Public Health

Mira Irons, MD, discusses vaccination rates and new CDC studies


Watch the AMA's COVID-19 Update, with insights from AMA leaders and experts about the pandemic.



In today’s COVID-19 Update, a discussion with AMA's Chief Health and Science Officer, Mira Irons, MD, to review COVID-19 vaccine numbers and trending topics related to the pandemic over the past week. Also covering variants, learnings from two new CDC studies released this week and AMA's statement regarding the Supreme Court’s decision to uphold the Affordable Care Act (ACA).

Learn more at the AMA COVID-19 resource center.


  • Mira Irons, MD, chief health and science officer, AMA

AMA COVID-19 Daily Video Update

AMA’s video collection features experts and physician leaders discussing the latest on the pandemic.

Unger: Hello, this is the American Medical Association's COVID-19 Update. Today, we have our weekly look at the numbers, trends and latest news about COVID-19 with AMA's Chief Health and Science Officer Dr. Mira Irons in Chicago. I'm Todd Unger, the AMA's chief experience officer in Chicago. Dr. Irons, on the heels of reaching the 600,000 death milestone from COVID in the U.S. last Wednesday, speculation is now turning to President Biden's Fourth of July goal regarding getting 70% of folks with at least one shot, all adults. Are we going to come up short here or are we going to make that goal?

Dr. Irons: You know, Todd, it is looking unlikely that we will reach that goal. If we continue at our current pace, an analysis by The New York Times shows that the country will be at 67.6% of Americans having had at least one shot by July 4. The good news is that from a disease control perspective the difference between 67% and 70% isn't really significant. During the White House appearance last Friday, the president avoided mentioning that goal but instead focused on a different milestone, how 300 million shots were administered in his first 150 days in office. He also joined the chorus of others talking about the seriousness of the more transmissible and possibly more deadly Delta variant, first identified India, and underscored the importance of getting vaccinated.

Unger: My guess is that if you would've talked to us in January and said almost 68% of people would be vaccinated by July 4, we'd have been pretty excited about that. And now it's even more important given what you just mentioned, which are these variants. How are we thinking about things like the Delta variant and others in terms of spreading right now?

Dr. Irons: It's really important and it's a concern. According to the World Health Organization, the Delta variant has now spread to more than 80 countries. Health authorities in Britain, which leads the world in genomic surveillance, say the variant is involved in more than 90% of a new surge of cases that has now delayed England's reopening. Some experts say that Britain's vulnerability might be at least partly explained by the country's decision to delay second doses to stretch the supply of first doses.

But while fully vaccinated people are amply protected against the Delta variant, people with only a single dose remain vulnerable according to public health authorities. Although the variant's been detected in more than 25 U.S. states, estimates from the CDC do not show any with high prevalence. However, on Friday the CDC director, Dr. Rochelle Walensky, said that the Delta variant would probably become the country's dominant strain in coming months.

Unger: We had spoke with Dr. Sandra Fryhofer, AMA's chair-elect, and I thought her quote was really good. She said basically, as long as this COVID-19 is spreading, we're going to see variants. And it sounds like, again, the push on vaccination is just so very important. Speaking of which, can you talk to us about vaccination progress over the past week?

Dr. Irons: Yeah. We're continuing, but it slowed. The CDC said about 177.3 million people have received at least one dose of the COVID-19 vaccine, including 150 million people who are now fully vaccinated. Percentage-wise that means 53.4% of all Americans have received at least one dose, and 45.2% are fully vaccinated. Slightly more than 65% of people 18 and older have received at least one shot. Again, this is the number President Biden is looking at. However, the pace of vaccination has slowed considerably to around a million doses a day. Also, we know that the effectiveness of the vaccines against the Delta variant is decreased after only one dose, so it's really important to get fully vaccinated.

Unger: Besides being at risk for COVID-19, what do we know about the folks that are still unvaccinated? Are they still firmly in the unvaccinated camp or are they becoming more open to the possibility of becoming vaccinated?

Dr. Irons: Well, it's become kind of a tale of two countries, those that are vaccinated and those that are unvaccinated, and we're seeing the new cases and the surges in those that are unvaccinated. In terms of what they're thinking, what we know is that while we're seeing those who took a wait-and-see approach becoming more open to getting vaccinated, 20% of American adults still say they will definitely not get the vaccine or will get vaccinated only if it's required, according to a poll released last month by the Kaiser Family Foundation.

