State has ‘hit the wall’ for vaccines
New approach needed for persuasion, access
The physicians at Marshfield Clinic Health System were given talking points late last month for persuading patients to get the COVID-19 vaccine. “When our patients come to see our care teams, this has got to be part of the conversation,” said William Melms, chief medical officer for the health system.
Those conversations will become increasingly important as gains in the state’s vaccination rate — particularly in north-central and northern Wisconsin where Marshfield Clinic provides care — slow.
“We truly have hit the wall,” Melms said. “It’s discouraging. This is the most worrisome aspect of the
pandemic now.”
Roughly 46% of the state’s population — and 57% of the state’s adults — have received one dose of a COVID-19 vaccine as of May 8. That’s well above states such as Mississippi, Louisiana, Alabama and Idaho where the rate ranges from 32% to 35%.
The approval of the Pfizer-BioNTech vaccine for adolescents will increase the percentage of people vaccinated in the state. But the pace clearly is slowing. In an unsettling sign, the state asked for just 8% of the doses that the federal government had set aside for last week, according to The Associated Press.
The vaccination rate also varies throughout the state, with sharply lower rates in some rural counties. And vaccination rates among people who are Black, Latinx and Native American remain well below the state average.
“We’ve moved from the really highly motivated segments of the population, who were really waiting to be able to be vaccinated,” said Matt Anderson, a physician and senior medical director of primary care for UW Health. “And now we are into people who maybe are a little less motivated to get vaccinated or on the fence about whether to get vaccinated.”
Some are wary, but others lack time or transportation
Ben Weston, a physician and director of medical services at the Milwaukee County Office of Emergency Management, doesn’t believe that the vaccination rate has hit a wall but instead entered a new phase that will require different approaches.
The goal will be to reach people who want to be vaccinated but haven’t done so yet. They are people who work multiple jobs, who lack transportation or child care and who simply haven’t made it a priority. It also includes those who are wary and want more information.
“We have a lot of work to do to reach the people who either have barriers to getting vaccinated or have questions about getting vaccinated,” Weston said. But he’s optimistic.
“We still have a sizable portion of population that we can reach as we modify our strategies on how to reach them,” Weston said. “Now part of it is reaching them just through convenience — vaccines in the places where they are. Part of it is reaching them through more messaging and probably more focused messaging and finding the right messengers.”
That will require an array of new approaches.
“With anything of this scale, it takes time to kind of stand up and then it takes a little bit of time to tailor,” said Zeno Franco, a professor at the Medical College of Wisconsin. “And we are seeing some of that tailoring happening.”
Vaccines are available at numerous locations, including independent pharmacies, Walgreens and CVS drug stores, Pick ’n Save supermarkets and Wal-Mart stores, and the state’s decentralized approach has been praised. But many sites close at 5 p.m. or earlier.
“People are working at very different times,” Franco said. “And to think that vaccinating people from 8 to 5 is going to work for everyone is probably just not the case.”
That said, most vaccination sites at pharmacies and supermarkets are open on weekends, and same-day appointments now are available. It’s another sign of the drop-off in demand.
The challenge going forward will be reaching people who cannot or are unlikely to go out of their way to get the vaccine.
The Milwaukee Health Department is scheduling temporary vaccine clinics throughout the city, even holding one at a Milwaukee Bucks game. Ascension Wisconsin partnered with the Social Development Commission and Boys & Girls Clubs of Greater Milwaukee to hold two vaccination clinics. Employers, such as Johnson Controls and Northwestern Mutual, also have held vaccine clinics.
And the Fox Cities COVID-19 Vaccine Clinic has partnered with Appleton Beer Factory, McFleshman’s and Stone Arch Brewpub to give a coupon for a free beer when someone gets vaccinated — though the coupon is not good until June when full immunity has developed. (People under 21 get a coupon for a free root beer or soda.)
“To me, this whole next phase is about how do we make it convenient for people while continuing to provide them with accurate information,” said Anderson of UW Health.
