About 18 years ago, while delivering a talk at a CDC conference, Gregory Poland punked 2,000 of his fellow scientists. Ten minutes into his lecture, a member of the audience, under Poland’s instruction, raced up to the podium with a slip of paper. Poland skimmed the note and looked up, stony-faced. “Colleagues, I am unsure of what to say,” he said. “We have just been notified of a virus that’s been detected in the U.S. that will take somewhere between 10,000 and 15,000 lives this year.” The room erupted in a horrified, cinematic gasp. Poland paused, then leaned into the mic. “The name of the virus,” he declared, “is influenza.”Call it funny, call it mean, but at least call it true. Poland, a physician and vaccinologist at Mayo Clinic, had done little more than recast two facts his colleagues already knew: Flu is highly contagious and highly dangerous, a staggering burden on public health; and for years and years and years, Americans, even those trained in disease control and prevention, have almost entirely ceased to care. Vaccines capable of curbing flu’s annual toll have existed since the 1940s. Close to a century later, some 50 to 60 percent of Americans adults still do not bother with the yearly shot. The crux of the uptake shortfall “is this normalization of death,” Poland told me. He predicts this pattern will play on repeat, and at higher volume, with SARS-CoV-2—another devastating respiratory virus that’s tough to durably thwart with shots.
COVID-19 is not the flu, and no one knows for sure exactly how often we’ll have to immunize ourselves against it. But it seems inevitable that someday, the entire American public will be asked to sign up for shots again—perhaps quite soon, perhaps every fall, as some vaccine makers would like. We have just one template for this: the flu shot. And expecting even similar levels of so-so uptake may be optimistic. “I’m guessing that flu-vaccine coverage is going to be a ceiling,” says Alison Buttenheim, a behavioral scientist at the University of Pennsylvania. “I just don’t think we’ll have 70 percent of U.S. adults saying, Oh, an annual COVID shot? Sure.”