A new Associated Press-NORC Center for Public Affairs Research poll of 1,125 U.S. adults found that 46% of unvaccinated Americans say they will definitely not get a vaccine, and 29% say they probably will not. The poll also found that only 21% of respondents are very or extremely worried about a COVID-19 infection in their inner circle, the lowest level since the pandemic began. And only 25% are highly concerned that the lifted restrictions will lead to additional people being infected in their community.

Unger: That's a real concern given the impact that we're seeing with this Delta variant right now. And I think from what you've said before, these vaccination rates vary substantially state by state. Can you give us a picture of how that's shaping up?

Dr. Irons: You know, the rates of vaccination continue to remain uneven around the country. There are 11 states in the U.S. where at least 20% of older adults, 65 and older, still haven't received a COVID shot, potentially putting the recovery there at risk because we know those are the people at highest risk. In line with what we've been seeing, most of those 11 states are in the South, Alabama, Arkansas, Louisiana, Mississippi, North Carolina and Tennessee. Georgia, Idaho and Missouri are at the 20% threshold. West Virginia and Wyoming also have more than 20% of people 65 and over without one dose. These numbers are not due to a lack of effort or resources, but are more about a population that has been resistant to receiving the message.

Unger: Well, two new CDC studies came out this week looking at factors like age and income and education, and how they affect vaccine hesitancy. Can you tell us a little bit more about those studies?

Dr. Irons: Absolutely. The big takeaway is that younger Americans are less likely to be vaccinated than their elders and factors like income and education may affect vaccine hesitancy. In one study among those who are 65 or older, 80% have been at least partially vaccinated compared with 34% of those between 18 and 39. Some of the gap in rates could be attributed to the fact that many young adults did not become eligible for vaccination until March or April. But uptake has also been slower among younger Americans, and a substantial proportion of them remain hesitant. If vaccine initiation rates remain stable, by late August just 58% of 18- to 29-year-olds will have been vaccinated compared with 95% of those 65 and up the researchers found.

Unger: Well beyond age, what did you see in terms of education and income play in terms of vaccine hesitancy?

Dr. Irons: In a second study, adults 18 to 24 years, as well as non-Hispanic Black adults and those with less education, no insurance and lower household incomes, had the lowest reported vaccination coverage and intent to get vaccinated. Concerns about vaccine safety and effectiveness were commonly cited barriers to vaccination.

Unger: So what's the net take away from this? What have we learned from these numbers?

Dr. Irons: The studies highlight the hurdles that remain in improving vaccine coverage in our country. Part of it may also be this narrative we've created, that COVID does not affect younger people seriously, which of course we know is not always true. One of the studies did point to possible strategies for increasing vaccination coverage which included providing more information about the vaccine safety and effectiveness, focusing on how vaccines help to prevent spreading the virus to family and friends or how getting vaccinated allows the return to normal social activities.

Unger: Just at that top level, we talked about crossing that 600,000 death milestone last week. What are the numbers looking like? Are we still seeing decreasing rates of new cases?

Dr. Irons: We are, but the numbers are continuing to rise predominantly or more in the unvaccinated population. So the numbers for today, 33,555,046 people affected with COVID, and the U.S. deaths are at 602,107. The U.S. has been averaging fewer than 15,000 cases a day since early June, the lowest total since testing became widely available. Around 350 deaths are reported each day, the fewest since March 2020.

Unger: It's interesting, I remember Dr. Tom Frieden being on the update and talking about that 15,000 case mark as being kind of where the public health system can handle. So let's hope we can see a decrease from that number right now. Well last up, Dr. Irons, any new messages that the AMA would like folks to hear this week?

Dr. Irons: Last Thursday, June 17, the AMA issued a statement regarding the Supreme Court's decision to uphold the Affordable Care Act. Today's decision by the U.S. Supreme Court is a victory for patients and for the gains in health care coverage achieved through the Affordable Care Act, ACA. The AMA is pleased that the high court rejected the challenge to the ACA thereby upholding critical patient protections that are improving the lives and health of millions of Americans, particularly amid a global pandemic. We remain committed to strengthening the current law and look forward to policymakers advancing solutions to improve the ACA.

Unger: And if there was ever a time where coverage is just so necessary, it's now, so that's really good news. Dr. Irons, thanks so much for being here, for your update. We'll see you next week with another. In the meantime, for resources on COVID-19, visit Thanks for joining us today and please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.