By Rose Hoban

In the 18 weeks since the first North Carolinian received a vaccination against the novel coronavirus that’s upended the world for the past year, the state has managed to put about 6.6 million doses of vaccine into the arms of more than 3.8 million people. 

That mass vaccination effort led to 647,415 doses being administered in the week of April 5. 

That week is likely to be a high water mark though. Last week, starting April 12, 519,373 total doses of vaccine were administered in the state, a lower number than the average for the six prior weeks. And with just under half the adult population in North Carolina having a vaccination now, local and state officials are anticipating that increasing the numbers of vaccinated will be more of a slog. 

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A report from the Kaiser Family Foundation this week estimates that the U.S. will likely “reach a tipping point on vaccine enthusiasm in the next 2 to 4 weeks.” The report writers surmise that once this occurs, “efforts to encourage vaccination will become much harder, presenting a challenge to reaching the levels of herd immunity that are expected to be needed.”

Census data compiled this week by Carolina Demography found that 2.4 million North Carolina adults reported they are vaccine hesitant, “meaning they will either probably not, or definitely not get a vaccine or that they did not plan on receiving all their required doses. 

In places such as Craven County, health director Scott Harrelson said he’s seen a distinct softening of demand for vaccines. 

At first, he said, when his department would announce 800 vaccination appointments on their website, most of them would be filled within a half hour. Recently, though, he’s started to see the process slow. 

“[Appointments] were hanging out there for, you know, 24 hours plus, and then we said, ‘Okay, I think we’re at a point now where we’re just gonna say 18 and up,’” he said. 

Earlier this month he reported that his department is scaling back. 

“We’re going to taper down and go to three [days a week] and then two, and then we’re going to cycle out and just have some probably Moderna on hand here in the health department for people who call in,” Harrelson said. 

With greater availability at physicians’ offices and drug stores, the county-run vaccination clinics aren’t as vital a link to a vaccine. 

“We are definitely getting to a place where you know, people may not be able to move the same volume that they are moving in a week now,” said Kody Kinsley, deputy secretary for health at the state Department of Health and Human Services. 

Lower throughput

“I think that the next phases will be harder to vaccinate than the first phase of the population,” wrote epidemiologist Whitney Robinson from the Gillings School of Global Public Health at UNC Chapel Hill in an email to NC Health News.

“I think we will need to switch strategies to meet the needs of the next group.”

Harrelson described how in his county, it had been relatively easy to bring a group of providers to one place, line vaccine recipients up and give out shots quickly. He said his vaccination clinics could process around 35 patients every quarter hour in clinics taking place four days a week. 

Second dose clinics went even faster. 

“Number one, you’re already registered, you’re already in the system,” he said. “And number two, you don’t have to have people to schedule second appointments either.”

graph from the Kaiser Family Foundation on where people would prefer to get COVID-19 vaccine. Overwhelmingly, it's at doctors offices, pharmacies, hospitals and local clinics

But the pace is slowing. There are people who can’t make it to a daytime clinic either because of work or family obligations, Harrelson said. There are homebound folks who lack the ability to travel to a centralized location, or people who lack transportation, for whom the vaccine will have to come to them. And then there are those vaccine hesitant folks.

It’ll take time, and more effort, to get the next layer of people vaccinated. 

“Just this past week, our hospital got 200 doses of the [Johnson &Johnson] vaccine. And they were just doing pop up clinics all around town,” Harrelson said. “And it took them pretty much the better part of the week to get rid of those 200 doses.”

Harrelson said he’s proud that Craven County has vaccinated more than 81 percent of the more than 20,000 people over the age of 65. All told, the county, with 104,000 residents, has had 30,605 people receive at least one dose.

But at only about 30 percent of the total population to have gotten a shot, that’s a long way from the level that health authorities estimate will be required for “herd immunity.” 

Gov. Roy Cooper said yesterday that his administration’s goal is to get about two-thirds of North Carolinians vaccinated. 

“With at least two thirds of adults vaccinated, our public health experts believe we’ll have enough protection across our communities to be able to live more safely with this virus,” he said.

Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, told CNN that herd immunity might be reached if 70 to 85 percent of people are immune.

