COLUMBUS, Ohio – Millions of Ohioans couldn’t get a coronavirus vaccine jab soon enough.
They believed in the science, were lonely for their loved ones and wanted to travel or see the office again. They put their names on vaccine waiting lists, regularly tracked their eligibility and loaded — and reloaded and reloaded — websites of providers, hoping for an open appointment.
Then, the impatient, sometimes frantic demand for the vaccine came to a screeching halt.
Appointments are now available in every corner of the state. There’s so much unused vaccine in the past couple of weeks that the state has been able to shift thousands of doses to regions with COVID-19 surges. Starting this week, vaccine clinics at the Summit County Fairgrounds are being scaled back from three to four a week to once a week. Mercer County in Western Ohio ended its mass vaccination clinic altogether, and is now sending doses to providers that serve minority communities.
The abrupt plunge in vaccine demand has occurred in the past month, when the people who wanted shots finally received them. Since then, the state has continued to receive weekly allocations of vaccines, but the number of people lined up has dwindled.
The sudden plunge in demand was even a shock to Dr. Michelle Medina, Cleveland Clinic Community Health’s associate chief of clinical operations.
“I think there was always going to be a slip between not enough, a lot of demand to a lot of supply, less demand,” she said. “What has been surprising is how quickly that came down. Everybody was expecting they’re going to have a big surge and maybe a tail-off. But what ended up happening is it was almost like we hit a wall.”
Ohioans age 16 and older are eligible for the vaccine. This is 9.4 million people. However, not even 4 million Ohioans have completed the vaccine, defined as receiving a second dose or the single-dose Johnson & Johnson shot.
Aside from some Ohioans who cannot take the vaccine due to medical conditions, millions of Ohioans are hesitant. Public health officials said many are on the fence — rather than dead-set opposed — and they remain hopeful that the state will eventually achieve herd immunity.
But it may take a while before Ohio gets there.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says he thinks herd immunity will be achieved when 75% to 85% of the population is vaccinated.
But it may not have to be that high.
Medina said that the number Fauci uses is one that gets communities to herd immunity with other vaccines. But the exact number with COVID-19 isn’t yet known.
“That may be the number we need here,” she said. “But what if it’s a lower number — just because they’re so effective? Pfizer and Moderna are both above 90%.”
A study in Israel found that with every 20 percentage point increase in adult vaccination rates in a community, the risk of children testing positive halves. The study hasn’t been peer reviewed.
It’s unknown whether the same protection for children will be found in the U.S., which is much larger and has a different pace of vaccinations, Medina said.
Some people are hesitant about getting vaccinated because the vaccines were developed so quickly in comparison to previous ones. They are concerned about long-term effects that haven’t yet been documented. People hear contradictions, such as 95% efficacy for one vaccine but 72% for another, Medina said.
“You’re going to have people be completely against it — and I think that’s probably a lower number — and then you’re probably going to have a fair number of people who continue to sit on the fence and say, ‘Well, I may wait another week, maybe another few weeks, maybe a few months just to see how this is going to shake out,’” she said.
Nearly a fifth (19.7%) of Ohio adults say they either probably or definitely won’t get the vaccine, according the Census Bureau’s Household Pulse Survey completed at the end of March.
Among these people, better than half (53.7%) said they were concerned about side effects. More than one reason could be cited by individuals. Not trusting the COVID-19 vaccine were 41.7%, and 40.3% said they didn’t believe they needed it.
More people, however, have grown interested in getting the vaccine. In early January, 25.5% of Ohio’s adults said they probably or definitely would not get the vaccine.
But Ohio during both periods lagged the national rate, which fell from 21.5% in the survey completed in mid-January to 15.6% at the end of March.
Nationally, among those with bachelor’s degree, 7.9 % said they probably or definitely would not get the vaccine. This compared to 17% among those with some college education, and 20.4% who had a high school degree but did not go to college.
The national rate was the same among men and women.
Age 16 up
There is a clear urban/rural divide in Ohio, with the rural numbers being driven down by low vaccination rates in several small southern Ohio counties.
Among Ohio’s largest counties – the 15 where there are at least 150,000 residents age 16 and up – nearly half of age-eligible people (49.9%) had received their first dose, based on Ohio Department of Health reporting through Thursday.
