Ohio coronavirus vaccine demand has slumped. Now comes the long slog toward herd immunity. - cleveland.com

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COLUMBUS, Ohio - Millions of Ohioans couldn’t get a coronavirus vaccine jab soon enough.

They believed in the science, were lonely for their loved ones and wanted to travel or see the office again. They put their names on vaccine waiting lists, regularly tracked their eligibility and loaded -- and reloaded and reloaded -- websites of providers, hoping for an open appointment.

Then, the impatient, sometimes frantic demand for the vaccine came to a screeching halt.

Appointments are now available in every corner of the state. There’s so much unused vaccine in the past couple of weeks that the state has been able to shift thousands of doses to regions with COVID-19 surges. Starting this week, vaccine clinics at the Summit County Fairgrounds are being scaled back from three to four a week to once a week. Mercer County in Western Ohio ended its mass vaccination clinic altogether, and is now sending doses to providers that serve minority communities.

The abrupt plunge in vaccine demand has occurred in the past month, when the people who wanted shots finally received them. Since then, the state has continued to receive weekly allocations of vaccines, but the number of people lined up has dwindled.

The sudden plunge in demand was even a shock to Dr. Michelle Medina, Cleveland Clinic Community Health’s associate chief of clinical operations.

“I think there was always going to be a slip between not enough, a lot of demand to a lot of supply, less demand,” she said. “What has been surprising is how quickly that came down. Everybody was expecting they’re going to have a big surge and maybe a tail-off. But what ended up happening is it was almost like we hit a wall.”

Ohioans age 16 and older are eligible for the vaccine. This is 9.4 million people. However, not even 4 million Ohioans have completed the vaccine, defined as receiving a second dose or the single-dose Johnson & Johnson shot.

Aside from some Ohioans who cannot take the vaccine due to medical conditions, millions of Ohioans are hesitant. Public health officials said many are on the fence -- rather than dead-set opposed -- and they remain hopeful that the state will eventually achieve herd immunity.

But it may take a while before Ohio gets there.

While nearly half of the age-eligible Ohioans have been vaccinated, nearly a fifth the the state - the 2.3 million children under the age of 16 - have not been approved by the federal government to receive any of the vaccines. This chart shows the share of Ohioans who have received at least one dose.Rich Exner, cleveland.com

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says he thinks herd immunity will be achieved when 75% to 85% of the population is vaccinated.

But it may not have to be that high.

Medina said that the number Fauci uses is one that gets communities to herd immunity with other vaccines. But the exact number with COVID-19 isn’t yet known.

“That may be the number we need here,” she said. “But what if it’s a lower number -- just because they’re so effective? Pfizer and Moderna are both above 90%.”

A study in Israel found that with every 20 percentage point increase in adult vaccination rates in a community, the risk of children testing positive halves. The study hasn’t been peer reviewed.

It’s unknown whether the same protection for children will be found in the U.S., which is much larger and has a different pace of vaccinations, Medina said.

The urban centers around Cleveland, Columbus, Cincinnati and Toledo have among the highest vaccination rates in Ohio, based on data available through Thursday.Rich Exner, cleveland.com

Some people are hesitant about getting vaccinated because the vaccines were developed so quickly in comparison to previous ones. They are concerned about long-term effects that haven’t yet been documented. People hear contradictions, such as 95% efficacy for one vaccine but 72% for another, Medina said.

“You’re going to have people be completely against it -- and I think that’s probably a lower number -- and then you’re probably going to have a fair number of people who continue to sit on the fence and say, ‘Well, I may wait another week, maybe another few weeks, maybe a few months just to see how this is going to shake out,’” she said.

Nearly a fifth (19.7%) of Ohio adults say they either probably or definitely won’t get the vaccine, according the Census Bureau’s Household Pulse Survey completed at the end of March.