Reaching the hesitant will require one-on-one conversations
The vaccination rate still is likely to hit a plateau.
“Then we are going to have to slowly chip away — appointment by appointment, interaction by interaction,” Anderson said. “Ones and twos are going to add up over time.”
That will require reaching people who are truly hesitant about the vaccine — as opposed to adamantly opposed. And here physicians and other health care providers will be important.
People trust their personal doctor, said Weston, who also is a professor of emergency medicine at the Medical College of Wisconsin.
He talks to just about every patient he sees in the emergency department at Froedtert Hospital about the vaccine.
“It’s amazing what a two-minute conversation can do to dispel some myths, to clear some things up,” he said.
The four community health centers and the Gerald L. Ignace Indian Health Center are well-positioned for conversations with patients. They provide care to about 85,000 people in Milwaukee. And their clinics are in low-income neighborhoods where vaccination rates have been low.
“They’ve been a key player from the beginning,” Weston said, “and they will continue to be a key player in the future.”
Milwaukee Health Services, for instance, has held one walk-in clinic on a weekend and plans to hold others in the community, such as one planned for Juneteenth Day.
“We are getting ready to hit the neighborhood strong,” Pamela Clark, a spokeswoman for the community health center, said last month.
Single-dose vials of the vaccine that could be given at a clinic, similar to vaccines for the flu and pneumonia, also would help, particularly in rural areas. That would enable physicians and other health care providers to give the vaccine immediately to patients.
“Any vaccinator would tell you that we would love single-dose vials,” said Anderson of UW Health.
(The vaccines must be used once a vial is punctured. The number of doses in a vial range from 5 to 11 depending on the vaccine.)
Church leaders, community health workers and especially family and friends also will have an essential role in encouraging people who are wary to get vaccinated.
“Individuals want to hear from their neighbors, their friends, their family why they were hesitant, why they changed their mind, why they decided to get the vaccine and what their experience was,” said Mara Lord, chair of the Milwaukee area vaccine communications and community mobilization effort.
Every individual vaccinated helps
Without question, reaching some people will be impossible.
Melms of Marshfield Clinic Health System has been surprised by the indifference and at times outright opposition to the vaccine.
“We’ve got this safe, effective way out of this thing,” he said. “The way we truly can save lives is through vaccination. And people are turning it down.”
Some of this is a result of misinformation, such as the belief that the vaccine will affect their DNA.
(The genetic material in the vaccines that triggers the immune response never enters a cell’s nucleus, the site of our
DNA.)
“People tend to believe Facebook over their physicians in many situations,” Melms said.
Other people don’t believe COVID-19 is a threat.
“And frankly it has become very political as well,” Melms said. “That a public health issue like this has to be drawn along party lines is a little heartbreaking.”
COVID-19 is not a benign disease, Melms said. And he tells patients that more than 99% of the physicians at Marshfield Clinic have gotten the vaccine.
“Our physicians know the science,” Melms said. “They know the risks and benefits. And, really, you probably should listen to them.”
He agrees that whether to get the vaccine is a personal choice. But he said, “It’s a personal choice that has consequences outside of the person.”
Roughly 550 people a day in Wisconsin still are testing positive for the disease. That figure doesn’t include people who are asymptomatic and can infect others. And, as one of Melms’ colleagues noted, every one of those people got the disease from someone else.
“It’s not just about vaccinating you,” Melms said. “It’s about preventing transmission to someone who may succumb to the disease.”
Melms doesn’t expect the state to hit the threshold for so-called herd immunity in which the virus can no longer spread.
“And most experts don’t,” he said. But Weston said that reaching herd immunity is not a magical number.
“It’s about vaccinating as many people as we can,” he said, “and continuing to drive down that disease transmission.”
That’s now the goal — getting as many people vaccinated as possible, reducing the number of cases and preventing hospitalizations and deaths. It will require new approaches, and the gains will be slower. But Weston, Melms and others said the state just needs to keep working at reaching people.
“When we get a vaccine into an individual,” Melms said, “we truly are changing the course of this epidemic.”