Covid vaccinations are slowing in the U.S. as supply outstrips demand. How states are targeting who's left

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After months of a steady climb in vaccinations, the U.S. is experiencing its first true slowdown in the rate of daily shots, an indication that the nation is entering a new phase of its inoculation campaign.

More than half of American adults have now received at least one dose, a significant achievement, but getting the second half vaccinated brings a different set of challenges. Vaccinations to date are likely made up largely of groups who most wanted the vaccine and have had greatest access to it, and continued progress is no longer about meeting demand for shots.

“We've gotten vaccinations to those most at risk and those most eager to get vaccinated as quickly as possible,” White House Covid czar Jeff Zients told reporters last week, “and we will continue those efforts, but we know reaching other populations will take time and focus.”

The country is averaging 2.6 million reported vaccinations per day over the past week, Centers for Disease Control and Prevention data shows, down from a peak of 3.4 million reported shots per day on April 13. That number is trending downward even with eligibility now open to all adults in every state.

The downturn comes on the heels of lots of positive vaccination news, said Dr. Jennifer Kates, a senior vice president with the nonprofit health policy group the Kaiser Family Foundation. The federal government has secured a large vaccine supply, states have ironed out kinks in their registration systems, and eligibility has opened up to all adults.

But now, meeting existing vaccine demand is no longer the main challenge, according to Kates.

“We feel like we're getting to the point where the people that are left are very hard to reach and need assistance and more education, or those that are resistant and don't want it,” she said, adding that “the pent-up demand is being met.” 

The question is what the response to the slowdown will look like. “How does the federal government, state government, and the private sector communicate to the public the importance of vaccination?” Kates asked.

States see demand slowdown

In tandem with the nationwide slowdown, many states are seeing their vaccination paces slide. Eleven states have reported a decrease in shots given for three weeks in a row or more, according to a CNBC analysis of CDC data through Sunday.

In West Virginia, which got off to a hot start with its vaccination campaign, the state has passed the tipping point of vaccine supply outpacing demand. Weekly doses administered have dropped for four straight weeks.

“If you remember, we put a lot of doses in a lot of arms really fast,” said Maj. Gen. James Hoyer, director of West Virginia's Joint Interagency Task Force for Vaccines, noting that his state was among the first to finish vaccinations among nursing home populations. “It was a lot of people who wanted them and were pushing hard to get out and get a vaccine.”

Now, Hoyer says, the state has asked the federal government to deliver doses in smaller vials to reduce the risk of wasting vaccines, something that he couldn't have imagined a few months ago when supply was so short.

“We got the doses and we're really good at administering them,” Hoyer said. “We're in that phase of educating people who are holding out on getting the vaccine.”

For a period of time, New Mexico was leading the country with a larger share of its population fully vaccinated than any other state.

But now the state is facing a plateau and finding it tougher to fill mass vaccination events, said Matt Bieber, communications director for the state's department of health.

“We were at a phase for a while with tons of demand and not enough supply, but now at the point where folks who know about the vaccine have gotten it,” he said.

Logistical hurdles

The share of Americans yet to receive a Covid shot is not exclusively made up of those who don't want one. 

While some are opposed — in a recent Kaiser Foundation poll, 13% of respondents said they would “definitely not” get a vaccine and another 7% said they would only get one if required to — there are also many groups that have not yet had the means or ability to get vaccinated.

“Some people are not able to take time off from work to easily go get vaccinated or may not have transportation,” said Kates, explaining that lack of access is sometimes purely logistical. “They literally lack access in the most fundamental way.”

Hoyer said that many West Virginians can't afford to sacrifice hours of pay to leave work for an appointment. His most successful form of outreach has involved offering vaccinations to employees and their families at local workplaces, where people can take 30 minutes off a shift to get a shot. A recent event at a Toyota manufacturing plant in West Virginia's Putnam County resulted in more than 1,000 vaccinations.

Bieber in New Mexico has received similar feedback. He heard from community members that a group of grocery store workers want to get vaccinated but they work a shift that lasts past the hours that their local clinic is open. Mobile vaccination units that bring shots to people can help with logistical challenges like this, he said.

