Vaccination rates increase only slowly

As COVID-19 vaccines continue to roll out in Nome, the Bering Strait and Norton Sound region, the number of people choosing to take them has started to level off. For the past weeks, the regional vaccination rate has hovered around 50 percent, climbing by just one or two percent each week.
Norton Sound Health Corporation, along with health officials at the state level, are working to spread the word about why vaccination is important. Through large public information campaigns and more pointed face-to-face conversations, doctors are working to convince regional residents to go in for the shot.
“How can we help people get good access to excellent, scientific, evidence-based information about the safety and the effectiveness of these vaccines? That’s what we’re trying to do,” said Dr. Joseph McLaughlin, Alaska’s state epidemiologist.
Alaska’s Department of Health and Social Services is currently running a statewide survey to measure people’s attitudes towards the vaccine, and what gives people confidence or makes them reserved. They also broadcast regular public information sessions called ECHOs, which are public videoconferences where members of the public can ask questions to state-level experts.
While demand still exceeds supply in the most populated areas of the state, in Nome and the surrounding region the opposite is true. Norton Sound Regional Hospital has enough doses of Pfizer and Moderna vaccine to vaccinate every adult in the region, but not every adult has chosen to accept it.
“Vaccine hesitancy is one of our biggest concerns right now, in Alaska and nationally,” McLaughlin said. A January study published in the Journal of Community Health, which surveyed a wide range of people across the United States, found that just 52 percent said they were “very likely” they would choose to get the vaccine. Another 27 percent said they were “somewhat likely,” 15 percent said they were “not likely,” and seven percent said “definitely not.”
As of Monday, about 53 percent of regional residents had received at least one dose, according to NSHC Medical Director Dr. Mark Peterson. He says 70 to 80 percent of the region will need to be fully vaccinated before large group gatherings can resume.
But people’s views on vaccines are not static and can change through targeted education and answering specific questions. “One of the things that we’re seeing is the idea of ‘Getting back to normal’ is really motivating a lot of people,” McLaughlin said. He focuses on that in his statewide messaging, along with a host of additional benefits: Vaccines produce better immunity than natural infection, they don’t cost any money and they have been scientifically proven to be safe.
He also emphasizes how minimal the drawbacks are. While some discomfort for a few days after the shot is normal, it’s never life threatening. Just under five in a million patients suffer an allergic reaction, he said, but the vast majority of those patients recover quickly after an epinephrine shot, which is on hand at all vaccination sites.
So far, almost 50 million Americans are fully vaccinated and none have died from the vaccine. Meanwhile, COVID infection has killed almost two percent of known cases in the United States: More than 549,000 people, according to Johns Hopkins University.
Most importantly, the vaccines work. The two vaccines readily available in the region, made by Pfizer and Moderna, reduce a person’s chances of catching COVID by more than 90 percent. The third, made by Johnson & Johnson, is not far behind. The small percentage of vaccinated people who do get infected only get mild symptoms. That’s the part that NSHC’s Dr. Peterson likes to emphasize – he pointed out that the big concern about the virus, the reason the world shut down last spring, was fear that it would kill or debilitate large swaths of the population.
“The benefit of the vaccine is that the risk of death from COVID is about as close to zero as it can be,” Dr. Peterson said. While doctors can never “guarantee” the outcome of any medicine, “the risk of severe disease and death from COVID, it goes away,” he said.
He added that getting vaccinated comes with a number of everyday advantages as well. Vaccinated people don’t have to quarantine after traveling from outside the region, and no longer have to show proof of a negative test before flying to a village community on Bering Air.
On top of that, “if you come into contact with someone with COVID, you don’t have to quarantine, you don’t have to test, you don’t have to do anything,” he said. “And that’s huge.”
Before, when there was a positive case in the region, they would often have close contacts in two or three other households, sometimes with five to ten people per household, Dr. Peterson said. All those households would then have to go into quarantine, and one case would often lead to multiple others, possibly even starting an outbreak.
Recently though, most positive cases’ close contacts have been vaccinated, so there hasn’t been a high risk of infection. Peterson said a few unvaccinated close contacts have had to go into quarantine, but ever since vaccines have become widespread, positive cases have been one-off occurrences that haven’t lead to additional cases and outbreaks.
“The next piece that we’re having discussions on is a reduction in the amount of testing needed for those who are fully vaccinated,” Dr. Peterson said. The details haven’t been worked out, but the plan is to require less testing for certain vaccinated groups in accordance with upcoming recommendations from the Centers for Disease Control.
So how do health organizations spread information about the benefits of being vaccinated? Dr. McLaughlin said it all comes down to thoughtfully responding to concerns on a person-by-person basis.
McLaughlin brought up one recent Science ECHO, where a woman said she didn’t want the vaccine because she was concerned about the size of the needle. Alaska Chief Medical Officer Dr. Anne Zink stepped aside and brought out an actual COVID-19 vaccine needle, showing the woman how small it was, and she signed up to get vaccinated that same day.
“All of us who are immersed in this understand the importance of it, but for the person who’s not immersed in it, it’s amazing how much somebody sitting down with them and answering their questions helps,” Dr. Peterson said.
He pointed to Stebbins as a prime example, where a 17 percent vaccination rate has jumped to 49 percent after local health aides and midlevel providers went door to door visiting with residents and addressing their concerns. While Stebbins is still below the regional average, Peterson hoped that persistent education efforts would keep convincing people to get the shot.
“We have some stragglers, and we’re going to do more of the same, which is focusing attention on those villages that are struggling a little bit with their numbers and sending personnel that will spend time there and visit with people,” he said.
He added that the other major factor in getting people vaccinated is convenience. While vaccines are available for walk-ins at the Nome hospital, most village clinics don’t have unclaimed doses on hand because the Pfizer and Moderna vaccines can only survive for five days in the refrigerator. They also require two doses delivered at specific intervals, another potentially discouraging factor.
The newest approved vaccine, made by Johnson & Johnson, may change that. It’s a single-dose vaccine that can survive in the fridge for up to three months. While supply is currently limited, production is increasing rapidly. Dr. Peterson said the region would likely have a surplus of J&J vaccine by the end of April or beginning of May.
At that point, regional residents will be able to walk into any village clinic and get their shot then and there, instead of having to call ahead and order doses from Nome. Dr. Peterson also mentioned J&J vaccine may be available at the airport for incoming travelers and at other gathering spots around Nome. “When there’s a surplus and every village clinic has it sitting in the fridge, that’s really when I think our rates of vaccination will go up,” he said.
He added that a shot for children ages 12 and up is anticipated in May or June. “And that’s a big segment of our entire population, so we’ll have a big jump in our percentage then too,” he said.
In the meantime, though, he encouraged regional residents to stay vigilant. “We’re not there yet. Fifty percent is not 80 percent,” he said. Until that high vaccination benchmark is reached, people will still need to wear masks, social distance in public  and avoid large gatherings.
And those who haven’t decided to take the shot yet should educate themselves from credible sources and learn about the safety and effectiveness of the vaccine. Those with questions or concerns are encouraged to tune in to state ECHOs, which can be accessed online through dhss.alaska.gov or through the Alaska DHSS Facebook page.
Regional residents are also encouraged to call into NSHC’s daily conference call with any questions or concerns. The call is held at 11 a.m. Monday through Thursday at 1-800-315-6338, access code 03286.

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