But two-thirds of people is a long way from where North Carolina is right now. 

“I think we will need to switch strategies to meet the needs of the next group and vaccinate them at a steady, strong pace,” Robinson said. 

Reasons for vaccine hesitancy among North Carolinians. The top reason is concern about side effects, then safety concerns.

Getting the hard to reach

Harrelson said he’s seen that some younger people are hanging back from getting vaccinations for several reasons: they may have already had COVID. Other young people tell him they’re willing to take their chances. 

“They’re just saying, ‘Hey, look, at this point, I know the transmission rates are lower than they’ve been in a long time, a lot of other people have been vaccinated,’” Harrelson said. “They also hear about people getting the second dose and maybe feeling sick for a day or maybe the weekend.

“I really do see that a lot of people are saying, ‘Well, you know, I’ve known people who actually got the virus that didn’t hardly get sick at all. So I think I’m just gonna take my chances.’”

Kinsley said the state department is pivoting on their strategy now. There will still be mass vaccination clinics, for instance, the timeline for the huge FEMA-run clinic in Greensboro has been extended to the end of May. But now, instead of requiring an appointment, people can just drive up and get a shot. 

That’s becoming the case around the state, with more walk-in opportunities springing up.

“My hope is that you walk down the street, you pass three opportunities to get vaccinated,” Kinsley said. “We’re definitely moving into this phase where we have to be easy for folks. We have to be everywhere for folks.” 

He admitted that this next phase would likely be slower. Instead of health directors like Harrelson being able to vaccinate hundreds in a couple of hours, now the throughput will be maybe a dozen people per hour in a drug store. 

“It definitely gets more complex,” Kinsley said. “Some providers may only be able to do 50 shots a week, as opposed to 100 shots a week.”

Who definitely does not want to get a COVID-19 vaccine? Bar graph shows that Republicans far outstrip other groups on their resistance to vaccination
A bar graph describes which parts of the public would like to wait and see about getting a COVID vaccination, the percentages range from 7 percent to 25% (young people), for a total of 17%

Encouraging the hesitant

Then there are the conspiracy theories.

“There’s some shady stuff out there,” said Lisa Harrison, health director for the Granville-Vance Health Department. 

Harrison said she’s heard it all: worries about safety, worries about the vaccine development process, worries about microchips, and lots and lots of distrust of the government. 

“It’s all been debunked, but nobody’s paying attention to the articles that talk about how false it is, right?” she said. “It’s interesting how many people… continue to just be anti-government, anti-vaccine. And that’s a group we’ll never get there.”

Paul Delamater, from the geography department at the University of North Carolina at Chapel Hill, ruefully agreed with Harrison. 

He studies vaccine hesitancy, including people’s attitudes about the annual flu vaccine. He noted that usually, the U.S. gives flu vaccine to just under 50 percent of people, “which I think is poorly considering almost every single person is eligible for one.”

Delamater has been tracking COVID cases, deaths, the spread and, now, vaccination and modeling how we’ll get to herd immunity. His estimate, right now, is that between people who got COVID – either with or without symptoms – and people who have been vaccinated, around 4 million North Carolinians are immune. That means there’s another 3 million or more people to get vaccinated before any herd immunity threshold. 

Some of those might be kids, who are not yet eligible for vaccination. There are about 2 million children in the state, but they likely won’t all get vaccines either. 

“Once it’s approved in children, you’re going to see a whole different level of activity from the anti-vaccination movement,” Harrison said. “Then that’s going to be lit on fire.”

Delamater agreed there are definitely some people who’ll never agree to get a COVID vaccine, and the effort shouldn’t be focused on trying to convince them. 

“Just put all your effort toward the people who are ‘wait and see’ and build confidence in them,” he said. “I feel like that group’s probably bigger. And it’s probably the group that you’re actually going to move some people, you know? And really have an effect.”

Kinsley said that to reach those “wait and see” folks, vaccines need to be everywhere, from doctors offices, to pharmacies, to mobile clinics that can go out to where people are. And there may need to be inducements too.  

“I’d just like to say that a vaccine and a hush puppy sounds like a winning option to me,” he said with a laugh.

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Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...