Among these people, better than half (53.7%) said they were concerned about side effects. More than one reason could be cited by individuals. Not trusting the COVID-19 vaccine were 41.7%, and 40.3% said they didn’t believe they needed it.

More people, however, have grown interested in getting the vaccine. In early January, 25.5% of Ohio’s adults said they probably or definitely would not get the vaccine.

But Ohio during both periods lagged the national rate, which fell from 21.5% in the survey completed in mid-January to 15.6% at the end of March.

Nationally, among those with bachelor’s degree, 7.9 % said they probably or definitely would not get the vaccine. This compared to 17% among those with some college education, and 20.4% who had a high school degree but did not go to college.

The national rate was the same among men and women.

County	Population Age 16 up	One dose	Pct.	All doses	Pct.
Delaware	153,408	105,370	68.7%	73,686	48.0%
Warren	178,795	99,135	55.4%	72,977	40.8%
Wood	106,853	57,790	54.1%	45,673	42.7%
Geauga	75,124	40,456	53.9%	29,699	39.5%
Medina	142,714	76,852	53.9%	54,982	38.5%
Lake	189,395	100,876	53.3%	68,010	35.9%
Union	44,524	23,648	53.1%	17,057	38.3%
Ottawa	34,088	18,093	53.1%	14,138	41.5%
Cuyahoga	1,017,354	521,593	51.3%	378,209	37.2%
Franklin	1,019,324	519,699	51.0%	359,708	35.3%
Summit	441,370	222,349	50.4%	157,848	35.8%
Hamilton	645,956	324,874	50.3%	238,179	36.9%
Lorain	248,229	124,762	50.3%	88,839	35.8%
Henry	21,615	10,378	48.0%	8,047	37.2%
Erie	61,552	29,418	47.8%	22,856	37.1%
Greene	136,388	65,056	47.7%	49,422	36.2%
Lucas	342,588	163,109	47.6%	124,339	36.3%
Fairfield	121,887	57,687	47.3%	42,237	34.7%
Mahoning	189,231	88,095	46.6%	67,561	35.7%
Clermont	161,992	75,144	46.4%	54,295	33.5%
Montgomery	427,551	198,310	46.4%	150,429	35.2%
Putnam	26,249	11,913	45.4%	10,225	39.0%
Licking	137,872	62,500	45.3%	47,961	34.8%
Butler	300,636	134,463	44.7%	93,091	31.0%
Sandusky	47,268	21,084	44.6%	16,428	34.8%
Portage	135,933	60,443	44.5%	41,950	30.9%
Clark	108,131	48,055	44.4%	39,196	36.2%
Trumbull	164,324	72,515	44.1%	53,048	32.3%
Stark	301,461	132,073	43.8%	91,937	30.5%
Fulton	33,522	14,599	43.6%	11,877	35.4%
Madison	36,168	15,727	43.5%	11,862	32.8%
Hancock	60,861	26,294	43.2%	20,693	34.0%
