In the beginning, there were tens of thousands of calls for coronavirus vaccination slots.
The residents trying to make appointments at the Kanawha-Charleston Health Department in January overtaxed the rural West Virginia community’s telephone provider, causing a temporary system outage.
“No amount of phone capability was going to match the public’s demand,” Dr. Sherri Young, the county’s health officer, said.
But over the last few weeks, she’s seen a shift. The clinic still vaccinates up to 100 people per day, but the center’s waitlist has shortened. The number of no-shows at an April 10 drive-thru clinic was the highest the department had seen.
Now, Young said, “you almost have to reach out to get appointments.”
West Virginia, the first state in the nation to widely vaccinate residents of long-term care facilities, is now among the first to confront the question of what happens when demand begins to taper off.
The state’s coronavirus response czar, Dr. Clay Marsh, said a number of local health departments have asked the state to pause sending additional doses until they can use up their backlog.
“We’re seeing vaccine hesitancy more than we’ve seen before,” he said. And amid a recent rise in coronavirus cases to levels not seen since late February and with the state still well short of herd immunity, he added, “We are very worried about what could happen to West Virginia if we don’t really vaccinate enough of our population.”
On Feb. 14, West Virginia reported that nearly 98 percent of the vaccine doses the state had received from the federal government had been administered. By April 15, that figure had fallen to nearly 72 percent. The drop of about 26 percentage points is the steepest in the nation, according to an NBC News analysis of data from the Centers for Disease Control and Prevention.
Louisiana, Montana and Wyoming are also among states seeing the greatest slowdowns.
Public health officials say there are many reasons for the rising surplus of vaccine doses sitting on shelves. Before vaccine production ramped up, providers often maxed out quickly as residents at the greatest risk from the virus scrambled to book scarce appointments. But as availability continues to swell, there are new challenges: how quickly front-line workers are able to push out the shots, whether those who want to get vaccinated face barriers in doing so — and, most significantly, hesitancy among some residents to get vaccinated at all.
Recent polling shows that although vaccine hesitancy is on the decline, 17 percent of Americans still want to “wait and see” before getting a shot, a figure that rises to 24 percent among Black Americans. Doctors and nurses say it’s still common to hear from patients fearing complications that they’re not ready to make an appointment. Public health officials and front-line workers say that not all of that opposition derives from concerns of safety or effectiveness. Polls show Republicans are among the most likely to say they won’t receive a jab at all.
The CDC figures showing a drop in the share of vaccinations administered in many states does not yet reflect the potential impact of the federally recommended pause this week on the Johnson & Johnson vaccine, as officials investigate whether the inoculation contributed to rare blood clots. Although public health workers said the suspension is a sign of transparency, they’re bracing for a potential fallout that could deter those who were already reluctant.
Now, health care workers in states that have seen a slowdown in demand are planning for the work they’ll have to put in to bring more people through their doors.
In Wyoming, which experienced the second largest overall drop in vaccine doses used after West Virginia, public health officials are ramping up their focus on messaging.
“With schools and most businesses open, it may be harder for some people to see the personal need for vaccination,” Kim Deti, a spokesperson for the Wyoming Department of Health, said.
Louisiana State Health Officer Dr. Joseph Kanter said the number of doses administered has been “fairly steady” as supply to the state has increased, when the goal is to see a rise in vaccinations.
“Whatever hesitancy that existed before was a little bit plastered over because supply was so limited,” he said.
While West Virginia is coping with a steep drop in the share of shots administered, some states have struggled to whittle down their stockpiles since the beginning. At their peaks, Alabama, Mississippi, Georgia, Arkansas and Tennessee used less than 85 percent of their doses, and as of April 15 they’ve used less than 70 percent, the lowest in the nation.
Alabama has seen a 13 percentage point decrease in shots administered. Dr. Karen Landers, assistant state health officer at the Alabama State Department of Health, said part of the reason may be because there’s a perception that improved case numbers in the state means the risk of contracting the coronavirus isn’t as high.
“Covid is still here and still circulating,” she said. “We need to have everyone vaccinated.”
In January, Mississippi’s appointment site struggled to handle the surge of statewide demand for doses at massive drive-thru clinics. Now, open slots linger in the thousands. In Hinds County, Mississippi’s most populous county, more than 5,000 windows were unreserved as of Friday afternoon.
