Pennsylvania herd immunity in jeopardy as vaccine demand falls off and hesitancy persists

Sam Ruland
York Daily Record

As the number of Pennsylvania residents with at least one dose of the COVID-19 vaccine passed 50%, state officials have said there would be enough vaccine to immunize 80% of everyone 16 and over by the end of June.

That would mean Pennsylvania could hit a key target to achieve herd immunity before the 4th of July.

"Wouldn’t that be a wonderful 4th of July celebration, to hit 80% community immunity in the state of Pennsylvania?" said Acting Physician General Denise Johnson. "I mean we can't really put a timeline on it, but it's nice to think about."

Dr. Anthony Fauci, the nation’s top infectious disease expert, has said the nation must achieve a vaccination rate of about 80% to reach herd immunity. Other health experts have said herd immunity won’t be reached until 90% of the population is vaccinated.

"Herd immunity, as it relates to coronavirus, means that there are so many people that are immune in society that the virus really doesn’t have much room to circulate," Johnson said. "So the few people that are not immune are unlikely to encounter the virus and get sick."

But numbers aside, getting enough people vaccinated is the way to get life closer to normal and keep people safe, said Jenny Englerth, president & CEO of Family First Health, a not-for-profit health care system dedicated to providing quality and cost-effective care in urban and rural communities throughout south central Pennsylvania.

"We’re talking about an illness that in a single year became not only the leading cause of death, but by a significant margin, outstripping cancer, outstripping heart disease, not to mention all the people who got severe infections who didn’t die but who may have medical consequences for years to come," she said. 

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"If you personally are not vaccinated and you get infected, ballpark, there’s a one in 50 chance of dying from it and a much higher chance of having a severe illness that could have consequences. It’s a severe deal, and by all measures so far, with a lot of very careful scrutiny, these vaccines are quite safe, even with the few question marks that have been raised about the Johnson & Johnson vaccine."

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Herd immunity remains in doubt in Pa.

To date, a little more than a quarter of the Pennsylvania population over the age of 16 has been fully immunized — a milestone, no doubt — but the uptake has slowed in the last month and some counties are speeding far ahead of others in the rollout, sparking renewed concerns of hesitancy.

On Monday, Pennsylvania reported 88,440 vaccinations over a two-day period, a 50% decrease from the 178,623 doses reported three weeks ago on April 12, according to Pennsylvania Department of Health data. 

The recent pause on the Johnson & Johnson vaccine likely didn't help matters, but any hesitancy is likely due to a combination of factors, including misinformation, political leanings and differing levels of education, said Dr. Frederic Bushman, co-director of the Penn Center for Research on Coronaviruses and Other Emerging Pathogens.

"I think people hear what they want to hear. … but there are some areas of hope when it comes to vaccine hesitancy," Bushman said. "Hopefully, one person at a time, we can get the message out and overcome some of the barriers of this hesitancy business."

Even before the first COVID-19 vaccine received approval late last year, talk swirled about whether some people’s reluctance to be vaccinated could jeopardize the goal of herd immunity. Many conversations focused on persuading minority populations that have a well-earned history of distrust of mainstream medicine to accept the vaccine.

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Five months into the nation’s most ambitious vaccine rollout program ever, it has become clear that it may not be just a matter of encouraging people of color to accept the vaccine. Studies suggest that white Evangelicals and conservative Republicans are exhibiting far deeper entrenched vaccine hesitancy.

Two polls out, one from Monmouth University in New Jersey and the other from Connecticut’s Quinnipiac University, found that about 45% of Republicans have no interest in vaccination. A March Pew Research Center poll found that about the same percentage of people who identified themselves as white Evangelical Christians would not agree to vaccination.

If people in these communities, which often overlap, hold out against vaccination, the pandemic could last a lot longer, many fear.

"Hesitancy is a wide spectrum. People have diverse and wide reasons for not getting the vaccine or not getting it right away," Johnson said. "So we have to be patient and persistent, and get ready, the more people vaccinated in our state, the safer we will be."

Age also appears to play a role. In Pennsylvania, the number of vaccinated individuals decreases steadily by age. As of Monday, 34.3% of Pennsylvanians 55-59 are vaccinated. That drops to 29% for Pennsylvanians 50-54, despite registration opening only days apart. 

The contrast grows starker with younger age groups. Just more than 11% of Pennsylvanians 30-34 are vaccinated, compared with 7.7% of Pennsylvanians 20-24 and 2.2% of those 16 to 19. 

Statewide, nearly 5.4 million Pennsylvanians, or 50.3% had received at least one dose of the vaccine as of Monday. Across the U.S., more than 246 million doses have been administered so far, according to the Centers for Disease Control and Prevention.

"We think that all of the people that are really interested in getting the vaccine have already done it," Englerth said. "Now we’re down to two sets of people — one is those who aren’t going to get it no matter what and those who are really hesitant and haven’t made up their mind."

