The existence of effective vaccines has reduced the overall threat that the COVID-19 poses to American society. But it has also redistributed the harms of the COVID pandemic towards weaker and less visible members of our society. As a result, cultural and political leaders have begun to embrace a more individualistic, less effective approach to COVID mitigation — potentially prolonging the pandemic and worsening its harms.

The vaccination campaigns of the last year have left approximately 75% vaccinated. Most Americans are relatively safe from a direct COVID infection. However, the virus still poses a massive risk to millions of Americans, regardless of vaccine status. There appear to be four groups at risk:

• The unvaccinated. This group includes young children, and of course, the voluntarily unvaccinated, who are concentrated in politically right-wing areas, often rural or exurban places.

• The medically susceptible. This group includes the elderly and people with serious risk factors or preexisting conditions. Although more dispersed than the unvaccinated, medical susceptibility is likely concentrated in places with poor health outcomes — i.e., poor communities, segregated urban communities of color, rural communities, and other socially marginalized and disadvantaged populations.

• Vaccinated people who have professional, familial, or social relationships with voluntarily unvaccinated or medically susceptible people. This groups faces the risk of death or serious harm to a loved one, colleague, or caretaker. These losses are often overlooked but can be almost as devastating as any medical condition, with potentially lifelong welfare effects. This risk group is concentrated in areas with high numbers of unvaccinated or medically susceptible people — in other words, poorer, more rural, and more politically right-wing places.

• People who rely on institutions that will be overwhelmed in a surge. Most notably, this includes hospitals and medical infrastructure, although a sufficiently large surge could also affect things like public transit, schools, and social services. Although this risk group includes most Americans to a certain degree, the people most at risk are those who already rely the most on medical and social institutions. Additionally, the institutions most at risk are those located in communities with high numbers of unvaccinated or medically susceptible people. So this institutional risk falls, again, on the poorest places, such as segregated communities of color, as well as lower-income, politically conservative rural and exurban places.

Viewed as a whole, tens or hundreds of millions of Americans still face serious risks during a COVID surge, either from direct infection or from other disruptions to their lives. However, that overall risk has been shifted away from cultural, political, and economic power centers and towards smaller, poorer, marginalized, and disadvantaged communities.

As a result, there has been a shift in the political response to COVID. As people in high-income, high-visibility groups have become more insulated from the crisis, political and social leaders have demonstrated lower appetite for disruptive policy responses to COVID. Government interventions like mask mandates or vaccine passports have not been widely adopted, and many existing mandates have been ended. School closures, business closures, and other restrictions on gatherings have been largely abandoned.

This shift is particularly noticeable among liberal elites, who are heavily concentrated in the power centers that are now most insulated. Many liberal elites in politics and media previously embraced an ethos of shared sacrifice to deal with the pandemic, in the name of “flattening the curve.” A number of these same political and social leaders have drifted towards a rhetoric of personal responsibility, sometimes suggesting that this is a “pandemic of the unvaccinated” that can be safely forgotten by the majority who have received a vaccine, or that people who suffer from a surge have no one to blame but themselves. This contingent increasingly includes Democratic federal and state officials, like Governor Polis of Colorado.

(Notably, this political shift is less observable in the general public. Most polls show that significant majorities of Americans remain concerned about the pandemic, and support aggressive interventions like vaccine and mask mandates.)

It is illustrative to compare the COVID-19 pandemic to another epidemic that, eventually, received a great deal of political attention: opioids. The opioid epidemic became emblematic of America’s “forgotten places” —a crisis tearing through poor and rural communities while political and cultural leaders looked the other way. The same is increasingly true of COVID-19. Also like COVID-19, the direct victims of the opioid epidemic usually shared some responsibility for the harms they suffered, but the harms branched out into entire communities.

There is one key respect in which COVID-19 differs dramatically from the opioid epidemic: the scale. Between 1999 and 2019, opioids killed fewer than 70 people a day in the US. COVID-19 is currently killing about twenty times as many — 1350 dead every day.

We know now that it was politically, morally, and socially foolish to ignore opioid epidemic for as long as we did. And yet, in COVID, we risk reliving that mistake, in extreme fast-forward.

No nation can afford to simply write off a quarter of its population to deadly disease without causing much greater suffering and hardship. And the bleak reality is that, vaccine notwithstanding, COVID-19 is still wreaking havoc on America. The virus is killing nearly 10,000 people weekly and crushing the health care system. This devastation is less visible than before, but remains unsustainable. Despite occasional calls to “move past” the virus or recognize a “new normal,” the situation is unstable: either important social infrastructure will collapse, or the virus will subside, either on its own or because we have taken action to suppress it.

Political leaders must recognize that the politics of personal responsibility are not an appropriate reaction to this moment. The current crisis is not caused by our efforts to mitigate the virus, but the virus itself. Political leaders and policymakers cannot place the vaccinated into a bubble where COVID-19 does not exist. All of us will see the effects of this virus in our lives; this is inevitable. Our leaders can only decide if those effects take the form of mitigation — or collapse.