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Fall vaccination campaign will bring new shots, worse access


Michael Brown cuts the hair of Michael Venable at The Spa Shop, a barbershop in Hyattsville, Md. on July 10, 2020. Prior to COVID-19, The Spa Shop would service up to 1,000 per week.

By Benjamin Mueller


Long past the point when pollsters said there were no more Americans willing to be vaccinated against the coronavirus, Coral Garner kept finding them.


An organizer of mobile clinics for the Minnesota Department of Health, she arranged to provide vaccines and booster shots to people who had resisted them, setting up in a retrofitted city bus outside a Nigerian church, a Hmong senior center, a Somali mall and dozens of other sites.


But even as the United States now prepares for a critical campaign to deliver omicron-specific booster shots, Garner’s job no longer exists. In June, her contract position was canceled because the state said funding had dried up.


At the very moment a better coronavirus vaccine is expected to finally become available, America’s vaccination program is feeling the effects of a long period of retreat.


Local programs to bring shots to the places where Americans gather and the institutions they trust have folded, a consequence in some cases of congressional resistance to more pandemic response spending.


The same local health department workers responsible for COVID-19 and flu shots this fall have also, without new staffing, been juggling a monkeypox outbreak and childhood immunization deficits that have left some places susceptible to polio.


And some state health officials, citing weak demand for vaccines and increased survival rates of late, said in interviews that they had stopped aggressively pushing coronavirus shots.


With the virus killing far fewer people than it once did and many Americans reverting to their pre-pandemic ways, the country’s attitude to saving lives has evolved into a response that has put a greater onus on individuals to protect themselves. In keeping with that approach, many health officials believe the vaccine machinery is in place to meet what they expect, lamentably, to be tepid demand this fall.


But others are worried that the country is surrendering a decisive opportunity to stoke that demand and restore the more robust vaccination efforts that lifted last year’s initial rollout.


“We are watching the dismantling of the hyperlocal infrastructure that actually brought needles to arms in the most vulnerable communities in the country,” said Stephen Thomas, director of the Center for Health Equity at the University of Maryland. “To this day, vaccine uptake in the United States is embarrassing.”


The Biden administration said about 70,000 sites were prepared to vaccinate people this fall. Although 60% of those are pharmacies, they also include doctor’s offices, community health centers and rural health clinics.


States can also seek money from the Federal Emergency Management Agency for certain vaccination-related expenses, such as setting up sites, buying equipment, and offering translation or transportation services.


Having shifted much of the rollout to private sites, though, states have been promised FEMA reimbursements on a relatively modest $550 million in vaccination spending so far this year. Last year, that figure was $8.5 billion.


And although providers are supposed to vaccinate everyone for free, with or without insurance, the federal government ran out of money this past spring to offer reimbursements for shots for uninsured people, making it more difficult for them to receive boosters.


Sonya Bernstein, a senior policy adviser for the White House COVID-19 response team, said federal spending to support vaccination efforts was being held back by a stalemate in Congress over the administration’s request for billions of dollars in additional pandemic aid. Republicans have said that additional coronavirus spending could be covered with funding already approved by Congress, an assertion that some state health officials say is false.


“We are working with less because Congress has not provided us with that funding,” Bernstein said. “But that has not gotten in the way of our preparations. We’re working day in and day out to make sure states and our partners have the resources and support they need.”


The United States is leaning ever more heavily on vaccines to defend against the virus at a time when health officials are pulling back on other preventive measures, such as masking, distancing and quarantining.


The fall vaccination campaign, which is expected to begin soon after Labor Day, could be crucial. Many Americans have gone months since their last COVID-19 vaccine or infection, allowing immune defenses to wane. More indoor gatherings are on the horizon, and public health researchers predict roughly 100,000 to 165,000 additional COVID-19 deaths by the spring.


And, for the first time, the government has bought vaccines that were reformulated in response to the virus’s evolution. Manufacturers may finally have gained on the virus: The omicron subvariant that the updated shots were designed to protect against remains dominant in the United States.


But, at the same time, the vaccination campaign is lagging. Although two-thirds of Americans have completed the primary vaccine series, only about one-third have received boosters. The country’s per capita booster coverage trails that of about 70 other nations, according to Our World in Data.


With COVID-19 deaths having plateaued around 480 a day, policymakers are grappling with whether renewed investments are needed. Some states believe they are not.


In Alabama, where one-fifth of residents are boosted, Dr. Burnestine Taylor, the state’s medical officer for disease control and prevention, said officials had pared back health department clinics and become more reliant on pharmacies as demand dropped. The decision to receive additional shots, she said, now fell to individuals.


“At this point, we’re not doing a hard push,” Taylor said. “It’s a personal decision.”


Bernstein, the White House adviser, said the administration was regularly surveying people about booster shots and using the results to inform messages it suggested to on-the-ground partners.


Ben Weston, Milwaukee County’s chief health policy adviser, said the nation’s underfunded booster campaign had hurt the same vulnerable and often nonwhite residents who have long struggled to gain access to good medical care.


“It’s putting up barriers,” he said, “particularly for populations that are more susceptible to those barriers.”

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