When U.S. officials temporarily paused the use of Johnson & Johnson’s COVID-19 vaccine Tuesday to warn patients and providers of an “extremely rare” blood clotting issue that has so far affected just six of the millions of Americans who have received the vaccine — all six of them women ages 18 to 48 — many observers worried the abrupt move would stop a substantial number of Americans from getting vaccinated.
But if you take a closer look at the data, it’s clear that unless regulators end up pulling J&J from the market — an outcome experts have all but ruled out, given the vaccine’s robust track record of safety and effectiveness and the relatively minuscule risk of clotting — this week’s (likely brief) time-out may ultimately have little impact on the larger dynamics of America’s vaccination campaign.
Why? Because even before the J&J news, the U.S. was already approaching a “vaccine wall” — the point at which supply outstrips demand, the country’s rapid pace of vaccination starts to slow down and every American who wants a shot can easily get whatever shot they want, whether it’s Pfizer, Moderna or the one-and-done J&J.
The question then is whether there will be enough Americans willing to get vaccinated — not whether there will be enough vaccines for Americans who are willing.
By all measures, the U.S. has made remarkable progress on vaccination. When President Biden took office on Jan. 20, the country was administering an average of 900,000 doses a day. Now, less than three months later, the pace has nearly quadrupled to 3.4 million daily doses. On Saturday, 4.6 million shots were reported — a new record. More than 63 percent of U.S. seniors have been fully vaccinated, up from 2 percent at the start of Biden’s term; nearly half of U.S. adults have already gotten at least one jab. And that’s before eligibility has even opened up to all Americans 16 or older, a threshold the country is officially set to cross on April 19.
Again, remarkable progress. But things are about to change.
For the next few days or weeks, Americans won’t have access to J&J, and as a result demand for Pfizer and Moderna will rise. As the New York Times reported Tuesday, “mobile vaccine clinics in rural areas” of California and Colorado that depended on J&J doses “were canceled. In Chicago, vaccination events for restaurant employees and aviation workers were postponed indefinitely. At colleges in Ohio, New York and other states, where the one-dose vaccine offered a chance to quickly inoculate students before they left campus for summer, appointments were called off en masse.”
And so “in the very short term, we do expect some impact on daily averages as sites and appointments transition from Johnson & Johnson to Moderna and Pfizer vaccines,” White House pandemic coordinator Jeff Zients explained Tuesday.
But the “very short term” won’t last long. First, as Zients put it Tuesday, the U.S. has “more than enough Pfizer and Moderna vaccine supply to continue or even accelerate the current pace of vaccinations”: 440 million doses to be delivered by the end of May, with an extra 3 million of those doses to be made available while J&J is sidelined this week (during a period when J&J supply was already expected to fall 80 percent because 15 million doses were ruined in a factory mixup.) Second, longer-term U.S. supply — which could include up to 200 million Johnson & Johnson doses once this week’s issues are ironed out — will soon start to exceed demand.
In many places, it already has. Last week, the New York Times reported that a “pileup of unclaimed appointments in Mississippi” — 73,000 open slots at the time of publication — “reflects … mounting supplies” but also “exposes something more worrisome: the large number of people who are reluctant to get vaccinated.”
Local headlines, meanwhile, are starting to register a similar shift. A few recent examples:
University says thousands of appointments are going unclaimed
“Now we’re moving on to the reluctant, uninformed and hesitant, as well as the people who are just like, ‘Hell no, I don’t want it.’”
“We’re reaching a tipping point. While we still need more [vaccine] at this stage, it’s going to require us to be more convincing of folks.”
“After the first rush, the first flood of people who wanted to get the vaccine, it has quieted down significantly.”
“Vaccine appointments that were once nearly impossible to find now sit unfilled. One reason is more doses are available, but health officials are also seeing a drop in the number of people signing up.”
“Groups that administer the vaccine are seeing appointment slots go unfilled, even after the state deemed anyone old enough to get the shot eligible last week.”
“Demand for COVID-19 vaccine has declined drastically over the past few weeks.”
“Despite best efforts to share information regarding appointment availability, the number of people visiting the county-run vaccine clinic has begun to decline.”
The trend is even beginning to surface in New York City, where competition for available doses has been fierce. “For the first time in 4 months, vax appts in NYC are not being immediately filled,” City Council member Mark D. Levine tweeted Wednesday.