Lack of internet access is another barrier to getting vaccination appointments that have largely been booked online to date, said Dr. Rupali Limaye, a faculty member at the Johns Hopkins Bloomberg School of Public Health who studies vaccine decision making and has been working with state health departments during the vaccine rollout. She said this is particularly evident in states with larger shares of Black residents, who have traditionally been less likely to have internet access. 

Rural communities in West Virginia and New Mexico may also have limited internet access, Hoyer and Bieber said.

Community outreach

Other barriers to vaccine access include misinformation or lack of education about vaccine safety.

For groups facing more than just logistical issues, states are turning to community leaders and organizations for help with outreach and education.

New Mexico is working with health-care providers to leverage relationships with patients into conversations about getting vaccinated. It has also been hosting virtual town halls aimed at answering questions from community groups, such as the state's Black and Hispanic residents and its population of agricultural workers. 

The town halls typically result in a vaccine registration spike, Bieber says, but the progress is slower going compared with the earlier days of the immunization campaign.

“As we move from a time where we could easily fill a mass vaccination event, it's about convincing people by the tens, dozens, or even one by one,” he said.

Arkansas, for example, is working with health-care professionals, religious and community leaders, and the chamber of commerce to distribute information about vaccines, according to Dr. Jennifer Dillaha, the epidemiologist and medical director of immunizations with the state health department. Some people want a familiar, trusted environment in which they can raise concerns and have questions answered, she said.

In East New York, Brooklyn, vaccines were not initially widely available to residents despite being an area hit disproportionately hard by Covid, according to Colette Pean, executive director of community organization East New York Restoration.

Residents in the neighborhood have high rates of preexisting health conditions like diabetes and asthma, and many are essential workers at grocery stores, nursing homes and in the transit department. A New York Times database shows about 20% of residents with at least one vaccine dose in East New York compared with 30% citywide, and more than 40% in many parts of Manhattan.

People want to get the vaccine, Pean said, but need to know where they can get it, which is better communicated through an in-person approach than a digital one. Her group is working in churches, food pantries, and subway stations to share information on vaccines and public health issues, Covid and otherwise, that exist in the community.

Johnson & Johnson pause

Earlier this month, the Food and Drug Administration and CDC asked states to temporarily halt using the Johnson & Johnson vaccine “out of an abundance of caution” following reports that six women had developed rare blood clots. U.S. health regulators last week lifted the pause after 10 days, saying the benefits of the shot outweighed the risk.

So did the J&J pause play a role in the drop in vaccinations? Kates said it's not enough to explain the full story of the slowdown. 

Only about 8.2 million of the 237 million total shots given in the U.S. to date have been from J&J, though it was being used for an average of 425,000 reported shots per day in mid-April. 

The single-shot option, which is also easier to transport and store, has proven valuable for certain situations and communities, such as in mobile vaccination units and for homeless people who have trouble accessing a vaccination site multiple times.

“We know there are some populations who wanted the single dose or were harder to reach and having a single touchpoint is ideal, so it's possible that some number of people did not get vaccinated because of that,” she said. “But big picture, it's not enough to be a huge shift.”

Indeed, counting PfizerBioNTech and Moderna shots alone, the downward trend still holds true. The combination of those two vaccines peaked at an average of 3 million reported daily shots on April 16 and has declined 13% since then.

The murkier question, though, is whether the J&J halt hurt confidence in the safety of vaccines more broadly and made Americans less likely to get a dose of any of the three vaccine options.

The J&J shot may have been more appealing to those who were hesitant to get a vaccine to begin with. Polling from the Kaiser Family Foundation in March showed that among those who said they want to wait to see how the vaccines are working before getting vaccinated themselves, a larger share would get the J&J one-dose vaccine compared with either of the two-dose options.

However, Kates does not believe the J&J pause was a significant factor in vaccine hesitancy. “From what I can tell, confidence has not been shaken at all,” she said.

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