‘Start mandating’: Officials eye options to combat sputtering rollout, vaccine hesitancy

Medical assistant Sara Vaeth was fired last week from her job in a pediatrician’s office in Stevensville, Maryland, because she refused to get vaccinated against COVID-19, saying the shots are experimental and unsafe.

Her job at an urgent care office, where she worked during the COVID-19 pandemic and rollout of the vaccines, also set a September deadline for employees to get vaccinated or lose their jobs.

“I truly believe that what they are putting in the vaccine is bogus,” said Mrs. Vaeth, 30, a mother of three. “Being on the front line, I’ve seen patients come in with the side effects of the vaccine, and that outweighs for me” the risk of catching the disease.

The risk of side effects and the “newness” of the vaccine are the top reasons people provide, at 53% each, for not getting COVID-19 vaccines that are free and plentiful in the U.S., according to a recent poll from the Kaiser Family Foundation, a nonprofit health care policy group that tracks the issue.

Other often-cited reasons include “just not wanting” the vaccine (43%), not trusting the government (38%) and believing they don’t need the shots (38%).

The speedy development of a vaccine was a scientific marvel under the Trump administration, but President Biden is taking credit for getting eight in 10 seniors and nearly half the U.S. population fully vaccinated. 

Those efforts greatly reduced U.S. hospitalizations and deaths from the virus but appear to be hitting a wall. The rolling average of doses administered per day dipped last week to fewer than 600,000, compared with 3.3 million at the peak in mid-April.

Less than half of the U.S. population, roughly 48%, is fully vaccinated — far short of the 70% to 90% that experts say is the level needed to wrangle the pathogen and stiff-arm devastating variants.

The sputtering rollout is raising debates about what, if anything, the government can or should do to persuade holdouts to take the shots, which are voluntary but considered the best way out of the pandemic.

The Biden administration is enlisting trusted voices — doctors, pastors and community advocates — to change minds. Still, the reasons behind hesitancy range widely and are deeply entrenched, giving the White House and state allies few options but to back unpopular mandates or beg.

Rural residents tend to be less eager because they feel less threatened by the virus, which ripped through densely populated parts of the country. Some minority populations distrust the health care system because of years of “medicine breaking its promise.” The Tuskegee syphilis study mistreated Black men, and Henrietta Lacks, a Black woman, did not have knowledge or give consent to have her cancer cells used to create a cell line for medical research.

Some people think hospitals are trying to help themselves by pushing vaccination after they were inundated with patient admissions, said Dr. Panagis Galiatsatos, an assistant professor at Johns Hopkins School of Medicine in Baltimore,

“For others, it’s still not knowing enough: How did we get it done in such a quick time?” he said.

COVID-19 vaccines were developed in record time under President Trump’s Operation Warp Speed, which oversaw the development and regulatory approval in less than a year, defying expectations. Somewhat paradoxically, MAGA-land is falling behind in the vaccine push.

A Kaiser Family Foundation analysis found relatively similar uptake in April between counties that voted for Mr. Biden versus those that backed Mr. Trump, but the gap has widened notably. Roughly 47% of residents in pro-Biden counties are vaccinated versus 35% in pro-Trump counties.

Michael Bars, who served as a senior communications adviser in the Trump White House, said people should remember that the COVID-19 vaccines were subjected to the same scientific process as many other common vaccines.

“Inevitably, some will be more comfortable than others as safeguards are relaxed, but thanks to President Trump’s Operation Warp Speed, achieving a safe and effective vaccine faster than ever before didn’t mean cutting corners,” he told The Washington Times.

Mr. Trump on Sunday issued a statement demanding credit for vaccine development and highlighting its global benefit, though it did not address hesitancy.

“While we get no credit for this from the Fake News Media, the people know — that’s why I got 75 million votes!” Mr. Trump said.

Experts say red-state resistance shows overlap with rural resistance and general distrust of government or the belief that the COVID-19 threat was overblown.

Arthur Caplan, director of the division of medical ethics at the New York University Grossman School of Medicine, said the dynamic is “ridiculous.” He noted that luminaries up and down the conservative landscape have rolled up their sleeves, including Mr. Trump and his family, Fox News magnate Rupert Murdoch, Senate Majority Leader Mitch McConnell, Texas Gov. Greg Abbott and former New Jersey Gov. Chris Christie.

