More than 312 million vaccine doses have been shipped to states, pharmacies and clinics and 56% of adults have received at least one dose.
But the pace of the nation’s unprecedented immunization effort is slowing. Inoculations have retreated more than 40% from the peak on April 10 of 4.6 million daily shots. Lines of vehicles at stadium-style mass vaccination clinics are winding down. Coveted appointments that required luck, timing or both a month ago are increasingly unfilled as growing numbers of clinics and chain pharmacies take nonscheduled walk-ins.
The vaccination drive has shifted from full throttle to a slower gear that requires state and local public health agencies to work harder to get shots in arms. Public health workers knock on doors, dispatch mobile clinics to large employers and send doses in smaller quantities to family doctors to reach more people. These outreach efforts will be critical to meet President Joe Biden's new goal of 70% of Americans getting at least one shot by July 4.
President Biden sets goal to have 70% of adults at least partially vaccinated by July 4
President Joe Biden set a new goal to have at least 70% of adults partially vaccinated against COVID-19 by July 4.
Associated Press, USA TODAY
Biden acknowledged the nation is entering a new phase of vaccination that must include education, outreach and convenience to nudge some Americans who have yet to get immunized.
"Now we’re going to have to bring the vaccine to people who are less eager," Biden said Tuesday in a speech outlining his administration's immunization goal. "We also know that there are millions of Americans who just need a little bit of encouragement to get the shot."
The number of Americans getting their first shot has fallen to its lowest level since mid-March – another sign vaccinations are slowing. In the past three weeks, the number of Americans getting their first shot fell by more than half, from a peak of nearly 14 million in the week ending April 13 to 6.5 million in the week ending Monday, according to figures from the Centers for Disease Control and Prevention.
In late February, states could not get shipments fast enough, routinely administering up to 85% of doses within the week they received the doses. That rate has dipped into the mid-70% range over the past few weeks, and the most recent figures show in excess of 65 million doses shipped but not injected in arms – more than double the number of unused doses in late March, CDC figures show.
Louisiana and Iowa are among several states that turned down doses and asked for less-than-full allotments as they manage declining demand. Those doses will be put in a federal pool that states with higher demand can tap if they want more doses than their population-based allotments, senior Biden administration officials said.
Other states and cities turned to financial incentives to get people inoculated.
The city of Detroit will hand out $50 prepaid debit cards to people who take a resident to get a vaccine shot. West Virginia, which set a quick pace during the opening weeks of the nation’s vaccination effort, will hand out $100 savings bonds to residents ages 16 to 35 who get a vaccine.
“We’ve known that at some point in time, you had to hit a wall,” West Virginia Gov. Jim Justice told USA TODAY. “You develop some level of resistance.”
The early weeks of immunization proved easier for states and local public health departments to manage. Deliver doses to hospitals and nursing homes or set up mass-immunization sites, and people flocked to get the vaccine.
The nation now enters a roll-up-the-sleeves phase of vaccination to reach Americans unable or unwilling to get vaccinated. That includes people who live in underserved communities, face obstacles such as a lack of transportation or access to health care or can't get time off work or school.
It also includes those who are skeptical about immunization. Public health officials want the help of doctors who can talk with patients one-on-one about the importance of COVID-19 vaccines.
Smaller medical offices had limited access to vaccines in the early weeks as states set aside doses for mass immunization clinics and hospitals to inoculate health workers.
Doctors will be part of "an intense ground game" to reach Americans who have not been vaccinated, said Dr. Steven Stack, commissioner of the Kentucky Department for Public Health.
Public health officials urged the federal government to encourage drug companies to ship smaller quantities of vaccine, which will be needed as more targeted efforts require fewer doses, Stack said.
Vials that contain 10 doses might be too large for doctors who consult an unvaccinated patient during a routine visit. If only one patient per day agrees to get vaccinated, the remaining doses in an open vial could be wasted.
