Biden’s Spaghetti-at-the-Wall Vaccine Campaign

The play-it-safe approach to inoculating Americans against COVID-19 may cost more lives.

President Biden's face, on a hot-pink background, is superimposed with dozens of teal syringes.
Chip Somodevilla / Getty; Adam Maida / The Atlantic

What will it take? Eighty-year-old Anthony Fauci is on TikTok trying to reach the young and unvaccinated. Dating apps are steering people toward health clinics. The first lady, Jill Biden, is venturing into red America to coax the unwilling into getting shots. White House aides regularly swap messages on an email chain dubbed “Ideas” that flags inventive ways of persuading people to do their part to end the pandemic. On Wednesday, the pop star Olivia Rodrigo made a cameo at the White House press briefing to urge her young fans to get vaccinated. “We’re focusing on an all-of-the-above strategy,” Vivek Murthy, the U.S. surgeon general, told me recently. Or maybe it’s a spaghetti-at-the-wall strategy.

You might think that, in his quest to quell the coronavirus, President Joe Biden would be ready to try anything. But there are indeed some things he won’t try, and the reason is a familiar one. Biden’s vaccination drive has the feel of a political campaign that’s targeting the persuadable middle, when what’s really needed is a novel way to reach the proudly irrational. He’s using many of the same tools he employed in 2020: celebrity endorsements and door-to-door contacts, TV ads and the bully pulpit. Fewer and fewer unvaccinated Americans are heeding the message. Compared with an average of more than 3.3 million doses a day in April, only about half a million people are now getting vaccinated on a given day. Nearly one-third of the adult population hasn’t gotten a single dose of a COVID-19 vaccine at a time when the far more infectious Delta variant is sweeping the nation. There’s no assurance that more of the same will produce a better result.

“The problem is, we’re out of time,” Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine, told me. “Even if you’re vaccinated tomorrow, you’re five or six weeks away from being fully immunized, and Delta is already on the rise.”

Reasons vary as to why the holdouts are unmoved. Polling shows that Black and Hispanic adults, for example, are more likely than white adults to forgo the vaccine due to fear of missing work. A disproportionate share of Republicans, white evangelical Christians, and rural residents—the durable core of Donald Trump’s base—say they won’t ever get vaccinated, according to surveys taken by the Kaiser Family Foundation. Nearly half of Republican adults who haven’t been vaccinated cite distrust of government as a major reason. (Only a quarter of unvaccinated Democrats mention that as a rationale for refusing a vaccine.) Trump supporters are not listening to Biden, and they don’t care what he says—but the president can’t simply ignore them. “You can win an election with 51 percent of the vote, but you can’t beat COVID with 51 percent of the vote,” Jerome Adams, the U.S. surgeon general during the Trump administration, told me. “The proof is in the pudding. [Biden administration officials] haven’t done as good a job as they need with the other people out there.”

One of the more visible officials during the Trump administration, Adams said he offered himself as an emissary of sorts to help Biden ramp up vaccinations, but was turned away. “I was told, ‘We don’t want your help; please leave,’” Adams said. (A White House spokesperson did not respond to a request for comment on Adams’s statement.) “For the group that’s vaccine-hesitant at this moment, I don’t see very many credible spokespeople that [the Biden administration has] engaged and empowered. Jill Biden goes to Nashville, and that’s great. But the people she’s trying to reach in Nashville don’t like or listen to her or her husband.”

Who might get their attention? Herschel Walker, the former football star whom Trump is trying to recruit for a U.S. Senate race in Georgia, could prove a persuasive ambassador to the Trump faithful. Former New Jersey Governor Chris Christie was infected with the virus and hospitalized last fall. He has already become something of a vaccine evangelist, and his story might be one that the Biden administration can showcase. Political figures, however, aren’t always the best ones to make the sale, White House aides told me. In devising the administration’s approach, they spent time talking with the longtime Republican pollster Frank Luntz, who held focus groups on the topic. People want to hear from trusted physicians and clergy when deciding whether to get a vaccine, Biden aides said. Andy Slavitt, who until last month was a senior adviser to Biden’s pandemic-response team, mentioned a TV-ad campaign in March in which all of the living ex-presidents—minus Trump—urged people to get shots. The ad “moved absolutely nobody,” Slavitt told me. “The feedback to that was, ‘Sorry, George W. Bush or Barack Obama are not going to convince me to take the vaccine if I’m skeptical. It’s my doctor, my pharmacist.’”

Just as liberals are impatient with Biden for not doing more to end a Senate filibuster rule that has blocked expanding voting rights, public-health experts are frustrated that he won’t deploy power more assertively to combat the virus. The problems are different; the pattern is the same—Biden will push conventional boundaries to a point, but not to the breaking point. “There is a real consequence to this slow vaccine rollout,” Leana Wen, the former Baltimore health commissioner, told me. “We are going to hit a wall—in fact, we’ve hit that wall. Right now, what the Biden administration has laid out is essentially tinkering around the edges. If we want to see dramatic results, we have to take dramatic action.”

One option that administration officials have privately discussed is requiring the 2.1 million members of the federal workforce to get vaccinated, a senior official told me. (Private employers are already free to demand that their workers be vaccinated before returning to the office.) As commander in chief, Biden could also order all 1.3 million members of the active-duty military to get injections. “We get shots for everything,” H. R. McMaster, a retired Army general and former national security adviser under Trump, told me. “And the vaccine is far from experimental, like the botulinum vaccine was prior to Desert Storm” in 1991. (Military leaders have signaled that they might require COVID-19 shots for troops once the FDA gives full approval to the vaccines, which could happen this fall.)

