Coronavirus vaccine is key to Fresno’s return to ‘normal.’ So why is demand plummeting?
Throughout the first nine months of coronavirus’ rampage in California and the United States, public health officials – and many in the public – pinned their hopes on the development of vaccines to bring a swift end to the global pandemic and pave the way for a return to a pre-COVID-19 way of life.
Indeed, when the first vaccines were granted emergency-use authorization by the U.S. Food & Drug Administration, supplies of vaccine needed to be rationed and prioritized for front-line health care workers, and other industries clamored for the protection afforded by the shots.
As pharmaceutical companies ramped up their production to meet the demand, eligibility for vaccines was gradually expanded to senior citizens, police and firefighters, teachers, and food and agriculture workers and, eventually, everyone ages 16 and older.
While a shortage of vaccine supply early on was a frustration for health officials in Fresno County and elsewhere, they’re confronting a different problem now: too few people willing to get the shots.
Over the past few weeks in particular, demand for the vaccines has plummeted not only in Fresno County and surrounding counties in the central San Joaquin Valley, but across California and nationwide. And that’s weighing like an anchor on hopes to vaccinate enough people to achieve what scientists call “herd immunity” – a critical mass in which enough people are protected against the virus that the contagion has very little opportunity to spread.
In Fresno County, interim health officer Dr. Rais Vohra said that’s about 75% of the county’s 1 million residents. Early on in the vaccine rollout, the Fresno County Department of Public Health set a goal of giving 1.2 million doses of vaccine by the end of this summer – enough, with a two-dose regimen for the two earliest vaccines, to afford full protection to about 600,000 people, or about 60% of the county’s overall population.
Demand for vaccines peaked in late March when almost 60,000 Fresno County residents were vaccinated each week, either through mass vaccination sites, clinics and special pop-up vaccine events in rural communities, or a growing number of retail pharmacies such as Rite Aid, CVS, Walgreens and, now, Walmart.
So far in Fresno County, about 652,000 doses have been provided, including to about 285,000 people who are now fully vaccinated. But the pace has dropped off dramatically. Last week, the number of doses provided was less than half what it was just three weeks earlier.
“If everyone who has gotten a vaccine can just convince one person, imagine what that would do … then I think we would be there,” Vohra said this week. “It really is going to require that kind of grassroots local persuasion for us to get into these pockets that are not being well-represented” in the vaccine effort.
No longer, it seems, is protection against the risk of sickness, hospitalization or death from COVID-19 – or a desire to put the pandemic far off in the rear-view mirror – enough to persuade people to get their shots. Now, county officials are scratching their heads and looking for ways to create additional incentives for people to be vaccinated.
Gift cards or certificates for groceries and coffee shops, or tickets to minor league baseball or the local zoo, are the newest tactics being explored to get people to roll up their sleeves, said Joe Prado, Fresno County’s community health director.
A slow start, then picking up steam
For a time, vaccination progress in Fresno County looked very good. By early February, less than two months after the first shots were given, the county had reached 100,000 doses, including more than 26,000 who were fully vaccinated.
Several weeks later, by early March, another 100,000 doses had been put into people’s arms. It took just over two more weeks to reach a total of 300,000 doses by mid-March. Before the end of March, the number was up to more than 400,000, including 135,000 fully vaccinated people.
Twelve days later, by April 9, the county reached more than half a million doses. County residents, it seemed, were on a roll to get their shots.
But over the past few weeks, demand has fallen off a cliff, falling from a peak of almost 60,000 doses administered during the week ending March 27 to less than half that volume last week – just over 28,000 shots in the week that ended on May 1.
This week, through Thursday, looked to be even slower, at fewer than 15,000 shots over the first five days of the week.
A similar pattern is evident across the entire central San Joaquin Valley, as well as the state and nation.
Vohra takes heart in the fact that about 80% of Fresno County’s senior citizens – prioritized early on as more vulnerable to COVID-19 complications that could hospitalize or kill them – have gotten at least one shot, and 62% are now fully vaccinated.
“To me, the risk group has now shifted younger because we’ve been so successful vaccinating our elderly,” he said.
“Now I’m worred about the 40-year-old person who may be prediabetic or (have high blood pressure) and just doesn’t understand that they’re at risk,” Vohra added. “That’s who’s going to go to the hospital with COVID if they don’t get their protection from the vaccine.”
“It’s our 30-year-olds, 40-year-olds and 50-year-olds, because they need to get the message that they’re now at more risk than our vaccinated elderly,” he said.
What’s the holdup?
The reluctance of some people to get their shots is often called “vaccine hesitancy.” Prado said that as he visits clinics, multiple factors appear to be at play.
For some residents in far-flung rural communities, language barriers, transportation issues, unfamiliarity with the health care system and a general lack of information are challenges. “Some people didn’t know there was a vaccine clinic in their town,” Prado said recently. “There’s definitely an opportunity to get the word out even more (about) where are the locations of these clinics.”
For others, he said, the recent pause of giving one-dose vaccines produced by Janssen/Johnson & Johnson after rare blood-clotting complications among some women who had received shots put a bit of a scare into people.
