The ‘successful failures’ of Apollo 13 and Covid-19 vaccination

Doomed from the start. That phrase neatly describes the Apollo 13 mission, which launched this day in 1970, and the ongoing Covid-19 vaccination effort in the U.S. Yet both can be seen as “successful failures.”

When astronauts James Lovell, John “Jack” Swigert, and Fred Haise blasted off from the Kennedy Space Center, they were anticipating mankind’s third trip to the surface of the moon. Two days into the mission, a defective oxygen tank exploded when they were some 200,000 miles away from Earth, imperiling their lives and making it impossible to complete their mission. Around-the-clock efforts by teams on the ground, imbued with NASA ingenuity, helped the astronauts return safely to Earth in what was nothing short of a miracle. “Our mission was a failure,” Lovell wrote later, “but I like to think it was a successful failure.”

We see parallels with Covid-19: a mission doomed from the start that has managed to eke out some successes.

More than two years into the pandemic, it’s clear that the country has failed its primary mission of saving lives. The U.S. is now approaching a devastating 1 million deaths from Covid-19, an incomprehensible loss of life. But within this massive failure there has been a public health success: The tireless work, ingenuity, and collective action of scientists, public health practitioners, and clinicians in both the public and private spheres — reminiscent of what NASA scientists and engineers did, but on a much larger scale — has led to what is arguably the single most successful vaccination program in U.S. history.

Months before Covid-19 emerged in December 2019, the Global Health Security Index indicated that no country was really prepared for a pandemic. Although the U.S. was deemed “most prepared,” its capabilities could not compensate for the many shortcomings of its health care and public health systems. These are the same shortcomings that have consistently led the country’s health care system to rank last among high-income countries: incomplete access to care, glaring inequities, insufficient public health resources and infrastructure, and mistrust in both government and industry, to name a few. There was no reason to think the pandemic would solve these problems. Indeed, it made many of them worse and also created new ones.

But the vaccines — their development, manufacture, and widespread uptake — have been a massive success. As we write this, the Centers for Disease Control and Prevention estimates that 88% of American adults have received at least one dose of a Covid-19 vaccine and 75% have been fully vaccinated, a higher Covid-19 vaccination rate than other non-mandatory vaccines have reached after being around for decades.

This means that in the span of about 18 months, some 227 million adults voluntarily got vaccinated despite the time it took to arrange an appointment, the discomfort, the likelihood of minor side effects like a sore arm or flu-like symptoms, and the uncertain likelihood of more serious side effects from the most rapidly developed vaccine of all time.

We know it might be hard to view any part of the Covid-19 pandemic response as a success. At times it feels impossible to think we’ve done anything right when Americans continue to spread SARS-CoV-2 and die from Covid-19 every day. The work is by no means done, and there are substantial gaps in vaccination coverage among adults, particularly when it comes to booster doses and younger populations.

Yet when rates of adult Covid-19 vaccination are compared to rates of vaccination against other vaccine-preventable illnesses, the U.S. has done remarkably well in a short amount of time: More American adults have received a two-dose Covid series since it became available than are current on their once-every-10-years tetanus boosters (about 70.5% of the adult population is up to date). Many more adults have been vaccinated against Covid than get vaccinated against influenza, where we’re lucky to see even half of the adult population vaccinated in a given year.

Eighty-eight percent is a simple statistic, but simple figures can reveal a lot about broader trends. For points of reference, a higher percentage of U.S. adults have had at least one dose of the Covid-19 vaccine than, according to Gallup, drink alcohol (60%); use Google (74%) in a typical week; find polygamy unacceptable (78%); or send their kids to public schools (83%). And despite the saying “as American as apple pie,” only 19% of Americans actually rate apple pie as their favorite, making Covid vaccination more American than apple pie — at least by the numbers.

There are few things Americans appear to agree on more than Covid vaccination, though two key issues have clearly been settled: “The Wizard of Oz” was a classic (89%) and “Gigli” probably should never have been made (94%).

It was by no means certain that Covid-19 vaccination would become a widely accepted part of American life in less than a year and a half. This should be viewed as an important public health accomplishment — a success within the country’s broader failure. Why? Surveys indicate that self-preservation and self-interest seem to be the major drivers as people make decisions to get vaccinated — meaning public health messaging has helped many Americans see through widespread disinformation, fearmongering, and conspiracy theories to understand their own risks and take the appropriate action to lower them.

But the sense of duty that serves as a primary motivator for some and a secondary motivator for many more can’t be discounted. Concerns about externalities — an economic term that refers to the effects an individual’s decisions has on others — are at the core of this sense of duty and are what make getting vaccinated not just a privately beneficial decision but a patriotic one, even when promoting the public good isn’t the primary motivator and even when people don’t necessarily view it this way. Indeed, one study has shown that a sense of purpose can be a motivator of vaccination decisions.

If we were to ask the NASA workers whose tireless efforts brought Lovell, Swigert, and Haise back home, we imagine that self-interest — wanting to keep their job — would have been one motivator. But other motivations that kept them working through sleepless nights would surely have included a sense of duty, purpose, and even patriotism.

Patriotism in America is about coming together under common threads and common values. More than 40 million people watched television to see if the Apollo 13 astronauts would make it back to Earth safely. When they did, a New York Times reporter wrote that the events “in all probability united the world in mutual concern more fully than another successful landing on the moon would have.”

If there is any indication of Americans’ “mutual concern” for our national health and well-being, it could very well be the 88% of us who have received Covid-19 vaccinations.

To be sure, uptake of Covid-19 vaccines in the U.S. has not been as high as in other countries, including countries like Brazil or Vietnam that have far fewer resources than the U.S. And it’s certainly worth making comparisons between the U.S. and countries that have outperformed it to learn whatever public health lessons this pandemic has to offer. But it is also important to consider what might have happened had the U.S. not achieved the high levels of vaccination it did.

It’s also tempting to point to divisiveness within the country as a sign of failure and, in particular, for the vaccinated to view the unvaccinated as paying no price for their decisions and being inconsiderate of their duty to their community and their country. Lies and misinformation have fueled very loud critics of scientifically undisputed infection-control measures, while assumptions about the character of “the unvaccinated” have led to vitriolic, misplaced accusations about entire groups of people.

While we personally think that our unvaccinated and undervaccinated neighbors could be doing more, extreme views are pervasive and ignore an important reality: We have all made sacrifices or done something other than getting vaccinated that supports our communities during the pandemic, whether it’s working an essential job with higher risk of infection, managing family life disruptions from social distancing and infection control measures, or helping neighbors that have been hit hard financially by economic disruptions. While most Americans now have some degree of biological immunity against Covid-19, none of us has been immune to the social and economic tolls of the pandemic. And, sadly, many more unvaccinated Americans have paid the ultimate price — death from Covid-19 — than vaccinated Americans since vaccines became widely available

Public health won’t be taking days off for the foreseeable future, nor will doctors and nurses and caregivers. Many of them are running on fumes, though some want to stop. Let’s not lose sight of the success buried within this larger failure and take a moment to recognize a truly remarkable achievement: 255 million (and counting!) people — children, adults, our neighbors and friends — have bettered their country by getting Covid-19 vaccinations.

Christopher M. Worsham is a pulmonologist and critical care physician at Massachusetts General Hospital in Boston and an instructor in medicine at Harvard Medical School. Anupam B. Jena is an internal medicine physician at Massachusetts General Hospital, an associate professor of health care policy at Harvard Medical School, a faculty research fellow at the National Bureau of Economic Research, and host of the Freakonomics, MD podcast.