choice not to get vaccinated was your own life-threatening one to make.
More so, the United States still seriously lags behind other high-income countries in terms of its vaccinated population. Just over 65 per cent of the US eligible population is ‘fully vaccinated’, compared to around 80 per cent in Australia and an OECD average of more than 70 per cent.
Yet, the ‘pandemic of the unvaccinated’, is actually a pandemic of the vulnerable – namely, the old, sick and poor.
Older age remains the strongest determinant contributing to severe COVID-19 illness and death. The risk of death is 10 times higher for those who are unvaccinated, but for those over 65 years old, the risk is 97 times higher. Currently, 91 per cent of this cohort is vaccinated, and yet they still comprise over 81 per cent of COVID deaths.
Relatedly, those with pre-existing health conditions face significantly higher rates of COVID-related mortality. According to the US Centers for Disease Control, co-morbidities like heart disease, neurological disease and diabetes, were listed on as many as 95 per cent of all COVID-19 death certificates. These conditions afflict Americans at any age and have seen many younger people die from COVID-19.
Level of income also often fails to get a mention yet has been another major driver of COVID-19 deaths since the start of the pandemic. Those in the counties with the lowest median income died with COVID-19 at rates over two times higher than those counties with the highest incomes.
Low income was also common among the nearly 30 million Americans whose health was uninsured at the start of the pandemic, and those who are most likely to delay or go without medical assistance.
In fact, at the time Biden foresaw a “pandemic of the unvaccinated”, almost a quarter of those under 65 who had not received the vaccine were uninsured.
Vaccine hesitancy is often seen as a purely political stand, but it is similarly closely correlated with isolation from the healthcare system – if you have historically lacked the resources to seek medical assistance and engage in protective health behaviours in the past, you’re less likely to think you require medical interventions (like vaccines) when your own whims and home remedies have brought you this far without it.
Access to health care and standards of health across age, income and race in the United States were far from equal before the pandemic. The statistics surrounding COVID-19 deaths just made this reality more pronounced.
On Thursday, President Biden gave a statement commemorating the “one million empty chairs around the dinner table”. Once again, the president urged his population to do “more testing, vaccines and treatments than ever before”. This is good, but the response can’t just be a call for greater personal responsibility. There needs to be greater scrutiny of the US healthcare system.
Far from cooked-up internet conspiracies, the more insidious threat to the US pandemic response is a failure to acknowledge those isolated from the healthcare system through no fault of their own.