Daily coronavirus vaccinations have slowed significantly for the first time since February, a sign that demand is slipping even though every American adult is now eligible for the shots.

About 3 million Americans are getting vaccinated daily, an 11% decrease in the seven-day average of daily shots administered over the past week. The unprecedented drop is rivaled only by a brief falloff that occurred in February, when winter storms forced the closure of vaccination sites and delayed shipments nationwide.

The downturn hits as half of all eligible Americans have received at least one vaccine dose. And it coincided with the pause last week of the single-shot Johnson & Johnson vaccine, which is under review by a panel of experts following a handful of cases of severe blood clotting.

Softening demand also appears to be a factor: Scores of counties from Iowa to Texas have begun to decline vaccine shipments, highlighting issues of hesitancy and barriers to health care that may hamper efforts to reach the levels of protection needed to halt the spread of the coronavirus.

Officials say they need to ramp up efforts to vaccinate hard-to-reach groups such as rural residents and homebound seniors, answer pointed questions from people leery of side effects and convince young people who don’t fear the virus that they, too, benefit from getting vaccinated.

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“This will be much more of an intense ground game where we have to focus on smaller events more tailored to address the needs and concerns of focused communities who have different sensitivities and different needs,” said Steven Stack, commissioner of the Kentucky Department for Public Health.

President Biden on Wednesday sought to remove one significant barrier to shots, promising tax credits for employers that give their workers paid time off to receive and recover from inoculations.

“The time is now to open up a new phase of this historic vaccination effort,” Biden said. “To put it simply, if you’ve been waiting for your turn, wait no longer.”

But the White House declined to comment on the weekly data, pointing to the president’s response to a question about whether supply had outpaced demand. “Not yet,” he answered.

Public health officials say the interruption of the J&J vaccine probably played a role in the downturn, with the shortfall on certain days this week roughly equivalent to the number of J&J doses reported on the equivalent day a week ago. An advisory panel to the Centers for Disease Control and Prevention is expected to make a recommendation on Friday about how, if at all, to move forward with that vaccine.

However, the pause was not the entire explanation, as federal officials said they were able to use more Pfizer-BioNTech and Moderna doses to compensate, while state and county health officers touted their efforts to reschedule patients initially slated to receive Johnson & Johnson’s product with other vaccines.

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The Johnson & Johnson pause also did not appear to undermine overall vaccine confidence, according to surveys showing between 65% and 70% of Americans who said they had received or were likely to receive a shot, little changed from before. Some public health officials said the development reassured Americans that the government paid close attention to vaccine safety.

“We have absolutely seen that anyone who was positing the theory that they just quickly threw out these half-baked vaccines and they don’t care even what happens to it have obviously seen that is not the case,” said Ngozi Ezike, director of the Illinois Department of Public Health. “We are much better off than we were before the pause.”

But millions of Americans are still not signing up for shots for a host of other reasons, from wanting to avoid the hassle of finding an appointment to wanting to wait longer for more research on long-term side effects.

Nirav Shah, who leads Maine’s health department and is president of the Association of State and Territorial Health Officials, said public health authorities are starting to turn their attention to those who are not able to get vaccines because they cannot make time or find transportation, as well as those who have “earnest questions” about vaccine safety.

The next stage requires more walk-in vaccination sites, free rides and door-to-door outreach, he said.

“What we’ve all seen in the work that we’ve done is it’s not enough for vaccine to be in a state, it’s not enough for it to be at a vaccination site or at the doctor’s office,” said Shah in a press call highlighting local vaccine efforts.

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The slowdown in shots is concentrated in certain parts of the country, exacerbating the regional divides in vaccinations.

The declines are especially acute across states in the Deep South that already have some of the lowest vaccination rates. Average daily shots plunged by more than 30% in Georgia and South Carolina over the past week. Texas reported a 25% decline with just under a quarter of its eligible population inoculated.

