Nudges needed to get shots in arms

Vast majority of new cases are among unvaccinated

With coronavirus cases rising among the unvaccinated and efforts to get them shots lagging, there is growing belief in some public health circles that more aggressive tactics are needed to get more of the population inoculated.

California has already tried prizes and game show-style events to encourage people to get vaccinated. But 41% of Californians of all ages have yet to be inoculated. And two troubling and related trends are bringing calls for fresh thinking.

The coronavirus is spreading in Cal

ifornia — mostly among unvaccinated people. While cases and hospitalizations are still more than 93% lower than they were at the peak, new daily coronavirus cases have nearly tripled over the last month, from about 900 a day to more than 2,600 a day; hospitalizations have risen by nearly 75%, from 915 to 1,594.

According to data reported in The New York Times on Wednesday, the number of cases in the U.S. has increased 109% in the last 14 days, with deaths increasing 17% over that same period.

Meanwhile, the pace of vaccinations in California continues to tail off. Only about 58,000 vaccine doses a day are being administered statewide, according to figures compiled by the Los Angeles Times. Though that average could rise as more data are reported, it won’t come close to the peak of 400,000 a day.

The solution won’t be easy, but officials and experts are pretty confident they know what will work.

First, sending trusted people in communities to advocate for vaccinations at events and doing door-todoor outreach can do wonders in convincing people to get vaccinated, said UC San Francisco epidemiologist Dr. Kirsten BibbinsDomingo. Getting vaccines into the offices of primary care physicians, where doctors can answer patients’ questions directly, can help too.

Another strategy would involve new requirements to get vaccinated, such as at workplaces, Bibbins-Domingo said. Short of that, she said, employers could require unvaccinated workers to get tested daily — an approach that has been used elsewhere around the world.

“When being vaccinated becomes the more convenient of the two options, that will drive people to be vaccinated,” Bibbins-Domingo said. “You have to make it slightly less convenient to be unvaccinated at this point.

“If you choose to get tested every day, because you don’t believe in vaccination, that might be fine. But I think for some, being tested every day or being tested at some very regular interval might be that the thing that says: ‘Well, yeah, when I look at the risk and benefits, the vaccine is looking a little bit better.’ ”

Fully vaccinated people do have very good protection against coronavirus infection and illness. Between Dec. 7 and June 7, unvaccinated people in L.A. County comprised 99.6% of its coronavirus cases, 98.7% of COVID-19 hospitalizations and 99.8% of deaths.

San Francisco has ordered all workers in “highrisk settings,” such as hospitals, nursing homes and residential facilities for the elderly, homeless and jails, to be fully vaccinated by Sept. 15. An exemption will be available for workers with valid religious and medical reasons, and they will be required to get tested for the virus weekly.

San Francisco has also ordered all 35,000 of its city workers — including police, firefighters, custodians and clerks — to get vaccinated or risk losing their jobs, unless they have a religious or medical exemption, once a vaccine has been formally approved by the U.S. Food and Drug Administration. Currently, all three available vaccines are being distributed under an emergency use authorization.

The University of California and California State University systems have also announced they will eventually require COVID-19 vaccinations for all students, faculty and staff on campus properties.

Even if mandates ultimately become more commonplace, on-the-ground outreach is still essential, experts say. And there is good reason to believe more of it will help.

San Francisco’s outreach to the hard-hit Latino community in particular has been a model, with 72% of Latino residents having received at least one dose — a rate even better than White residents, 65% of whom are at least partially vaccinated. In much of the U.S., the vaccination rate for Latinos lags behind White residents.

There have been teams that go out to places like San Francisco’s Tenderloin District, where they interact with people on the streets, in stores and churches to promote vaccinations and administer the shots.

In Santa Clara County, which also has a high vaccination rate and stable hospitalizations, officials identified census tracts with the lowest vaccination rates and focused on them to launch vaccination clinics. They’ve also focused on essential workers in industries like child care, education and agriculture, and have worked with unions and employers to reach more people.

In the Central Valley, UC Merced Community and Labor Center Executive Director Ana Padilla said there still needs to be better access to the vaccine — and good information about it — to people like agricultural workers, who are now working the busiest time of the year. She suggested that there be a greater effort to link trusted communitybased groups to administer vaccines near work sites, which will be better equipped to answer questions from workers.