Any attempt to change Americans’ behavior might also focus on the conspiracism that surrounds the vaccines. A recent poll found that 44 percent of Republicans believe that Bill Gates wants to use the injections to embed subcutaneous microchips in an unsuspecting population. Eric Topol, a molecular-medicine professor at Scripps Research, says he’s privately told Biden-administration officials that they need to be far more systematic in debunking misinformation. “I’ve talked to several officials in that leadership group and said to them, ‘Why are you not mounting a counteroffensive and calling out these people?’” he told me. “I’ve gotten nowhere. They say, ‘We don’t want to get into that.’” (Yesterday, Murthy released a 22-page advisory warning of a blizzard of misinformation that has “led people to decline the COVID-19 vaccines.”)

None of the bolder steps that Biden could take seems to be gaining traction inside the White House. The notion of compulsory vaccinations for federal workers has fallen flat. Biden wouldn’t even mandate vaccinations for the 1,000-some guests who showed up to eat pulled pork and popcorn at his July 4 celebration on the White House’s South Lawn. “One of the concerns about central mandates is that you’re going to get a lot of pushback politically on that because people don’t like the federal government to mandate anything, and that’s the reason they’re staying away from that,” said one Biden-administration official, speaking on the condition of anonymity to talk about internal deliberations.

That’s no baseless fear. Both Representative Marjorie Taylor Greene of Georgia and Representative Lauren Boebert of Colorado have invoked Nazi Germany when describing a more tepid program in which the Biden administration is sending people house-to-house to encourage vaccinations. Even more reasonable voices in the GOP are wary of anything that smacks of a mandate. Ohio Governor Mike DeWine, a Republican, is open to fresh ways to spur vaccinations, having set up a $1 million lottery and scholarship program as an incentive. When I asked him about requiring vaccinations, though, DeWine told me: “We’re not going to do that in Ohio. It simply would not be accepted.” He predicted a “groundswell of opposition to any kind of requirement like that.” Only about 60 percent of the state’s adult population has gotten at least one dose of a vaccine, ranking Ohio 39th of all the states and territories in terms of vaccine uptake.

In speeches over the past six months, Biden has at times made vague references to the Trump administration’s work in producing viable vaccines in the first year of the pandemic. More often, he resorts to the standard trope of praising his own record in cleaning up what he calls “the mess we inherited.” He’s not wrong about the mess. And you can hardly blame Biden for distancing himself from a president who downplayed the pandemic, belittled masks, and, for good measure, now leads a movement bent on razing American democracy. If Biden wants to reach the Trump loyalists, though, he might consider spotlighting the Trump administration’s vaccine-development drive. He “had an opportunity to do that months ago, and probably should have done it,” Neil Newhouse, a Republican pollster, told me. Newhouse said he’s tested a message that could potentially sway at least a portion of Trump supporters: emphasizing that the vaccines were an initiative of the ex-president. “What a surprise!” Newhouse said. “The Trump message works better for people who voted for Donald Trump! You know what? A helluva lot of those people are not vaccinated right now.”

Intermediaries have approached Trumpworld and asked that he tout the vaccines at future rallies. A scenario they’d like to see is Trump directing the crowd to a pop-up vaccination clinic on-site. John Bridgeland, a co-founder of Covid Collaborative, a group that has consulted with the Biden administration on combatting the virus, says that if Trump were to tell his followers that the vaccines are “safe and effective” and steer them to a nearby vaccination site, “I know there would be increased uptake.” He told me that he’s broached the idea with a former senior Trump White House official. But helpful public-service announcements that align with Biden’s goals would be completely out of character for the 45th president. So far, Trump hasn’t shown any interest, Bridgeland said. (A spokesperson for Trump did not respond to a request for comment.) “The burden isn’t on Trump to do anything,” Bryan Lanza, a former Trump-campaign aide, told me. “The burden is on Biden to push on the promises he made to the American people.”

Biden’s dilemma illustrates how America has cleaved along partisan lines. He’s governing at a time when basic reality has become a game of choose your own adventure. Millions of Americans came away from the 2020 election believing that the losing candidate had actually won. Many of the same people look at a vaccine with a remarkable degree of efficacy and see a billionaire plotting to control their life. In April, the average vaccination rate in counties won by Biden was about 23 percent, compared with 21 percent in counties won by Trump, according to Kaiser Family Foundation data. That two-point gap ballooned to nearly 12 points this month.

Biden is working from an outdated script. During Obama’s presidency, the White House scrambled to get young people signed up for health-care coverage, his signature accomplishment. In 2014, Obama appeared with the actor Zach Galifianakis on the comedy show Between Two Ferns in hopes of reaching more young people. (“Why would you get the guy that created the Zune to make your website?” Galifianakis asked Obama.) “We were eagerly trying to get people enrolled, and we learned a lot about what reaches particular audiences,” Cecilia Munoz, then Obama’s domestic-policy adviser, told me. “Between Two Ferns drove the mainstream media nuts. He got a lot of criticism for it being undignified. But it was hugely impactful with the audience we were trying to reach.”

The trouble here is that the audience just isn’t the same; the audience may well be unreachable. “It’s a problem that shows up with vaccines, with respect to other kinds of issues too,” continued Munoz, who lost a family member to COVID-19. “We are not operating from a common set of facts anymore.”