But the steepest declines have been among small states with relatively high penetration of the vaccines: Maine, Alaska and New Hampshire.

And average daily vaccinations are still climbing in Delaware, California, Hawaii, Kentucky and Utah, in addition to the District of Columbia and Puerto Rico.

Some counties with as few as a quarter of residents fully vaccinated are seeing steady or even increasing coronavirus infections, a harbinger of how inadequate coverage could allow the virus to spread. Most are relatively rural and overwhelmingly Republican, in line with polling that suggests conservatives are particularly skeptical of the vaccines. Health officials in these places said they had not expected the degree of anti-vaccine antipathy in that demographic.

Philip Keiser, the top health official in Galveston County on the Gulf Coast of Texas, asked the state not to send him new vaccine supply this week as he plans more targeted outreach, including events in hard-to-reach communities and at schools. Just over a quarter of residents have been fully vaccinated, according to CDC data.

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“We’re past that point of vaccine eagerness, well into vaccine hesitancy, and having supply drive what we do is a mistake,” Keiser said.

Mercer County in western Ohio has not received new vaccine shipments for the past three weeks, said Jason Menchhofer, the local health administrator. Originally, he had hoped to shift vaccine from the county’s main clinic to smaller providers, but even these have seen demand dry up.

“We had a couple of private practices that were scheduled to get shipments, but before it even got here they were looking to offload it to someone else,” he said. “They don’t have demand for it among their clientele anymore.”

Nearly half of Iowa’s counties rejected vaccine doses, state officials reported Wednesday, as Gov. Kim Reynolds, a Republican, implored the unvaccinated, “What are you waiting for?”

“If you’ve been a hard ‘no’ from the start, what’s your reason?” she asked. “And if you can’t answer those questions, maybe, we hope, that you take the time to reconsider.”

West Virginia, which was lauded for its early success vaccinating nursing home residents and seniors, is now struggling to administer all of its vaccine doses because of low demand.

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“It takes us longer each week to get those vaccines in arms not because of the logistics, but because of people getting to those vaccines,” James Hoyer, a retired major general who heads the state’s coronavirus task force, said at a news conference this week.

To address low demand, many vaccine administrators are dispensing with appointments and some are taking their shots directly to people.

The North Georgia Health District, which includes six small counties, saw vaccinations slow after an initial burst of demand that included residents of metropolitan Atlanta in search of shots. Local health officials are trying to combat 20% vaccination rates by removing appointment requirements and bringing doses to poultry plants and schools while parents are picking up their children.

“A lot of people really appreciate you making the extra effort to come to them,” said Ashley Deverell, the district’s immunization coordinator.

A spokeswoman for the state health department said officials are also trying to counter misinformation and hesitancy by partnering with churches and other groups serving people of color, who surveys show have become more open to vaccines while Republicans have remained resistant, and by launching a statewide ad campaign featuring real people explaining why they got vaccinated.

Alaska hit a wall in its inoculation efforts because of vaccine hesitancy, with a nearly two-thirds decline in daily shots over the past week -and a third of the state fully vaccinated.

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Anne Zink, the state’s chief medical officer, says officials are trying to reach holdouts with positive messaging such as reminding youth athletes they do not need to quarantine after exposure once they are vaccinated.

Eventually, the nation will see fewer mass vaccination sites at convention centers and stadiums, and more shots offered at doctor’s offices when patients show up for unrelated care. But experts say vaccine doses need to be shipped in smaller packaging so they can be spread out among more facilities and doctors without going to waste.

For example, a single vial of Moderna vaccine contains 10 doses, but once it’s opened, all doses must be used within 12 hours or they are spoiled.

“We are at that tipping point where we are going to have to be willing to take advantage of any opportunity to vaccinate, which might lead to some wasted doses,” said Claire Hannan, director of the Association of Immunization Managers.

Navigating the pandemic
(Jennifer Luxton / The Seattle Times)

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