First, medical care in the U.S. is notoriously fragmented. There is neither a centralized record system, as in Taiwan, nor a universal insurance system, as in Canada and Scandinavia, to remind people to get another shot. Many Americans also do not have a regular contact point for their health care.
As a result, preventive care — like a booster shot — often falls through the cracks.
The second problem is one that has also bedeviled other aspects of U.S. Covid response: Government health officials, as well as some experts, struggle to communicate effectively with the hundreds of millions of us who are not experts.
They speak in the language of academia, without recognizing how it confuses people. Rather than clearly explaining the big picture, they emphasize small amounts of uncertainty that are important to scientific research but can be counterproductive during a global emergency. They are cautious to the point of hampering public health.
As an analogy, imagine if a group of engineers surrounded firefighters outside a burning building and started questioning whether they were using the most powerful hoses on the market. The questions might be reasonable in another setting — and pointless if not damaging during a blaze.
A version of this happened early in the pandemic, when experts, including the C.D.C. and the World Health Organization, discouraged widespread mask wearing. They based that stance partly on the absence of research specifically showing that masks reduced the spread of Covid.
But obviously there had not been much research on a brand-new virus. Multiple sources of scientific information did suggest that masks would probably reduce Covid’s spread, much as they reduced the spread of other viruses. Health officials cast aside this evidence.
Tests, vaccines, boosters
Similar problems have occurred since then, especially in the U.S.:
Regulators were slow to give formal approval to the Covid vaccines while they waited for more data — even as those same regulators were pleading with people to get shots.
Regulators were slow to approve rapid tests — even as Britain and Germany were using rapid tests effectively.
U.S. officials were slow to tell people who had received the Johnson & Johnson vaccine to get a follow-up shot — even as some experts were persuaded enough by the data to do so themselves.
As a result, Americans were slower to put on masks and slower to be vaccinated than they could have been. The pattern is repeating itself with boosters. Across Europe, Canada and Australia, health officials are urging adults of all ages to receive booster shots. Israel and several other countries are even giving second booster shots to vulnerable people.