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Now it gets harder to vaccinate people

We reached this point pretty quickly. The hill gets steeper from here.

After months of not having enough COVID-19 vaccines to meet demand, Texas suddenly appears to have plenty of shots but not as many people lining up to receive them, even though more than three quarters of the state still isn’t fully vaccinated.

Almost 7 million Texans have been vaccinated against COVID-19 — more than 23% of the state’s population — and health officials say they are starting to see lower demand at public vaccination sites. Recent data show reported vaccine doses have decreased: The number of people who have gotten at least one shot in Texas grew by over 1 million during the week ending April 14; the following week the number dropped to about 660,000.

Across Texas, local leaders are trying to ramp up outreach efforts and fill more appointments. Houston’s FEMA hub at NRG Park is now offering walk-in slots, a shift from prior appointment-only requirements that kept some residents from getting early doses. The state will also be rolling out a TV campaign to boost vaccinations, Department of State Health Services spokesperson Chris Van Deusen told the Wall Street Journal.

Local health officials say efforts to vaccinate older Texans have been successful: As of April 21, nearly 60% of Texans age 65 and older have been fully vaccinated. Since the state opened vaccinations to all adults on March 29, around one-fifth of Texans between 16 to 49 years old — who make up the biggest proportion of eligible adults — have been fully vaccinated.

“It seems we’re getting to the point that most people eager to get vaccinated have gotten at least their first dose,” Imelda Garcia, associate commissioner of laboratory and infectious disease services for DSHS, said during a Thursday press conference. “The next phase will be about helping ensure that vaccine is more easily available to those folks who are not going to go as far out of their way.”

Nationally, vaccine supply may outpace demand within the next month, according to the Kaiser Family Foundation, a health nonprofit.

Vaccination rates vary across Texas: most large urban and suburban counties, except for Tarrant County, are above the overall state rate in terms of the percentage of people who have received at least one dose. Along the border, a region that has been particularly hard hit by the pandemic, more than 40% of the population in many counties, including El Paso, Starr and Cameron, have gotten a dose — compared with 36% statewide.

[…]

Texas’ vaccination efforts are still missing people who have faced obstacles for months, said Catherine Troisi, an infectious disease epidemiologist with UTHealth School of Public Health in Houston. Some lack internet access or the computer skills to make an online appointment, while others lack transportation to reach a vaccine provider.

And Black and Hispanic Texans continue to be vaccinated at lower rates than whites, even as appointments become more available across the state.

According to the embedded map in the story, Harris County has fully vaccinated 22.8% of its residents, which is a bit below the statewide average of 23.6%. However, more than twice as many people have had at least one shot, which by my calculation is 56.7% of the Harris population, and that’s pretty darn good. In theory, in a month’s time our baseline number should be close to sixty percent. The one-shot Johnson and Johnson vaccine has been resumed, and that should help with some of the harder-to-reach folks as well, since it only requires the one appointment.

There’s a lot of effort going on now to reach the people who have obstacles to getting vaccinated, and while that will take more time I believe they will get there. That leaves the anti-vax zealots, and I have no more idea how to reach them than you do. That said, there is one obvious strategy to maybe draw some of the more resistant folks out of the woodwork:

There are public policy “interventions” that can encourage further adoption: publicizing how safe the vaccine has been so far for people who’ve gotten it, stocking doctors’ offices and mobile clinics to make the shots more convenient, tying access to public spaces to being fully vaxxed, promising to eliminate mask mandates and other societywide restrictions once a certain percentage of the population has gotten its doses, and so forth.

Those are among the suggestions you’ll find being made by individuals arguing against the one really obvious way to get people to do something: paying them. Economist Robert Litan, former Democratic presidential long shot John Delaney, and an Oxford professor named Julian Savulescu are among those who’ve proposed such cash-for-vax payments; Litan would make them $1,000 and Delaney $1,500. In response, ethicists affiliated with the University of Washington and the Cornell and University of Pennsylvania medical schools have written, in the Journal of Medical Ethics and Journal of the American Medical Association, that it would be a bad idea.

The arguments against payment are reasonable ones: It’s crude and coercive to put proportionally huge pressure on lower-wealth citizens to do something that they might not want to; the idea that you get something like “hazard pay” for taking a vaccine might convince people it is risky; and setting a precedent of paying people to protect their health might make them less likely to take vaccines and follow guidelines in the future if there’s no money in it. Localized and incentive-driven initiatives like the ones described above, ethicists say, are more likely to build the long-term trust between officials and residents that will be crucial to ending this pandemic and preventing future ones.

The problem with this case is that it exists for the most part in an abstracted, theorized version of the United States that is populated by individuals making good-faith decisions based on credible public information and conversations with medical professionals. Our actual country, however, is one in which one of the two major parties sees an advantage in the weaponized misunderstanding of medical science, celebrity influencers build followings by pretending to uncover sinister threats everywhere, and media outlets spam every speciously correlated story about someone having a health problem after getting a shot into millions of pockets multiple times a day. Informational and incentive-based campaigns to reach people who have genuine, medically oriented hesitations about the vaccine are good ideas that should definitely be pursued. Does anyone honestly think they’re going to be enough? This is a fractured polity we’re dealing with here, folks!

Contemporary Americans self-evidently do not share a common trust in any government or media institution. On the other hand, almost all of us still appreciate and believe in the institution of the United States dollar, and the ways it can be earned and spent.

Maybe most of these people are die-hard Trumpers. As the author notes, those folks happily cashed their Biden stimulus checks. Money talks. It sticks in my craw to reward this kind of selfish and self-destructive behavior, too, but in the end the more vaccinated people the better off we all are, especially those who have legitimate medical reasons for not getting vaxxed. There is an inverse to this approach, which I’ll get to in another post. Put me down as being in favor of all reasonable strategies for getting as many shots in arms as we can.

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5 Comments

  1. Bill Daniels says:

    Speaking as a super straight White male, I think it’s incumbent upon me to reject my White privilege and allow the blacks, Mexicans, and gays to all get their shots first, in the name of equity and unity. Let me know when they’re all vaccinated, and then I’ll think about taking it.

  2. Mainstream says:

    Bill, are you trying to win one of those Darwin awards?

  3. […] Paying people to get vaxxed has its merits. One of the hesitant Methodist employees from the story says that some of her fellow hesitators are thinking about getting the shots to keep their jobs. Clearly, incentives work. Maybe that’s a lesson for us for the broader issue. […]

  4. Jason Hochman says:

    Looking at history, every epidemic or pandemic in the past has ended without a vaccine. Herd immunity was reached without a vaccine. Now, they claim that herd immunity is ONLY achieved by vaccination.

    This is mass psychosis through fear appeal.

    I am upset about all of the Biden Covid deaths in Michigan. It has total shutdown and mask laws and higher deaths about the same as the November peak thanks to Biden and his 100 day mask challenge. He needs to get back into his lab and cook up some more science.

  5. […] discussed how it’s more challenging to vaccinate people now, because everyone who really wanted the vaccine and had no barriers to getting it has gotten it. […]