As vaccination rates decline, DHHS and health care providers trying to reach rural, underserved communities

The total number of vaccinations dropped by 23% over one week in April, an indication that North Carolina still faces challenges in achieving its vaccination goals.

Now the state Department of Health and Human Services wants to direct vaccination efforts toward neighborhoods where few people have gotten shots.

“We have likely gone through all of the people who were very ready to get their vaccine,” said Amanda Fuller-Moore, a pharmacist in the public health division of the NC Department of Health and Human Services. “They were ready to do whatever it takes. Now we’ve reached a population that is more ‘bring the vaccine to me.’” 

Last week, DHHS Secretary Mandy Cohen announced ways to make it easier for more doctors to administer COVID-19 vaccines at their offices. In a YouTube video aimed at medical practices, Cohen said that the state has ended the requirement that they use all their weekly doses in seven days. Now, doctors can use half their weekly allotment and still request more vaccines. And the state has eased its mandate that doctors must use all doses in each vial.

“We want to ensure that vaccines are everywhere and are easy to access for everyone in our state,” Cohen said. “Our goal is to have vaccine in every primary care practice and as many other specialty practices as possible.”

When vaccines initially became available earlier this year, people jockeyed for appointments at vaccination clinics. But that demand tailed off as supplies increased and pharmacies began to offer shots. UNC Health said last week that it no longer requires appointments at its vaccination clinics and is now accepting walk-ins.  

Health officials say that the people most eager to get shots and had the means to do so have been vaccinated; and that now they’ll have to find ways make it easier for those who are left.  

Gov. Roy Cooper set a goal that two-thirds of North Carolinians would be least partially vaccinated. As of Sunday, nearly 50% of people in North Carolina 18 and older have had at least one shot.  

However, 412,050 people got shots the week of April 19, down from 536,626 the week before – for the lowest total administered in about two months, according to information posted Monday morning on the NC DHHS dashboard.

A temporary pause in Johnson & Johnson vaccine use began on April 13. It’s unclear how that may have played a role in the decline due to canceled appointments or renewed vaccine skepticism.  

“It’s hard to know,” said Dr. Charlene Wong, chief policy officer for COVID-19 at DHHS. She hopes the results from another round of market research will yield an answer.  

A Granville-Vance Public Health vaccination clinic earlier this year filled all its 1,200 appointments in a few days, said health director Lisa Harrison. For an April 16 clinic, it took two weeks to fill 400 appointments. Granville-Vance did not use the Johnson & Johnson vaccine.  

Public health officials will move to smaller communities, to reach people facing transportation challenges or other obstacles, Harrison said.  “In rural areas, we are all starting to head out to the countryside to make sure every has everybody has ample opportunity for access, she said.   

DHHS has mapped vaccination rates by census tract and overlayed it with the Social Vulnerability Index, data developed by the Centers for Disease Control and Prevention that measures of the percentage of people living in households without vehicles, speaking limited English, or are Black, Native American, or Latinx. The map also shows vaccine providers’ locations. The goal is to get vaccines to areas where vaccination rates are low and social vulnerability is high.  

The Social Vulnerability Index was developed to help emergency planners prepare for disasters. States have used it to help direct their vaccine allocations.  

“The challenge of getting in these rural areas exists nationwide,” Fuller-Moore said. “We’re looking to partner with local health department and we’re working with our vendors to do some pop-up clinics and mobile clinics,” she said. One idea is to have vaccination vans drive through communities like ice cream trucks.

The expectation is that organizations in North Carolina receiving grants through the Healthier Together initiative will use the data to know where to concentrate their efforts. Healthier Together is a public-private partnership the state announced in March that aims to get vaccines to marginalized communities.    

Vaccinations will fall and rise as new populations become eligible, said Dr. David Wohl, an infectious disease specialist at UNC who helps run the vaccination clinic at the Friday Center in Chapel Hill. But it’s likely that many of the “hand-raisers,” the people who actively sought out shots, have gotten them, Wohl said.  

There are still questions about how many eligible unvaccinated people want shots but haven’t been able to get them, how many are ambivalent, and how many are adamant about not being vaccinated.   

“We have to make sure the hand-raisers get access to the vaccine,” he said. “I’m committed – if we have to bring the vaccine to you, we’ll bring the vaccine to you.” 

For people who are reluctant, it may help to have their doctors give them advice.  

UNC Health is starting to get vaccines into its clinics, Wohl said. More and more, vaccinations need to be incorporated into primary care.  

“People trust their providers more than others,” Wohl said. “Strike while the iron is hot.”