BOISE, Idaho — Major Idaho hospitals have been operating in crisis standards of care for weeks.

And for months, elected representatives, public health officials and hospital leaders have been pleading with Idaho residents to get vaccinated, which they have said is the only viable path to ending the pandemic more quickly.

But data show that those pleas have not been heeded by much of the public. Over the past month, the number of new people getting vaccinated has fallen while the hospitals have been in crisis.

The sluggish uptake prompted Dr. Steven Nemerson, the chief clinical officer at Saint Alphonsus Health System, to say on Oct. 12 that the state has “lost the war” with COVID-19, and that the virus is here for the long haul.

“The reason it is here to stay is because we cannot vaccinate enough of the public to fully eradicate the disease,” he said. “And absent being able to do that … we now need to move into the phase of recognizing that COVID is going to be a disease to be managed for the long-term future.”

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Crisis standards were activated statewide on Sept. 16.

The week of Sept. 12-18, about 13,115 people received either a first dose of the Moderna or Pfizer vaccine or a first — and only — dose of the Johnson & Johnson shot. That number has declined every week since, to a low of 6,141 first doses administered the week of Oct. 10-16, according to data from the Idaho Department of Health and Welfare. That’s a decline of about 63%.

The declining demand for vaccines has kept Idaho among the nation’s least-vaccinated states. Through Tuesday, only 53.9% of eligible Idahoans were vaccinated against COVID-19 — the second-lowest rate in the nation.

On Oct. 5, Sarah Leeds, immunization program manager at Health and Welfare, addressed the dip in demand.

“We don’t know exactly why, when crisis standards of care went into effect, (first-dose) vaccine administration by day started to decrease,” she said at a press conference.

Over the past two months, an average of about 1,500 new Idahoans have decided to get vaccinated each day, according to Dr. Kathryn Turner, deputy state epidemiologist.

“Every single one of those people is a reason to celebrate,” she said at a press briefing on Tuesday.

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Though fewer unvaccinated Idahoans are choosing to get shots, the story is slightly different for people already vaccinated who are becoming eligible for additional doses.

In mid-August, the Centers for Disease Control and Prevention recommended third doses of Moderna and Pfizer shots for certain people with weakened immune systems, including people receiving certain types of chemotherapy, no less than one month after their second dose. On Sept. 23, the CDC recommended booster doses of the Pfizer shots for high-risk Americans six months after receiving the two-dose Pfizer course.

The week of Sept. 26, around 19,000 Idahoans received a third dose or booster shot, according to state data. The week of Oct. 3, that number fell to around 17,000.

On Oct. 14, a U.S. Food and Drug Administration panel advised that the same group of vulnerable Americans — this time, those who received two doses of the Moderna vaccine — be eligible to receive another shot. On Wednesday, the FDA authorized booster shots for Moderna and J&J vaccine recipients. The Moderna boosters — a half dose of the original shots — were authorized for people 65 and older and those in other vulnerable groups, while the J&J boosters are authorized for anyone 18 or older. The FDA also authorized booster-eligible Americans to receive a booster shot of any available vaccine, not just the kind they initially received, which is known as a “mix and match approach.” On Thursday, Oct. 21, influential CDC advisers endorsed extra doses of all three of the nation’s vaccines — and opened the possibility of choosing a different company’s brand for that next shot.

Since August, as groups have become eligible for additional doses, the overall number of administered shots in Idaho has increased, but Leeds said the increase has been slow.

As of Tuesday, 66,152 Idahoans have received a third dose or booster dose. It’s unclear how many total people are eligible.

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“I would not say that people are absolutely flocking,” Leeds said. She said IDHW will have a better idea of uptake if booster doses for the other vaccines are also authorized.

While health providers in Idaho were administering well over 10,000 vaccine shots a day in the spring as many eager Idahoans lined up to get vaccinated, uptake of the inoculations has dropped dramatically since then, to a low of just a few thousand per day over the summer.

While older children, age 12 to 17, have been eligible to be vaccinated since May, only 30% of 12- to 15-year-olds are fully vaccinated and 36% of 16- and 17-year-olds are, according to Health and Welfare.

Later this month, the FDA likely will decide whether to authorize shots of the Pfizer vaccine for children aged 5 to 11, who so far have been ineligible to receive any COVID-19 vaccines.

If those younger children become eligible in the coming weeks, the number of doses administered daily could tick up again, but officials aren’t sure by how much.

Leeds said she was “cautiously optimistic” that many parents would choose to vaccinate their children, but added that the uptake trajectory will likely “mirror” what happened with previous eligible groups.

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“I think we’ll probably see a large uptake in the beginning and maybe, perhaps (the uptake) waning after a few months,” she said.

If young children are vaccinated at the same rate as teens, Idaho’s overall vaccination percentage of eligible residents likely will drop even lower.

“I hope parents will embrace this vaccine as a safe and effective one for children,” Leeds said. “We really want to make sure that parents understand that when the FDA and the CDC review that data and say the benefit outweighs the risk, that it is a safe and effective vaccine.”