evidence: The COVID-19 vaccine has been a miraculous, life-saving advance, offering staggering efficacy in adults, and was developed with astonishing speed. The time from sequencing the virus to authorizing the first COVID-19 vaccine was so brisk even the optimists appear close-minded. Yet, simultaneously, United States’ COVID-19 vaccination roll-out and related policies have contained missed opportunities, errors, run counter to evidence-based medicine, and revealed limitations in the judgment of public policymakers. Misplaced utilization, contradictory messaging, and poor deployment in those who would benefit most—the elderly and high-risk—alongside unrealistic messaging, exaggeration, and coercion in those who benefit least—young, healthy Americans—is at the heart. It is important to consider the history of COVID-19 vaccines to identify where we succeeded and where we failed, and the effects that these errors may have more broadly on vaccination hesitancy and routine childhood immunization programs in the decades to come. [...] Beyond this, the rise of immune evasive viral variants meant that no amount of vaccination would halt viral spread. The goals of vaccine campaigns, particularly additional doses, had to shift to focus solely on further reductions in severe disease—beyond what was achieved by the first 2 doses—and not merely to reduce symptomatic infection. Ironically, this was the original point by Topol and colleagues in 2020. This is true for a simple reason, that, if one lives long enough, with repeated exposure, infection and re-infection are inevitable, likely many times over a long life. Instead, avoiding bad outcomes is the only justification for repeated dosing of mRNA vaccination.