3 Explanations for the Vaccine Slowdown

Daily shots are plummeting. Why?

An illustration of a circle of vaccine needles, buffering
Getty / The Atlantic

For a few weeks this spring, the United States was a world leader in vaccines, administering shots to a larger share of its population than even the United Kingdom or Israel. But since the middle of April, our vaccine campaign has stalled. The average number of people getting a first or single dose is down almost 50 percent from its peak on April 13.

What’s notable about that date? Well, it just happens to be the same day that the CDC and the FDA recommended a pause in the use of the Johnson & Johnson vaccine.

This is a coincidence too big to ignore, and so a lot of people haven’t ignored it. Several analysts and health-care experts have slammed the U.S. government for bringing America’s incredible vaccine acceleration to a sudden halt. (The Johnson & Johnson pause was lifted after 10 days). But a closer look at vaccine progress and polling suggests that this might not be the whole story.

What really explains America’s vaccine-slowdown mystery? Let’s consider a few explanations.

1. Blame the J&J pause

Don’t fight the obvious: Average daily vaccinations peaked the very same day—or, perhaps, the day after—U.S. health officials warned about the Johnson & Johnson vaccines. After April 13, first doses cratered simultaneously for every age group over 18, showing the same sharp reversal for 20-somethings, 30-somethings, 40-somethings, and people over 50, suggesting that Americans of all ages pulled back immediately from the vaccination line. The Washington Post, quoting a survey from the Kaiser Family Foundation, said, “The Johnson & Johnson pause did hurt vaccine acceptance.”

But in that same Kaiser survey, just 5 percent of all Americans told pollsters that the J&J pause made them less likely to get vaccinated. It’s mathematically nonsensical to blame a sudden and sustained collapse in overall vaccine demand because such a small percentage of the country felt squeamish.

Other nations that dealt with brief health scares related to vaccines haven’t seen anything like the U.S.’s steady decline weeks after the fact. In the U.K., doses recovered two weeks after a dip that followed reports of clotting connected to the AstraZeneca vaccine. But in the U.S., nearly a month after the initial Johnson & Johnson report, vaccines are still falling every week.

What’s more, doses of Pfizer’s and Moderna’s vaccines are now steadily declining as well, even though the FDA and the CDC never plausibly linked those shots to any serious health effects. This suggests that something unrelated to the Johnson & Johnson pause might be at work.

2. Blame the wall of vaccine hesitancy

“The impact of the pause on vax demand was: BUBKES,” according to David Lazer, a professor at Northeastern University and a principal investigator at the COVID States Project, a research group. Given the high and steady level of vaccine hesitancy, he said, daily shots were always going to peak in April, with or without an FDA pause.

His story makes good sense if one believes that when the Johnson & Johnson vaccine surged into the market, it absorbed a lot of low-hanging demand for shots. By the time the FDA recommended a pause, the remaining population was a lot less keen for the vaccine. Although the J&J pause might have determined the exact day vaccinations peaked—because the supply temporarily dried up—the extended nature of the decline has much more to do with the fact that the remaining unvaccinated group is just much more reluctant to get jabbed.

More specifically, the extended decline has to do with conservative reluctance. Today, there are 20 states where the daily rate of first doses is higher than the national average; all 20 went for Joe Biden in last year's election. Meanwhile, of the 13 states where vaccination rates are below average and fewer than half of the population has at least one shot, all but one (Georgia) went for Donald Trump in November.

The huge gap between liberal and conservative areas may indicate that supply is exceeding demand not because the FDA abruptly gutted vaccine demand, but because most nonseniors in Republican states weren’t planning on getting the shot to begin with.

3. A synthesis view: Vaccination rates were likely destined to slow down in May, but the Johnson & Johnson pause wiped out a great chance at converting the remaining vaccine skeptics.

From December to February, the share of Americans who said they’d already received a shot or wanted one as soon as possible rose by 21 points—from 34 percent to 55 percent. In March, that number increased by only six points. In April, it increased by only three points. We’re persuading fewer and fewer people as we approach the solid bloc of vaccine resistance.

The Johnson & Johnson shots offered an ideal chance at expanding vaccine enthusiasm at a time when we were running out of eager adults. Across the country, health clinics said that many patients were uniquely excited about the one-shot regimen—due to either skepticism about mRNA technology or fear of needles. Some of that enthusiasm evaporated after the pause, doctors told The Wall Street Journal.

That is, the government’s underselling of the vaccines (and overselling of their risks) did not exactly cause the dip, but did make it harder for enthusiasm to bloom among the skeptical.

Vaccine hesitancy is not one single thing, but a constellation of notions about personal autonomy, safety, and science. At base, it is a highly personal cost-benefit analysis, in which individuals are weighing their feelings about the pandemic against their feelings about the shots. Before its reputation took a hit, the Johnson & Johnson vaccine offered skeptics a confidence booster. If we can’t turn back time and restore their confidence, we might have to pay them instead.