Wyandot	17,618	7,456	42.3%	6,018	34.2%
Muskingum	68,863	29,143	42.3%	25,264	36.7%
Defiance	30,495	12,878	42.2%	10,421	34.2%
Washington	49,998	20,957	41.9%	16,934	33.9%
Ashtabula	78,853	32,856	41.7%	24,443	31.0%
Miami	84,088	34,659	41.2%	27,252	32.4%
Seneca	44,654	18,242	40.9%	14,265	31.9%
Athens	57,409	23,205	40.4%	17,432	30.4%
Pickaway	46,894	18,763	40.0%	14,162	30.2%
Ross	62,382	24,836	39.8%	20,552	32.9%
Hocking	22,937	9,070	39.5%	7,316	31.9%
Huron	45,821	18,077	39.5%	13,791	30.1%
Marion	52,912	20,845	39.4%	15,547	29.4%
Williams	29,453	11,446	38.9%	9,859	33.5%
Jefferson	54,870	21,287	38.8%	16,630	30.3%
Monroe	11,414	4,401	38.6%	3,725	32.6%
Van Wert	22,433	8,611	38.4%	6,706	29.9%
Jackson	25,476	9,765	38.3%	7,719	30.3%
Crawford	33,706	12,864	38.2%	10,719	31.8%
Scioto	61,448	23,219	37.8%	19,874	32.3%
Columbiana	84,499	31,835	37.7%	25,113	29.7%
Wayne	91,002	34,228	37.6%	25,052	27.5%
Guernsey	31,460	11,816	37.6%	9,865	31.4%
Gallia	23,969	9,000	37.5%	7,613	31.8%
Knox	49,017	18,317	37.4%	14,819	30.2%
Paulding	14,867	5,506	37.0%	4,492	30.2%
Champaign	31,345	11,441	36.5%	9,251	29.5%
Carroll	22,402	8,152	36.4%	6,434	28.7%
Tuscarawas	73,768	26,841	36.4%	21,094	28.6%
Richland	97,923	35,471	36.2%	28,340	28.9%
Clinton	33,281	12,048	36.2%	10,031	30.1%
Belmont	56,646	20,504	36.2%	15,705	27.7%
Allen	82,102	29,588	36.0%	25,350	30.9%
Noble	11,944	4,302	36.0%	3,533	29.6%
Auglaize	36,050	12,975	36.0%	10,980	30.5%
Harrison	12,494	4,492	36.0%	3,535	28.3%
Pike	22,177	7,942	35.8%	6,788	30.6%
Morgan	11,959	4,280	35.8%	3,611	30.2%
Meigs	18,704	6,688	35.8%	5,599	29.9%
Mercer	31,612	11,247	35.6%	9,174	29.0%
Logan	36,144	12,827	35.5%	10,490	29.0%
Morrow	28,038	9,858	35.2%	7,708	27.5%
Fayette	22,646	7,960	35.1%	6,263	27.7%
Coshocton	28,823	10,099	35.0%	8,512	29.5%
Perry	28,635	9,827	34.3%	8,083	28.2%
Vinton	10,472	3,492	33.3%	2,925	27.9%
Darke	40,635	13,512	33.3%	11,324	27.9%
Ashland	42,900	14,217	33.1%	9,837	22.9%
Preble	33,028	10,888	33.0%	8,541	25.9%
Hardin	25,075	8,137	32.5%	6,848	27.3%
Shelby	37,941	12,000	31.6%	9,593	25.3%
Highland	34,122	10,386	30.4%	8,466	24.8%
Brown	34,824	10,494	30.1%	7,696	22.1%
Lawrence	48,590	13,897	28.6%	10,821	22.3%
Adams	21,808	5,872	26.9%	4,318	19.8%
Holmes	31,595	5,657	17.9%	4,620	14.6%