Yet in the 49 smallest counties with fewer than 50,000 people age 16 and up, 37.5% had received their first vaccine.
Ashtabula County Health Commissioner Ray Saporito said there are reasons for the gap. At the beginning of the pandemic, outbreaks were concentrated in urban areas. It took longer for Ashtabula County to become a “red” county in the state’s Public Health Advisory system.
“I think there was a perception of, ‘Oh, I’m not going to get this.’ I think the numbers play a role,” he said.
The urban areas had mass vaccination clinics, which were well-publicized and convenient.
“We did not have that luxury,” he said.
Much of the hesitancy in his area is among younger people, he said.
“In the very beginning when the vaccine was made available to us, we had waiting lists that were, gosh, we had 3,000 to 4000 on a waiting list,” he said. “The people who really wanted this, most of the people who took the vaccine, percentage-wise, are going to be the older people. I’d say 60 and above were more motivated. They perceived themselves as more vulnerable. The younger people – 30-, 40-, 50-year- olds, I think they were less motivated.”
The federal government’s pause on administering the Johnson & Johnson shot — after six women had severe blood clotting out of 6.8 million doses administered – may have also rattled people who were skeptical about the vaccine, Saporito said.
The disinterest in getting vaccinated among some Ohioans comes despite strong evidence of them working. For example, hospitalizations have dropped dramatically for the older people who were the first to be offered vaccines.
In December, just as the vaccines were getting started, Ohioans age 70 and older accounted for 51% of all coronavirus hospital admissions. That share has dropped to just 26% this month.
And data is starting to show a change for the next groups eligible as well. For example, those age 50 and older became eligible for shots in mid-March. Already, their share of hospitalizations has leveled off, following what had been an increased share in previous months as fewer older people were admitted.
Yet the share of hospitalizations is on the rise for younger age groups, those both to be last offered the vaccine and with the lowest vaccine rates.
At the state level, Gov. Mike DeWine has encouraged vaccine providers to work with labor unions, employers and other groups to offer vaccine clinics in an attempt to distribute more shots.
That appears to be working, although not on a massive scale.
For instance, in Union County, outside of Columbus, Scott’s Miracle Gro recently held two weekend drive-up clinics for employees and others in the community; 800 people were vaccinated.
In Lucas County, where contagion is especially high due to the proximity with Michigan and virus variants, health officials are targeting neighborhoods by studying ZIP codes where vaccination rates are lower.
Alternating between small community clinics and larger clinics seems to be working in Cuyahoga County, said Kevin Brennan, communications officer for the Cuyahoga County Board of Health, who said he isn’t seeing a lot of vaccine hesitancy.
Each week on Tuesdays and Wednesdays, a mass vaccination clinic alternates between The Word Church in Warrensville Heights and Cuyahoga Community College Western Campus in Parma, he said.
“This past Tuesday and Wednesday, we were at 95% percent capacity, in terms of the number of people we put through in a day,” Brennan said.
Last weekend, the health department worked with the Islamic Center of Cleveland at its location in Parma. Approximately 200 people were served. And on the east side, the department works with the Salvation Army to host clinics, he said.
The Cleveland Clergy Alliance and other organizations also arrange to give people rides.
State health officials and the governor’s office will continue to look for ideas to target vaccinations, said DeWine’s spokesman, Dan Tierney.
On Wednesday, DeWine disclosed he’s considering changing the metric for which all public health orders – from the mask mandate to the rules at schools – will be lifted. Currently, cases need to drop to 50 per 100,000 residents over two weeks for life to return to what it was before the pandemic.
But now he’s thinking about switching to a vaccine benchmark. Kentucky Gov. Andy Beshear earlier this month created one for his state.
This could work as an incentive for people to get vaccinated and, in the end, increase vaccine demand. And it’s easier for the public to track vaccination progress on the Ohio Department of Health’s coronavirus dashboard, than cases per 100,000 residents, which is an average that requires some digging into the dashboard, plus some math to calculate.
“By no means is that the end of it,” Tierney said about the state’s efforts thus far to increase demand. “We’re constantly looking at it and will move on to new initiatives in the state.”