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People wait in line March 13 outside the Douglass Center in Champaign at a COVID-19 vaccine clinic hosted by Walgreens that featured the county’s first shots of the one-dose Johnson & Johnson vaccine.

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After months of negative

news about COVID-19, there is reason for optimism. Although the virus is still spreading and concern that more-contagious variants could contribute to a new wave of cases, since the mid-January peak, cases, hospitalizations and, most importantly, deaths are on a downward trajectory.

Most welcomed is the FDA’s recent emergency-use authorization for a one-shot Johnson & Johnson vaccine to complement the previously approved two-shot Pfizer and Moderna vaccines.

Also encouraging, after a sluggish start, is that the pace of vaccinations has picked up. President Joe Biden’s ambitious goal of vaccinating 100 million Americans in his first 100 days in office was quickly reached in 58 days, and on Thursday, he doubled it to 200 million by Day 100.

With a coordinated federal strategy and approval of a third vaccine, the average daily number of shots given, now at 2.5 million, will exceed 3 million in April. Since vaccine distribution began in the U.S. on Dec. 14, the CDC reports the more than 84 million people, or 25 percent of the U.S. population, have received one dose, and about 44 million, or 14 percent, are fully vaccinated.

But despite the increased rate of vaccinations, there is a long way to go to reach the goal of 70 to 80 percent full vaccination in order to achieve herd immunity.

In the short term, the problem

is a lack of supply. States, cities and the public have expressed frustration in obtaining sufficient vaccine as demand far exceeds supply, as evidenced by the long lines and millions anxiously waiting their turn. With supply being ramped up and improved delivery logistics, it is likely these shortages won’t last long.

More importantly, the problem will shift from supply to demand — to getting enough people to want to be vaccinated. Achieving herd immunity will require sufficient demand to be vaccinated, and that will be a formidable challenge.

It is one thing for the president to say that anyone who wants a vaccine will be able to get one “by the end of July,” and another to say that that will be sufficient to achieve herd immunity. To date, vaccinations in the midst of supply shortages have been embraced by the “low-hanging fruit” of those who want to be vaccinated.

Going forward, the challenge will be getting a larger population segment lined up to be vaccinated. Adequate supply will not be a problem. There will be enough vaccine on order to vaccinate the entire population.

Polls suggest that many Americans would refuse a shot if offered immediately. Surprisingly high rates of vaccine resistance have been noted among health care workers, caretakers in nursing homes and correctional and police officers who are in higher-risk populations than the general public.

Department of Defense officials recently reported that about 33 percent of military servicemembers declined voluntary vaccination. A recent Kaiser Family Foundation poll reported that a majority (55 percent) of U.S. adults reported having received at least one dose of the vaccine or said they would get it as soon as they could (37 percent). However, 22 percent want to “wait and see” how it is working for others before getting vaccinated themselves. More concerning is that more than one in five say they will either get the vaccine “only if required for work, school or other activities” (7 percent) or will “definitely not” get vaccinated (15 percent).

The initial challenge of developing safe and effective vaccines has been accomplished. But the challenges that public-health agencies face did not disappear with the introduction of a vaccine. And the next one — to secure herd immunity — won’t be medical or logistical, but behavioral.

It will take effective messaging and broad public support to accomplish this goal. Reliance on a “one size fits all” messaging by medical experts alone will not suffice. The best approaches will involve messages that are consistent with American values. These include concern for the common good and for family and friends, and the importance of personal responsibility.

Messages will need to be tailored to specific sub-populations. It will require different messages to different groups using different sources of information and channels of communication.

Messages must be factually accurate, persuasive and apolitical, as well as culturally and linguistically appropriate.

The belief that “if you build it, they will come” might be true for baseball or Disneyland, but not for sufficient COVID-19 vaccination compliance.

Thomas O’Rourke is a professor emeritus of community health at the University of Illinois.

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