PHILADELPHIA — It's 2 p.m. on a Wednesday in Chester, Pennsylvania, and nurses Susan Pollock and Carol Von Colln are inside a Delaware County vaccine clinic doing what they spend a lot of time doing these days: waiting.
Last spring, Americans were in a frenzied rush to get the COVID-19 vaccine; this spring, business has slowed to a crawl. Now, whenever someone walks in, "we're ready to throw a party," Von Colln said.
That day, they vaccinated eight people in six hours.
It's a scene playing out across the region and the United States as the number of shots being given each day is at an all-time low — even though a third of Americans are still unvaccinated.
With the omicron surge in the rearview mirror, "there's a sense of 'Hey, we're OK; maybe I don't need [the shot],'" said Chet Patel, pharmacist at Lititz Apothecary in Lancaster County.
The swift post-surge shift in the pandemic landscape — mask mandates and other restrictions lifted, state and federal leaders declaring it time to move forward — has worsened the already-declining demand for shots, doctors and vaccine providers say.
The slowdown raises questions about where the vaccine effort goes from here, how long resources should be spent on outreach, and whether the strategies of the last year are still effective in persuading the unvaccinated, who are at higher risk of severe illness, hospitalization, or death from COVID. It comes as experts urge preparedness for the next surge and, after funding plans last week collapsed in Congress, the future of the national coronavirus response is uncertain.
"The hope a year ago that we could vaccinate enough people that we will reach herd immunity and the virus will go away is now fantasy," said Bob Wachter, chair of medicine at the University of California, San Francisco. "We shouldn't give up on vaccination — it remains an important part of the strategy — but it no longer is the dominant thing to focus on to the exclusion of other things."
With 65% of the total population and 69% of those over 5 fully vaccinated, the national vaccination rate is close to the 70% minimum goal that some public health experts named at the start of the rollout. But there was hope the national rate would reach a higher level than it has before plateauing, said Bill Moss, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health.
In Pennsylvania, over the last week, about 9,000 people a day were getting shots on average; until last month, the level had never fallen below about 20,000 shots a day. Similar trends are occurring in New Jersey and nationwide.
"If we do 10 a day, we're lucky," said Jon Moran, a Philadelphia health department coordinator, as he helped set up the city's East Germantown vaccine clinic at Waterview Recreation Center last week. "I think that really reflects the change in policy that's going on."
In Philadelphia, the "All Clear" lifting of restrictions took away any "real motivation" for people on the fence, said Ala Stanford, founder of the Black Doctors COVID-19 Consortium. She and others are now concerned that, with a false sense of security, people won't get vaccinated until the next surge.
That would be too late. Many epidemiologists and doctors agree that the pandemic is not yet endemic, despite political leaders' declarations. The vaccine provides the best protection against severe illness and death from COVID — and immunizations now can help both prevent surges and protect people against them.
That includes for those who contracted omicron, because it's unknown how long natural immunity will last. Vaccine immunity wanes over time, too, so many experts are additionally concerned about the low rates of booster shots — only 44% of vaccinated Americans have gotten one.
Also still in flux: the yet-to-be-approved vaccine for children under 5, whether a fourth-dose booster shot will be needed, and how much higher the particularly lagging rates of pediatric vaccines can be raised.
"Vaccination is the foundation of our being protected against future surges of COVID," said Megan Ranney, emergency physician and academic dean at the Brown University School of Public Health. "As much as we are in a lovely moment of the pandemic right now, we are fooling ourselves if we think that COVID is not sticking around."
In Potter County, just over a third of residents have been fully vaccinated, nearly the worst rate in Pennsylvania. Providers there like the University of Pittsburgh Medical Center Cole hospital are still offering shots and distributing doses to clinics, schools, and rural health centers, but demand is simply low.
Of Pennsylvania's total population, 67% are fully vaccinated, according to the CDC. In about half of Pennsylvania counties, however, it's less than 60% of residents. New Jersey stands at 75%, among the states with the best rates, but even there, certain areas are under-vaccinated.
"We've kind of asked ourselves, What else can we do?" said Jennifer Scheible, director of quality management for UPMC Cole. "It's hard to know what would work."
With few truly new strategies left, the current future of the vaccination campaign resembles the past — community-based canvassing, pop-up clinics, and social media campaigns.
Some experts and providers believe the prospects for encouraging many of the 31 million unvaccinated adults to get the shot are dim, noting they have been unmoved by incentives, mandates, outreach, or science and often influenced by misinformation or politics.
Only 4% of unvaccinated people said they would "wait and see" about getting the shot in a February Kaiser Family Foundation poll, down from 22% a year earlier, indicating most may have made up their minds.
"The term I prefer is vaccine denialist," said Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia and a member of the FDA Vaccine Advisory Committee. "They're not hesitant — they're not getting it."
Others believe enough people can still be persuaded to make continued outreach worth it. Ranney is seeing patients change their minds in her emergency room every week.
"This is the worst time to give up on discussions using trusted messengers," she said.
Officials in places like Cumberland County, N.J., and Delaware County see momentum left in these grassroots-type efforts. Philadelphia and Montgomery County plan to eventually close their mass clinics in favor of smaller sites. More burden may also fall on doctors to make headway with patients who haven't sought out the vaccine.
Experts say putting resources toward other measures is also key: increased testing availability, accessible treatment, surveillance of new variants, improved ventilation. Strategies like those are included in President Joe Biden's recent pandemic plan and were laid out in a road map of recommendations from a group of experts. They pushed the administration to go further on some steps, including vaccination, recommending 85% of Americans be immunized by the end of 2022.
The experts said the Biden administration should do zip code analyses to determine what areas are under-vaccinated, use community-level teams to do outreach, and fund efforts to improve vaccinations in certain nursing homes.
"The more we vaccinate," said Mayo Clinic infectious disease specialist Priya Sampathkumar, "the closer we come to ending the pandemic without more loss of life."
____
(Staff writer Jason Laughlin contributed to this article.)