Mississippi’s State Health Officer Dr. Thomas Dobbs said on Tuesday that in some areas the state’s “uptake is not quite as rapid as before.” The health agency will shift more vaccines to doctor’s offices and focus resources on areas with low vaccination rates.
Dr. Andrea Phillips, a physician in Jackson, Mississippi’s capital, said there aren’t enough patients at her small practice to use all of the doses recently sent by the state. Earlier this month, a local church reached out asking if she would coordinate a vaccination event, to help ensure each shot would be claimed.
One parishioner volunteering at the site initially declined to get vaccinated. The woman was unsure whether being prone to seizures would lead to complications. Phillips explained how her condition could put her at greater risk if she contracted the virus and the woman decided to get the shot.
Beyond hesitancy, spotty internet access and lack of transportation are persistent barriers in Mississippi, particularly for Black residents and those in rural areas. Serious illness or mobility issues can also make it harder for those who are among the most vulnerable to the disease to reach vaccination sites. Phillips has made home visits but said there are more people to reach.
“The fact that people don’t get online and sign up for something, or sit in a line, does not mean they don’t want the vaccine,” she said.
Phillips drew laughs from staff members when she asked whether they should set up an information table outside of a local nightclub. But she made it clear she was serious. The clubs are still packed on weekends, she pointed out.
Part of that, she believes, derives from a series of contradicting messages.
Gov. Tate Reeves has urged residents to get vaccinated and received the shot himself on camera. But he’s also directed barbs at President Joe Biden, who criticized his decision to lift the state’s mask mandate.
Phillips believes the removal, despite Reeves encouraging Mississippians to exercise their individual choices and wear a mask, “signals to people we’re OK” and there’s less urgency to get vaccinated.
One-on-one conversations with trusted health care providers or community leaders might be the key in tipping the undecided toward vaccination.
Kanter, the Louisiana state health officer, said the “sweet spot” is “people who haven’t written off the vaccine,” but aren’t “quite ready” to get it yet.
That’s where Tara Gallion, who works as a nurse at the Delta Health Center, which provides low-cost care in the Mississippi Delta, has found success. She said it’s not uncommon to have lengthy conversations with patients reluctant to get vaccinated.
She doesn’t miss the opportunity to ask neighbors, or relatives bringing older relatives to the clinic, if they’re interested too.
Last week, she offered the shot to two women who brought their mother to the clinic. At first, they resisted.
“They felt like they were young and invincible,” Gallion said.
She asked them a series of questions. Both told her they had children and worked in retail.
Gallion told them the vaccine wasn’t just for them — it was to stay healthy and protect their families.
“If you do get it, you’ll have something to help your body fight against it,” she said.
The prodding worked, but there’s a question of how many will make it to this step.
While people of varying political backgrounds have been vaccinated, surveys about vaccine views show the push has not been spared from the nation’s polarization.
“Politicization is a concern, of course,” Deti, the Wyoming health department spokesperson, said.
A March poll from the Kaiser Family Foundation found that Republicans were the most likely to express vaccine hesitancy; almost 30 percent responded “definitely not” when asked whether they would receive the shot.
That could leave states with strong Republican bases, like West Virginia, at a greater disadvantage.
Ken Reed and his wife, Tally, run a pharmacy chain in the eastern region of West Virginia. Reed, who is also a Republican state legislator, said some in the communities they serve will “quietly” get vaccinated, but “still fuss.”
He often appeals on social media that vaccinations are a pathway to easing restrictions. On occasion, he tries to nudge those on the fence by letting them know when doses are available.
Some will respond, “Yes, I’ll get the vaccine just to speed this up.”
Others, he said, see their refusal as keeping in lockstep with what Reed considers libertarian beliefs about limited government. Some view the urgings from government officials to become vaccinated as an infringement, or being “told what to do,” he said. It’s a subset he’s not sure can be convinced by presenting evidence of vaccination trials or answering questions.
After a year of attempting to drive down the pandemic, the recalcitrance is draining.
“It’s starting to bump heads a little bit,” he said.
But there’s little choice to do anything else but try to break through.