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Some think vaccine is just too risky  

The Johnson & Johnson vaccine pause after six women experienced severe adverse effects both played into fears about vaccines and sidelined those who were willing to take the time for a single-dose vaccine but not to schedule two doses. 

Even though the Johnson & Johnson vaccine returned, people who preferred it before may now be shying away from all of the vaccines, public health officials fear.

The Johnson & Johnson news may only confirm the doubts of the vaccine hesitant like Megan Stoner. A 23-year-old York resident, Stoner had no plans to get vaccinated before the Johnson & Johnson vaccine was pulled, and has no plans to do so now. 

Three to five years down the road, Stoner said, she might consider vaccination but for now she’s resolute, even though she fears not having had the shot might keep her out of concerts or other events that stipulate attendees must be vaccinated.        

"It’s because it’s so new," she said. "I think there’s more that they’re not telling us, with how quickly it came about. It’s just too risky."

Erin Crandall also is not rushing to get the vaccine. A 39-year-old Dauphin resident, she is waiting to see what happens. 

Most of her friends and some family members have been vaccinated. Crandall, who said she’s been exposed to COVID-19 multiple times, says she doesn’t feel at risk.

"I just kind of want to learn more about this and understand better about how this is going to work. I like to know there’s a bigger plan and right now I think it’s by the seat of our pants and figure it out as you go," said the mother of two young children. "I just want to see where the science goes with this because in past years, things have changed so much so drastically so often."

Who is hesitant to get the vaccine and why

People fall into five categories when it comes to the vaccine, according to a January study by Surgo Ventures, a non-profit in Washington, D.C., that studies health data.

  • About 40% of the population eagerly awaited the vaccine and were immunized as soon as possible.
  • Another 20% said they would wait a few months.
  • About 14% were "cost-anxious," did not want to pay for a vaccine or spend time scheduling or traveling for a shot. All three vaccines, though, are free. 
  • Just under 10% were system distrusters, which included Black people who often do not have faith in the medical field because of long-standing equity issues.
  • The final 17% will not get the vaccine because of misinformation either about the vaccine’s development or the pandemic in general.

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In April, Surgo Ventures conducted another survey and found that while fewer people fit into the cost-anxious, system distruster and watchful waiting groups, about the same percentage of "conspiracy believers" still had no intention of getting the vaccine.  

Given these numbers, the study estimated, just over half of Americans will be vaccinated by July. About a third will still hold out, the study found.

"We do think that remaining group might be particularly hard to convince," Englerth said. "It’s a really big question in the vaccine confidence world: How do you build trust enough that you convince people to get vaccinated? It’s meeting people where they are and listening to their concerns."

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The art of persuasion

State and county officials have acknowledged that it's time for a shift in COVID-19 vaccine strategy.

Weeks and months ago, getting a COVID-19 vaccine appointment was a big deal. Demand was high and supply was not keeping up. Appointments posted for sites disappeared in minutes. But now it's getting to the point where there are enough doses but a declining interest in getting them. 

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Public health officials are doing more to promote the vaccine and encourage residents to take it.

"We can’t do this alone. We need each person who has been vaccinated to be an advocate. If they have been vaccinated, they know that the vaccines are safe, you know that they’re effective, and you know that they’re available to all. So people need to help spread the word," said Eric Kiehl with the Pennsylvania Association of Community Health Centers.

Counties are also working to spread the word by partnering with community organizations such as churches and other groups and having trusted local leaders encourage people to get vaccinated. 

There's also some recognition that getting vaccinated needs to be more convenient, because some people are never going to make use of large-scale vaccine sites for various reasons, including transportation issues and language barriers. 

York County, for example, is launching mobile vaccine units that don't require appointments. The DOH has been partnering with healthcare providers to offer more vaccine pop-up events in individual communities. And the state is opening some of its large sites to walk-ins who don't have appointments.

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Health officials have sent out flyers, made calls, videos and reached out to local churches all to encourage vaccine holdouts to reconsider. Still, less than a quarter of Franklin County residents have been fully immunized.

"I think younger people just aren’t interested in it right now, I don’t know the reason," Kiehl said. "I hope they come around but I won’t be surprised if they don’t."

In the Philadelphia region, where officials once claimed they were being shortchanged on vaccine doses to meet demand, both Bucks and Montgomery counties are now offering walk-in appointments at vaccine clinics. 

Lancaster County, where a large portion of the population is Amish, has long struggled to increase the rate of childhood immunizations among their residents. They knew the new COVID-19 vaccine would pose a challenge. Health officials have placed ads in publications geared towards the Amish and have met with respected bishops, said D. Holmes Morton, a pediatrician and researcher known for his work with the Amish and Mennonite communities. He also operates the Central Pennsylvania Clinic in Belleville focused on treating rare genetic diseases among Plain sect people.

But it’s not just the Amish that need to be persuaded, noted Kiehl.

"More than one person has been worried that there’s a chip in the vaccine that the government is putting in you," Kiehl said. "If you did a poll in our community, you’d be surprised how many people believe that’s true. It just shows the misinformation out there."

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