“There is hesitancy out there that we’re seeing still,” Prado said. “Some of the comments we’ve heard since January are that, ‘The vaccine was made way too fast,’ (or) ‘I’m afraid of the side effects.’”
Vohra was reluctant to paint the issue with a broad brush, and said the health department’s epidemiology team plans to conduct surveys of residents to learn in more detail why they’re reluctant.
But he allowed that there are “twin threads” involving not only vaccine hesitancy but also residents’ overall attitudes fed by misinformation.
“You know, there’s denial because some people may think that the virus is not real or not deadly, both of which are inaccurate, or that the vaccines aren’t safe or effective, also both of which are inaccurate,” Vohra said. ”I think some people try to outsmart the science, as it were, and really just try to come up with other explanations for why they don’t want to get the vaccine, when really both the common sense and the scientific opinion at this point are that these vaccines are safe and effective.”
The doctor cautioned that COVID-19 continues to crop up with new cases, including a growing number of troubling variant strains that are believed to be even more contagious than the conventional virus. Over the past 14 months, the coronavirus has caused more than 101,000 confirmed cases in Fresno County and claimed 1,680 lives. As of this past week, nearly 100 people were still in hospitals across Fresno County being treated for COVID-19.
“Really at this point, no one should be hospitalized because these vaccines work that well,” Vohra said. “These numbers just represent the fact that we are failing to vaccinate the community at the capacity we have available.”
Ample supplies of vaccine
The decline in demand for vaccine comes as even more places are offering the shots. But one of the county’s most prolific mass vaccination sites will be shutting down by mid-May because the need has diminished.
Rick Lembo, director of sports medicine at Sierra Pacific Orthopedic Center, established a drive-through vaccination clinic at the center’s northeast Fresno campus on Jan. 13 to give shots first to health-care workers and then to others as eligibility expanded. But like many other coronavirus vaccine clinics, “Our numbers are considerably down,” he said this week.
May 14 will be the last day of the SPOC vaccine clinic. “We anticipate by that point we will have delivered close to 50,000 vaccines since our very first day of the drive-through,” Lembo said Thursday.
“My perception is, a lot of people have gotten the vaccine. We are fortunate that (the vaccines) are available for so many other providers,” he said. “The mass vaccine sites, like here or the (Fresno) Fairgrounds, it’s time for us to just wind down a little bit.”
After the vaccine eligibility was expanded to anyone over the age of 16, regardless of occupation or health condition, “I think … the people that wanted it have already gotten it,” Lembo added. “People that are still on the fence, that’s the biggest hurdle that (the county) is dealing with on a day-to-day basis.”
At the COVID Equity Project’s drive-through vaccination site being operated by UCSF-Fresno in the main parking lot at Fresno City College, the lot was almost empty on Friday – a sharp contrast to the scene a month ago with long lines of cars carrying people waiting for their shots.
The county health department, however, isn’t ready to wrap up its mass vaccination efforts, even though thousands of available appointment slots are going unfilled each week.
“For the month of May, the Fresno County Department of Public Health will continue to maintain the mass vaccination sites at the Fresno Fairgrounds, (the) UCSF (clinic at) Fresno City College, Sunnyside clinic, and at the rural OptumServe sites,” Prado told The Bee in an emailed statement. “In addition to these sites, we are coordinating mobile pop-up sites county-wide.”
But Prado added that all of the vaccination sites will be re-evaluated in June.
In the meantime, Fresno County is slashing the amount of vaccine that it is ordering from its weekly allocation of doses from the state. From a point about a month ago when Fresno County was receiving 30,000 to 40,000 doses a week, the orders are way down: 6,000 two weeks ago, 4,000 last week, and 3,000 for this coming week, Prado said.
The county has enough vaccine stockpiled in its freezers that, even with the smaller orders, it could still handle a modest surge in demand for appointments, Prado added.
As it is, what doses Fresno is not taking in from its weekly allocations are being redirected within the state’s vaccine distribution system to other areas where there is more demand.
What’s in the (gift) cards?
Ambitious partnerships with community-based organizations, with a broad network of community health workers reaching out to residents in Latino, Black, southeast Asian, Indian and other ethnic neighborhoods across the county, continue to get the word out to people in their own language and culture about the importance of vaccines.
But as those efforts get more difficult, the county hopes a shift in tactics from education and reasoning to incentives, discounts and freebies will reinvigorate the momentum – similar to what the Central California Blood Center has done for years with coupons for ice cream and other goodies for people who donate blood.
“We’re talking about gift cards to grocery stores, gift cards to Starbucks,” Prado said this week. “The 20-somethings and 30-somethings, Starbucks is really popular with them.”
“We want to support local businesses in each of these communities, so each community would have their own tailored incentives,” he added. “And then there will be just a grand (program)“ with prizes like tickets to the Fresno Grizzlies minor league baseball team or admission to the Fresno Chaffee Zoo. “But there is going to be a very tailored focus for each of the rural cities and in the metropolitan area.”
