https://www.pnas.org/content/118/43/e2117185118
More than 25% of adults in the United States remain unvaccinated for coronavirus disease 2019 [COVID-19 (1)]. Although some of the unvaccinated are vaccine-resistant and may never be convinced that they should get the shot, the hope is that a sizable proportion of the unvaccinated will accept vaccination under the right circumstances. The recent US Food and Drug Administration (FDA) approval of the Pfizer vaccine—and Centers for Disease Control and Prevention (CDC) recommendation for a booster—may aid acceptance. And various incentives have been instituted to encourage vaccination, including free transportation to vaccination locations, time off from work, and monetary lotteries for those who have been vaccinated. Outreach has entailed the use of trusted messengers such as personal physicians, local community and faith leaders, and social media influencers; partnering with familiar community sites such as houses of worship; and expanding vaccination sites to include pharmacies, primary care offices, and mobile units (2⇓–4). An increasing number of private businesses and universities have announced vaccination mandates as part of returns to in-person work and school (5). Hopefully, many more people will elect to get vaccinated. And when they do, they should have a choice of vaccines. Whether vaccinating in hard-to-reach communities or requiring vaccination as a condition of employment or on-campus education, we argue that offering a choice of vaccine should be an essential component of COVID-19 vaccination strategies.
Vaccine administration in underserved communities often requires mobile units to facilitate vaccination clinics in urban or rural communities or to deliver vaccine directly into the homes of people who cannot access centralized vaccination sites (e.g., owing to age, disability, or lack of transportation; inability to access registration sites because of internet access; language barriers; or inability to take off work). Some have suggested that the Johnson & Johnson (J&J)/Janssen vaccine be selectively targeted to these populations to maximize operational efficiency in light of its single-dose delivery and lack of cold storage requirements (6). But this argument is tempered by CDC guidance that the Pfizer vaccine may be stored in the refrigerator for up to 31 days before mixing—thus making it easier to administer through mobile units (7). The Moderna vaccine still relies on cold storage. Thus far, of the fully vaccinated in the United States, 54% have received the Pfizer-BioNTech vaccine, 38% the Moderna vaccine, and 8% the J&J/Janssen vaccine (1).
