Half of American adults have received at least one shot of the coronavirus vaccine. Now comes the hard part: persuading the other half to get it.
People were vaccinated outside a live music venue in New Orleans this month. In Louisiana, 40 percent of adults have had one shot even though all adults have been eligible since March.Credit…Emily Kask for The New York Times
By Sheryl Gay Stolberg and Annie Karni
WASHINGTON — Now that President Biden has met his goal to have the coronavirus vaccine available to all adults, health officials around the country are hitting what appears to be a soft ceiling: More than half the nation’s adults have gotten at least one dose, but it is going to take hard work — and some creative changes in strategy — to convince the rest.
State health officials, business leaders, policymakers and politicians are struggling to figure out how to tailor their messages, and their tactics, to persuade not only the vaccine hesitant but also the indifferent. The work will be labor intensive, much of it may fall on private employers — but the risk is clear: if it takes too long to reach “herd immunity” — the point at which the spread of the virus slows — worrisome new variants could emerge that evade the vaccine.
“If you think of this as a war,” said Michael Carney, the senior vice president for emerging issues at the U.S. Chamber of Commerce Foundation, “we’re about to enter the hand-to-hand combat phase of the war.”
Mr. Biden plans an address Wednesday afternoon, in part to mark the week that the United States will exceed 200 million shots. But the distribution of those shots in uneven: New Hampshire has given at least one shot to 59 percent of its citizens, adults and children, Mississippi and Alabama 30 percent.
The laggards are trying to adjust. In Louisiana, where 40 percent of the adult population has had one shot even though all adults have been eligible since March, officials are delivering doses to commercial fishermen near the docks and running pop-up clinics at a Buddhist temple, homeless shelters and truck stops. Civic groups are conducting door-to-door visits, akin to a get-out-the-vote effort, in neighborhoods with low vaccination rates.
In Alabama, fewer than 40 percent of adults have had at least one shot, and Dr. Scott Harris, the state health officer, is trying to reach out to rural white residents, who demonstrate high rates of vaccine hesitancy. They are mistrustful of politicians and the news media, so Dr. Harris is asking doctors to record cellphone videos. “Please email them to your patients, saying, ‘This is why I think you ought to take the vaccine,’” he has pleaded.
Some companies are contemplating running their own vaccine clinics and trying to educate their workers about the benefits of getting protected against a virus that has already killed more than 560,000 Americans. Vaccine mandates could be an option, just as many employers led campaigns to ban indoor smoking. But with the economy gearing up, managers are reluctant to demand inoculation for their employees, fearing too many would seek work elsewhere.
White House officials say they take it as a good sign that nearly 51 percent of American adults have turned out for a first dose — “a major milestone,” said Dr. Bechara Choucair, the White House vaccinations coordinator, and an indication that “there are tens of millions of people who are still eager to get vaccinated.”
But he is well aware that there will come a time when Americans are no longer fighting for vaccine slots, and when supply will exceed demand.
In some parts of the country, that point may be here. In Mississippi, which opened vaccinations to all adults a month ago, 21 percent of the population is fully inoculated. In Alabama, the figure is just 19 percent. In Georgia, home of the Centers for Disease Control and Prevention, just 20 percent of the population is fully vaccinated.
“There are states where they feel they have hit the wall,” said Mike Fraser, the executive director of the Association of State and Territorial Health Officials. “The folks that wanted it have found it. The folks that don’t want it are not bothering to find it.”
The fear is that even as some regions race toward broad immunity, others will harbor coronavirus infections that could transform into more dangerous and more contagious variants, which could break through existing vaccinations.
Mr. Fraser said the soft ceilings in some states do not mean, “‘OK, everybody, give up.’ It’s: ‘What do we need to change? What do we need to pivot to?’”
The C.D.C., for instance, is working with states to identify primary care doctors in neighborhoods with a high “social vulnerability index” to get them vaccines.
“It’s really going to be all about the ground game,” Dr. Choucair said. “It’s going to be about planning at the local level. It’s going to be about microplans. It’s going to be about county by county, ZIP code by ZIP code, census tract by census tract to make sure what are the strategies that work.”
