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Health

Ohio coronavirus vaccine demand has slumped. Now comes the long slog toward herd immunity. – cleveland.com

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.

Ohio vaccinated, not vaccinated and not eligible, April 22

While nearly half of the age-eligible Ohioans have been vaccinated, nearly a fifth the the state – the 2.3 million children under the age of 16 – have not been approved by the federal government to receive any of the vaccines. This chart shows the share of Ohioans who have received at least one dose.Rich Exner, cleveland.com

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.

Ohio coronavirus vaccination rates by county, April 22

The urban centers around Cleveland, Columbus, Cincinnati and Toledo have among the highest vaccination rates in Ohio, based on data available through Thursday.Rich Exner, cleveland.com

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.

County Population
Age 16 up
One
dose
Pct. All
doses
Pct.
Delaware 153,408 105,370 68.7% 73,686 48.0%
Warren 178,795 99,135 55.4% 72,977 40.8%
Wood 106,853 57,790 54.1% 45,673 42.7%
Geauga 75,124 40,456 53.9% 29,699 39.5%
Medina 142,714 76,852 53.9% 54,982 38.5%
Lake 189,395 100,876 53.3% 68,010 35.9%
Union 44,524 23,648 53.1% 17,057 38.3%
Ottawa 34,088 18,093 53.1% 14,138 41.5%
Cuyahoga 1,017,354 521,593 51.3% 378,209 37.2%
Franklin 1,019,324 519,699 51.0% 359,708 35.3%
Summit 441,370 222,349 50.4% 157,848 35.8%
Hamilton 645,956 324,874 50.3% 238,179 36.9%
Lorain 248,229 124,762 50.3% 88,839 35.8%
Henry 21,615 10,378 48.0% 8,047 37.2%
Erie 61,552 29,418 47.8% 22,856 37.1%
Greene 136,388 65,056 47.7% 49,422 36.2%
Lucas 342,588 163,109 47.6% 124,339 36.3%
Fairfield 121,887 57,687 47.3% 42,237 34.7%
Mahoning 189,231 88,095 46.6% 67,561 35.7%
Clermont 161,992 75,144 46.4% 54,295 33.5%
Montgomery 427,551 198,310 46.4% 150,429 35.2%
Putnam 26,249 11,913 45.4% 10,225 39.0%
Licking 137,872 62,500 45.3% 47,961 34.8%
Butler 300,636 134,463 44.7% 93,091 31.0%
Sandusky 47,268 21,084 44.6% 16,428 34.8%
Portage 135,933 60,443 44.5% 41,950 30.9%
Clark 108,131 48,055 44.4% 39,196 36.2%
Trumbull 164,324 72,515 44.1% 53,048 32.3%
Stark 301,461 132,073 43.8% 91,937 30.5%
Fulton 33,522 14,599 43.6% 11,877 35.4%
Madison 36,168 15,727 43.5% 11,862 32.8%
Hancock 60,861 26,294 43.2% 20,693 34.0%
Wyandot 17,618 7,456 42.3% 6,018 34.2%
Muskingum 68,863 29,143 42.3% 25,264 36.7%
Defiance 30,495 12,878 42.2% 10,421 34.2%
Washington 49,998 20,957 41.9% 16,934 33.9%
Ashtabula 78,853 32,856 41.7% 24,443 31.0%
Miami 84,088 34,659 41.2% 27,252 32.4%
Seneca 44,654 18,242 40.9% 14,265 31.9%
Athens 57,409 23,205 40.4% 17,432 30.4%
Pickaway 46,894 18,763 40.0% 14,162 30.2%
Ross 62,382 24,836 39.8% 20,552 32.9%
Hocking 22,937 9,070 39.5% 7,316 31.9%
Huron 45,821 18,077 39.5% 13,791 30.1%
Marion 52,912 20,845 39.4% 15,547 29.4%
Williams 29,453 11,446 38.9% 9,859 33.5%
Jefferson 54,870 21,287 38.8% 16,630 30.3%
Monroe 11,414 4,401 38.6% 3,725 32.6%
Van Wert 22,433 8,611 38.4% 6,706 29.9%
Jackson 25,476 9,765 38.3% 7,719 30.3%
Crawford 33,706 12,864 38.2% 10,719 31.8%
Scioto 61,448 23,219 37.8% 19,874 32.3%
Columbiana 84,499 31,835 37.7% 25,113 29.7%
Wayne 91,002 34,228 37.6% 25,052 27.5%
Guernsey 31,460 11,816 37.6% 9,865 31.4%
Gallia 23,969 9,000 37.5% 7,613 31.8%
Knox 49,017 18,317 37.4% 14,819 30.2%
Paulding 14,867 5,506 37.0% 4,492 30.2%
Champaign 31,345 11,441 36.5% 9,251 29.5%
Carroll 22,402 8,152 36.4% 6,434 28.7%
Tuscarawas 73,768 26,841 36.4% 21,094 28.6%
Richland 97,923 35,471 36.2% 28,340 28.9%
Clinton 33,281 12,048 36.2% 10,031 30.1%
Belmont 56,646 20,504 36.2% 15,705 27.7%
Allen 82,102 29,588 36.0% 25,350 30.9%
Noble 11,944 4,302 36.0% 3,533 29.6%
Auglaize 36,050 12,975 36.0% 10,980 30.5%
Harrison 12,494 4,492 36.0% 3,535 28.3%
Pike 22,177 7,942 35.8% 6,788 30.6%
Morgan 11,959 4,280 35.8% 3,611 30.2%
Meigs 18,704 6,688 35.8% 5,599 29.9%
Mercer 31,612 11,247 35.6% 9,174 29.0%
Logan 36,144 12,827 35.5% 10,490 29.0%
Morrow 28,038 9,858 35.2% 7,708 27.5%
Fayette 22,646 7,960 35.1% 6,263 27.7%
Coshocton 28,823 10,099 35.0% 8,512 29.5%
Perry 28,635 9,827 34.3% 8,083 28.2%
Vinton 10,472 3,492 33.3% 2,925 27.9%
Darke 40,635 13,512 33.3% 11,324 27.9%
Ashland 42,900 14,217 33.1% 9,837 22.9%
Preble 33,028 10,888 33.0% 8,541 25.9%
Hardin 25,075 8,137 32.5% 6,848 27.3%
Shelby 37,941 12,000 31.6% 9,593 25.3%
Highland 34,122 10,386 30.4% 8,466 24.8%
Brown 34,824 10,494 30.1% 7,696 22.1%
Lawrence 48,590 13,897 28.6% 10,821 22.3%
Adams 21,808 5,872 26.9% 4,318 19.8%
Holmes 31,595 5,657 17.9% 4,620 14.6%

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.

Large, small county Ohio vaccination rates

Vaccination rates are highest in Ohio’s most populated counties. In the 15 largest counties with at least 150,000 residents age 16 and up, 49.9% have received at least one dose. But in the 49 counties where there are fewer than 50,000, the rate is just 37.5% for those age 16 and up.Rich Exner, cleveland.com

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.

Vaccines work

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.

Ohio coronavirus hospital rates by age group, April 22

The share of hospitalizations among Ohioans age 70 and up has been cut in half since vaccinations started. And the next age group, those from 50 to 69 years old, are seeing a leveling off in just the first few weeks after all became eligible in mid-March.Rich Exner, cleveland.com

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.”

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