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The Guardian

Decline in US Covid vaccinations poses new problem: how to cut operations

With less than a third of Americans fully immunized, health officials are moving from mass vaccination clinics to awareness campaigns. View of the American Museum of Natural History vaccination site in New York City on April 23. Photograph: Angela Weiss / AFP / Getty Images A drop in daily vaccination rates against Covid-19 has left US public health officials with a new problem: how to effectively scale down operations. In the campaign to immunize all American adults against the coronavirus, most of the difficulties to date have involved overwhelming demand and tight supply. Now, with less than a third of Americans fully vaccinated, local public health officials have described a whiplash feeling as they move from mass vaccination clinics to awareness campaigns, all within weeks. “We knew that when people became eligible, people who were ready to receive [would] get out right now, ”said Mary Jo Brogna, director of nursing at Harbor Health Services, who runs a community clinic in Cape Cod, Massachusetts. “Achieving the final percentage of herd immunity,” estimated to be at least 70% of all adults, “will depend on awareness and resolution of any hesitation about vaccines,” Brogna said. For most of 2021, the history of the vaccination campaign has been an overwhelming demand. Emergency authorities have taken control of stadiums, big box stores and community centers staffed with dozens of nurses and volunteers to immunize thousands of people a day. But in the past two weeks, daily immunization rates in the United States have peaked, from a high of 3.2 million vaccine administrations per day to 2.5 million. Today, national health officials know what red states like Mississippi and Wyoming have started to see with the first signs – a major slowdown. “Across the country we started with mass clinics and these mass clinics were working very well for the elderly,” said Gary Edwards, executive director of the Salt Lake County Department of Health in Utah. The mass clinic model is not reaching the segment of the population that we are trying to reach Gary Edwards However, he said, “We have reached a point, and it has been very interesting to see how quickly that has gone. ‘occurs, that the mass clinic model does not reach the segment of the population that we are trying to reach, ”Edwards said. The phenomenon is repeating itself across the country. Local authorities in Los Angeles, California; Colorado; Florida; Nevada and Texas are set to shut down mass vaccination sites by the end of May. Georgia has already decided to close all its mass vaccination sites by the end of May, citing a lack of demand. The state is far behind the country in terms of vaccine administration, with 34% of the population having received at least one dose, compared to 43% nationally. In Galveston, the public health director has apparently called for a “pause” on vaccine shipments because he feared the district could use all those shipped before they expired. The reasons for the slowdown are mixed, most experts said. Reluctance about vaccines, especially among conservatives and racial minorities, plays a role. But so do the difficulties with schedules and transportation, as working-age adults lag far behind older people in terms of vaccination rates. One of the most notable trends in the vaccination campaign is the relatively low vaccination rate among adults aged 18-49. In this age group, 9 to 12% of people are fully vaccinated, compared to over 27% in people aged 50 to 64. “I had a patient the other day where I was trying to go through the online planning process with him and we kept hitting a wall,” said Dr. Ann Chahroudy, pediatric infectious disease specialist and faculty at Emory University in Atlanta, Georgia. Importantly, hers could also be one of the most important groups to be vaccinated. In the summer of 2020, research in the journal Science found that working-age adults 20 to 49 were the most likely to transmit the disease to more than one person. “So adult workers who need to support themselves and their families have fueled the resurgence of epidemics in the United States,” concluded an international group of researchers. The same age group appears to be behind cases in states like California and Utah. Also noteworthy is the lack of adoption in conservative regions. CDC data shows that the southern and western states have the highest levels of vaccine reluctance, and uptake is particularly low in those states. Several polls have now revealed that Republicans are more likely to say they will not get the shot. “Reaching out to these young Republicans and conservative groups is becoming a priority because it’s the difference between normalcy or something less,” said Dr. Peter Hotez, vaccine researcher and dean of the National School of Tropical Medicine at Baylor College from Houston, Texas. The lack of vaccination, he said, “will not be distributed evenly. This means that Covid-19 is becoming a disease of the red state ”. The politicization of the pandemic and the rejection of science to the right, especially by Donald Trump, has led many influential conservative experts to question the public health measures of Covid-19 – from Fox News’ Tucker Carlson to influential podcaster Joe Rogan. “We have to wrest the anti-science out of the Republican Party,” Hotez said. “We must help our conservative brothers and sisters.” High levels of vaccine reluctance are also blamed on imbalances in supply and demand, as in Illinois. But, as Cape Cod shows, the whole story is much more nuanced. Barnstable County, regionally known as Cape Town, has the lowest vaccine reluctance rate in the country. According to data from the United States Centers for Disease Control and Prevention (CDC), only 6% of residents are somewhat hesitant. The county has administered more vaccines than any other in Massachusetts, and 59% of people here have received at least one dose of the vaccine, compared to 43% nationally. Simply put, it is a success. Nevertheless, demand has also stagnated at clinics in Brogna, and public health authorities are still trying to understand why. “We survey our own patients,” Brogna said. “We reach out and look at patients who haven’t been vaccinated to say, ‘Damn, we’ve contacted you three times and noticed you haven’t scheduled a Covid vaccine. Can we talk about it? “, She says.



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