Dr. Ngozi Ezike, director of the Illinois Department of Public Health, said she expects more doses will be wasted because it's impossible to predict which primary care patients will agree to get vaccinated each day.
Doctors don't want to deny vaccines over fear of wasting doses or referring people to a clinic at another time or place. "We do need to take advantage of anyone who made that decision and not then refer them to another location," Ezike said on a call with reporters.
Doctors are “trusted messengers” for people unsure about vaccination, said Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention
“We are not writing them off,” Shah said. “We keep respect and equity front of mind. … Treating earnest questions with disdain has never changed anybody’s mind.”
Gov. Justice conceded his plan to reward younger adults with savings bonds is unconventional.
West Virginia charted its own course and developed a vaccination pace faster than most other states during the early weeks of vaccination. The state tapped the National Guard and partnered with 250 local and independent pharmacists to administer vaccines rather than relying on national chains CVS and Walgreens like other states.
About 52% of residents have received at least one vaccine dose, but fewer than one-third of young adults are immunized, according to state figures. The Republican governor hopes enticing younger adults with savings bonds paid with federal funding from the Coronavirus Aid, Relief and Economic Security Act will lift West Virginia's vaccination rate high enough to make it difficult for the virus to spread.
If the state’s vaccine rate reaches 70% of eligible residents, “I can shut this thing down. I can stop people from dying,” Justice said.
West Virginia will deploy mobile vaccination clinics to hard-to-reach communities and large employers. It will send doses to federally qualified community health centers, which serve as the primary health provider for about 1 in 4 residents.
"We’re surely going to take the vaccines to the people," Justice said. "But we also need the people running to us."
A major obstacle is reaching people who are unable to take time off work, said Joe Peal, chief of staff for the state's National Guard-led Joint interagency Task Force that coordinates and strategizes vaccine supply.
The task force sent surveys to employers to gauge interest on worksite vaccine clinics for employees and family members. The state held clinics at coal mines and a Toyota manufacturing plant to reach workers unable to take time off to go to a mass immunization site or other community clinic.
West Virginia dispatched public health workers to community events. A mobile clinic sent to a basketball tournament yielded 16 vaccinations. Other mobile units will be sent to state parks over Memorial Day and to dozens of summer festivals.
A month ago, the task force considered thousands of shots a successful day, Peal said. The state's goal has since shifted – every vaccination is a potential life saved, he said.
“Now you are in that group of people who say, ‘I think I’m going to take it, (but) I’m unsure,’” Peal said. “It’s a different phase.”
Outreach efforts have focused on getting vaccines to underserved communities. Public health experts warned rural residents who object to vaccination for political reasons or personal beliefs will be harder to convince.
“We are reaching out to minority populations, ethnic groups, and that’s yielding positive results,” said William Schaffner, a professor of preventive medicine and infectious disease specialist at Vanderbilt University School of Medicine in Nashville. “But the politically stubborn, they are hard to reach.”
As of Monday, 35% of Tennessee residents had received at least one shot. The vaccinated rate was higher in metro regions such as Davidson and Knox Counties, while rural counties reported lower rates, according to Tennessee Department of Health figures.
Schaffner said he believes vaccination rates would improve among those who object for political reasons if the governor, state and local elected officials would discuss the importance of vaccination. Business leaders, chambers of commerce and religious leaders also should promote vaccination, Schaffner said.
Schaffner said there's "a real political veneer" to the portion of the population that has refused vaccination. Without strong endorsements from local political and business leaders, it might be difficult to convince people to get vaccinated.
"It’s everybody’s individual responsibility to make this decision. The question is, what is the most responsible thing you can do?" Schaffner said. "The most responsible thing for you to do is get vaccinated to protect yourself and your family and your whole community."
Contributing: Janie Haseman, Mike Stucka
Ken Alltucker is on Twitter as @kalltucker or can be emailed at alltuck@usatoday.com
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