There is a clear urban/rural divide in Ohio, with the rural numbers being driven down by low vaccination rates in several small southern Ohio counties.

Among Ohio’s largest counties - the 15 where there are at least 150,000 residents age 16 and up - nearly half of age-eligible people (49.9%) had received their first dose, based on Ohio Department of Health reporting through Thursday.

Yet in the 49 smallest counties with fewer than 50,000 people age 16 and up, 37.5% had received their first vaccine.

Ashtabula County Health Commissioner Ray Saporito said there are reasons for the gap. At the beginning of the pandemic, outbreaks were concentrated in urban areas. It took longer for Ashtabula County to become a “red” county in the state’s Public Health Advisory system.

“I think there was a perception of, ‘Oh, I’m not going to get this.’ I think the numbers play a role,” he said.

The urban areas had mass vaccination clinics, which were well-publicized and convenient.

“We did not have that luxury,” he said.

Vaccination rates are highest in Ohio's most populated counties. In the 15 largest counties with at least 150,000 residents age 16 and up, 49.9% have received at least one dose. But in the 49 counties where there are fewer than 50,000, the rate is just 37.5% for those age 16 and up.Rich Exner, cleveland.com

Much of the hesitancy in his area is among younger people, he said.

“In the very beginning when the vaccine was made available to us, we had waiting lists that were, gosh, we had 3,000 to 4000 on a waiting list,” he said. “The people who really wanted this, most of the people who took the vaccine, percentage-wise, are going to be the older people. I’d say 60 and above were more motivated. They perceived themselves as more vulnerable. The younger people – 30-, 40-, 50-year- olds, I think they were less motivated.”

The federal government’s pause on administering the Johnson & Johnson shot -- after six women had severe blood clotting out of 6.8 million doses administered – may have also rattled people who were skeptical about the vaccine, Saporito said.

Vaccines work

The disinterest in getting vaccinated among some Ohioans comes despite strong evidence of them working. For example, hospitalizations have dropped dramatically for the older people who were the first to be offered vaccines.

In December, just as the vaccines were getting started, Ohioans age 70 and older accounted for 51% of all coronavirus hospital admissions. That share has dropped to just 26% this month.

And data is starting to show a change for the next groups eligible as well. For example, those age 50 and older became eligible for shots in mid-March. Already, their share of hospitalizations has leveled off, following what had been an increased share in previous months as fewer older people were admitted.

Yet the share of hospitalizations is on the rise for younger age groups, those both to be last offered the vaccine and with the lowest vaccine rates.

The share of hospitalizations among Ohioans age 70 and up has been cut in half since vaccinations started. And the next age group, those from 50 to 69 years old, are seeing a leveling off in just the first few weeks after all became eligible in mid-March.Rich Exner, cleveland.com

At the state level, Gov. Mike DeWine has encouraged vaccine providers to work with labor unions, employers and other groups to offer vaccine clinics in an attempt to distribute more shots.

That appears to be working, although not on a massive scale.

For instance, in Union County, outside of Columbus, Scott’s Miracle Gro recently held two weekend drive-up clinics for employees and others in the community; 800 people were vaccinated.

In Lucas County, where contagion is especially high due to the proximity with Michigan and virus variants, health officials are targeting neighborhoods by studying ZIP codes where vaccination rates are lower.

Alternating between small community clinics and larger clinics seems to be working in Cuyahoga County, said Kevin Brennan, communications officer for the Cuyahoga County Board of Health, who said he isn’t seeing a lot of vaccine hesitancy.

Each week on Tuesdays and Wednesdays, a mass vaccination clinic alternates between The Word Church in Warrensville Heights and Cuyahoga Community College Western Campus in Parma, he said.

“This past Tuesday and Wednesday, we were at 95% percent capacity, in terms of the number of people we put through in a day,” Brennan said.

Last weekend, the health department worked with the Islamic Center of Cleveland at its location in Parma. Approximately 200 people were served. And on the east side, the department works with the Salvation Army to host clinics, he said.

The Cleveland Clergy Alliance and other organizations also arrange to give people rides.

State health officials and the governor’s office will continue to look for ideas to target vaccinations, said DeWine’s spokesman, Dan Tierney.

On Wednesday, DeWine disclosed he’s considering changing the metric for which all public health orders - from the mask mandate to the rules at schools - will be lifted. Currently, cases need to drop to 50 per 100,000 residents over two weeks for life to return to what it was before the pandemic.

But now he’s thinking about switching to a vaccine benchmark. Kentucky Gov. Andy Beshear earlier this month created one for his state.

This could work as an incentive for people to get vaccinated and, in the end, increase vaccine demand. And it’s easier for the public to track vaccination progress on the Ohio Department of Health’s coronavirus dashboard, than cases per 100,000 residents, which is an averagethat requires some digging into the dashboard, plus some math to calculate.

“By no means is that the end of it,” Tierney said about the state’s efforts thus far to increase demand. “We’re constantly looking at it and will move on to new initiatives in the state.”

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