“They’re all vaccinated,” he said.

Some holdouts say they have had the virus and don’t need the vaccine because of natural immunity.

A Cleveland Clinic study from June showed previously infected people might not benefit from vaccination, though dangerous variants of the virus are raising concerns about the durability of infection-induced antibodies.

A study in Nature found antibodies in recovered COVID-19 patients were four times less potent against the delta variant, first detected in India, than the “alpha” variant that made headlines in Britain and swept the U.S.

Previously infected people benefited from getting one dose of a COVID-19 vaccine in the study, released Thursday, while those who hadn’t been exposed to the virus received robust protection against delta from two doses of the Pfizer or AstraZeneca vaccines but little protection from a single dose.

Mrs. Vaeth, who had COVID-19, said she doesn’t believe she needs the shot.

“If I had the antibodies, there’s no reason to get a double antibody with the vaccine,” she said.

More broadly, she said she has seen patients with medical issues after vaccinations, including shingles, heart conditions and blood clots.

“We’ve seen all of it that they say on the news but sugarcoat it,” she said. “I think that the side effects are far more severe than COVID.”

Part of the debate around vaccination pivots on personal choice versus community obligation. 

Biden administration officials have argued that vaccination is a “patriotic duty” that extends beyond a personal choice on whether to be protected or not because it is a communicable disease and children or the immunocompromised cannot get the vaccines. 

Wider transmission of the virus also raises the likelihood of breakthrough infections in those who have been vaccinated. The shots are effective but not perfect.

Mr. Biden says the exports of vaccines to other countries is a form of national defense because it will fight possible mutations that can come back to the U.S. Experts say it should be a catalyst for vaccination at home, too.

“It’s not just a protection for you. You are helping deprive the virus of its main biological purpose for living: to replicate and make more of itself,” Dr. Galiatsatos said. 

“By being vaccinated, you stop it from spreading and, thereby, helping end its existence overall. And this, in turn, will stop mutations, too,” he said.

The best performing states such as Vermont and Massachusetts have more than 60% of their populations vaccinated. At least 6 in 10 remain unvaccinated in over a dozen states across the South, Midwest and West. As a result, the nation is far from the 70% to 90% vaccination level.

Governors are offering cash incentives and prizes to try to boost vaccination numbers, though West Virginia Gov. Jim Justice, a Republican, said it is still difficult to persuade young adults to get vaccinated. He also said conservatives are reluctant.

“You know, the red states probably have a lot of people that, you know, are very, very conservative in their thinking. And they think, ’Well, I don’t have to do that.’ But they’re not thinking right,” Mr. Justice recently told ABC News. “We have a lottery, you know, that basically says, ‘If you’re vaccinated, we’re going to give you stuff.’ Well, you’ve got another lottery going on. And it’s the death lottery.”

Some public health analysts say it’s time to get tough instead of relying on free beer, lotteries and other incentives.

“I don’t think it’s working, and I think the solution is going to get the vaccines licensed and start mandating: military, certain occupations, first responders, health care workers, require it for college, maybe requiring it for public-facing jobs,” Mr. Caplan said. “We’ve got to shift. We’re fooling around while these variants pop up.”

Biden officials have left it up to private entities to draft their own rules but avoided government mandates. He said it is up to individuals to come forward and his administration will enlist trusted voices.

A recently announced door-to-door effort to promote the vaccines, however, ran into opposition from Republican governors such as South Carolina’s Henry McMaster, who ordered state health officials to reject doorstep pressure.

That resistance sparked a rebuke from White House press secretary Jen Psaki, who said Friday that the canvassers will be community partners and ignorance about vaccines “is literally killing people.”

Joshua Ratner, executive vice president and chief strategy officer at the Westchester Medical Center Health Network, said working with trusted local organizations at their mobile vaccine clinics has helped them as they target ZIP codes with low vaccination rates in the southern counties of upstate New York.

“Simply being able to talk to someone, especially if that someone looks like them and comes from their community, it helps,” Mr. Ratner said.

He said the needle is moving slowly, though expectations must be set differently than before.

“You’re not looking for a pop-up clinic where you vaccinate hundreds of people; you’re looking for opportunities for tens of people,” he said. “The longer we’ve been vaccinating the public and the more time goes by and they realize there are very few side effects or complications, the more folks are jumping in.”