While estimates of what it takes to reach herd immunity vary, most experts put the figure at 70 percent to 90 percent of the population. That figure includes children, who are not yet eligible to be vaccinated. And judging by the vaccination rates so far, herd immunity will be difficult to reach, particularly in red states and in the South.
Polls show that vaccine hesitancy is on the decline, as more people see their friends and relatives get vaccinated without incident. John Bridgeland, a founder and the chief executive of the Covid Collaborative, a bipartisan group of political and scientific leaders working on vaccine education, said the challenge was not being dogmatic in a public awareness campaign, but treating every person’s concern as unique and valid.
But he added that “the last miles here are going to be the toughest.”
“People have very legitimate concerns,” Mr. Bridgeland said, “and they need good answers from trusted people.”
Complicating such reassurances is rising concern about vaccine safety after the government’s decision to “pause” the single-dose Johnson & Johnson vaccine while regulators investigate reports of rare blood clots among six female recipients.
A C.D.C. advisory panel is expected to meet on Friday to determine whether to place restrictions on use of the vaccine, which public health officials had expected to use in hard-to-reach communities, like homeless shelters.
In the meantime, Mr. Fraser said his organization was exploring ways to move away from mass vaccination clinics, which assume “everybody in the population is really chomping at the bit to get vaccinated,” toward “more retail public health,” in which state and local health departments and providers reach out directly to the unvaccinated, almost like a door-to-door campaign.
In some states, there have been surprises. In Alabama, Dr. Harris said, officials prepared extensively to address vaccine hesitancy among African-Americans and put “a lot of time into trying to build local relationships with trusted voices” — an effort that he said paid off. But officials did not anticipate such strong resistance from rural whites.
The state has done polling to figure out how to reach that group, and learned that the techniques used to reach Black people were not likely to work with rural people who “are mistrustful of politicians in general and maybe state government in particular.” But, Dr. Harris said, they do trust doctors.
Yet having individual doctors administer the vaccine poses a logistical challenge for pharmaceutical companies and the Biden administration, which ships doses to states in large quantities. One vaccine maker, Pfizer-BioNTech, ships 1,170 doses in a single pallet; the other, Moderna, ships packets of 10 vials containing 100 doses.
Those amounts are unsuitable for doctors’ offices and smaller settings, which have been the focus of Alabama’s vaccination effort. Dr. Harris said the vaccine packaging “has been disastrous for us.”
Private employers may be the next pressure point. The private sector is eager to jump in and help educate employees — and even administer vaccines, said Kathryn Wylde, the president of the Partnership for New York City, the city’s leading business organization.
But at this point, mandating vaccination for employees does not seem to be on the table. “Employers feel that Covid has caused such stress on their people, they are reticent to put on any more pressure,” Ms. Wylde said.
Shirley Bloomfield, the chief executive of N.T.C.A. — The Rural Broadband Association, which represents small, rural telecommunications companies, has been working with the White House on pushing her members to get the vaccine. “One of my C.E.O.s is paying everyone $100 to get the vaccine,” she said. “But I think we all have to be a little more creative because we’re seeing that saturation point.”
Even with broad public awareness campaigns, television commercials, and incentives like cash payments and personal time off, Ms. Bloomfield said vaccination rates among staffs at her member companies were topping out at about 50 percent to 60 percent.
On top of that, Ms. Bloomfield said her members reported to her that as many as 15 percent of people in small towns were not showing up for their second shot. She attributed some of that to social media posts about side effects. “That doesn’t help us,” she said.
It also does not help that in a highly polarized nation, vaccination is still a topic of political debate. In Tennessee, for instance, Gov. Bill Lee, a Republican, has emphasized that vaccination is a personal choice, a message that Dr. William Schaffner, an infectious disease expert at Vanderbilt University, criticized as “not on the correct wavelength” amid a pandemic that threatens all of society.
When Ivanka Trump, the daughter of former President Donald J. Trump, posted a picture of herself getting vaccinated on Instagram and urged others to do the same, the responses ranged from “nope” to “no thanks.” Her father suggested in a recent interview with Sean Hannity of Fox News that Biden officials “want me to do a commercial” to promote vaccination.
But, Mr. Trump indicated, he was not inclined to do so because of the Johnson & Johnson pause, which he described as “the worst thing possible.”
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