The latest CDC numbers reinforce these reports. So far, 14 states have administered less than 75 percent of the doses distributed to them (in ascending order): Alabama, Mississippi, Arkansas, Georgia, Alaska, Wyoming, Louisiana, Tennessee, West Virginia, Florida, Hawaii, Oklahoma, Indiana and South Carolina. Among them, only Hawaii has at least partially vaccinated a larger share of its residents than the national average (about 37 percent).
At the other end of the spectrum, 22 states have administered more than 80 percent of the doses distributed to them (again, in ascending order): Pennsylvania, Washington, Nebraska, Virginia, Connecticut, Colorado, Nevada, New York, Vermont, Iowa, New Mexico, Massachusetts, Utah, Wisconsin, New Jersey, Rhode Island, North Dakota, Minnesota, Maine and New Hampshire. Among them, only North Dakota, Utah and Nevada have at least partially vaccinated a smaller share of their residents than the national average.
The gap between doses distributed and administered can’t perfectly capture differences in demand from state to state; disparities in delivery systems, individual access and data reporting may also play a part.
But roughly speaking, a pattern is emerging: redder, more Republican states across the South and Great Plains are tending to see supply outstrip demand before bluer, more Democratic states in the Northeast and elsewhere.
Note how closely they resemble each other, suggesting a correlation between local vaccine hesitancy and statewide gaps in supply used. Note too how closely they resemble the 2020 U.S. presidential election map.
This tracks with recent polling. According to the latest Yahoo News/YouGov survey, conducted earlier this month, 60 percent of Democrats say they’ve already been vaccinated, versus just 41 percent of Republicans — and the share of unvaccinated Republicans who insist they will “never” get a shot (49 percent) is more than twice as high as the share of unvaccinated Democrats who say the same (23 percent). A separate poll by the Kaiser Family Foundation found that a combined 30 percent of rural Americans say they’ll only get vaccinated if required (9 percent) or they “definitely” won’t get vaccinated at all (21 percent). In suburban areas that combined number falls to 21 percent; in urban areas it falls further, to 16 percent.
Yet while Republican areas seem to be hitting the vaccine wall first, the rest of the U.S. will almost certainly follow. According to a report Saturday in the Washington Post, “states have delayed” even “ordering hundreds of thousands of vaccine doses available to them”; at one point last week, 13 states had more than 100,000 doses apiece available and not ordered. And as Renton notes, the gap between doses distributed and administered may be increasing faster in a state like Mississippi than a state like Massachusetts right now — but it’s “increasing in all states” just the same.
A new report from Surgo Ventures, a leading global health data foundation, shows why: Vaccine acceptance, which has steadily risen in recent months, is unlikely to keep rising forever without a shift in strategy.
According to Surgo’s latest survey, a combined 59 percent of U.S. adults now say they’re either already vaccinated or plan to be as soon as the shot is made available to them. At the current rapid pace of vaccination, Surgo concluded, the U.S. is likely to burn through this vaccine-enthusiastic population in fairly short order — meaning “the supply-demand shift for the vaccine will happen earlier than expected — as early as the end of April — and before the nation reaches the 70-90% threshold for achieving herd immunity.”
Vaccination rates will then slow, and Surgo’s projections show that if what Americans now say about their preferred timelines for getting vaccinated is true — “as soon as it’s available,” “in three months,” “in a year,” “don’t know” and “would not get vaccinated” — overall U.S. coverage will plateau around 52 percent of the population by July. When combined with people who have already been infected, the overall immunity rate overall may hit 65 percent by then, according to Surgo — still not high enough for herd immunity.
To reach that threshold, Surgo estimates the U.S. will have to flip as many as a third of American adults from “noes” or “not sures” to “yeses” — and/or start vaccinating children en masse. That won’t be easy, especially if COVID-19 cases plummet amid warming weather and widening immunity, and many reluctant Americans say “why bother?” as a result. (In Israel, the world’s leading vaccinator, coverage hit 50 percent one month ago and has increased only incrementally since then.)
To keep its vaccination campaign chugging along, the U.S. will have to stop relying on demand and start strengthening its persuasion tactics and its delivery systems, particularly in underserved communities. It will have to start meeting people where they are.
Right now, it’s impossible to say precisely how the Johnson & Johnson pause will play out. Some experts are worried it will increase overall vaccine hesitancy; others predict a wash as those eager to get vaccinated either follow updated J&J guidance or shift to a different vaccine, with long-term trust actually rising because the government chose to be transparent.
Either way, any American who wants a shot will soon find it all too easy to get one — and the U.S. will find it harder and harder to give them out.
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