with Alexandra Ellerbeck

Daily coronavirus vaccinations have been declining in the United States for a week and a half.

That trend seems likely to continue. More than half of the remaining unvaccinated don’t plan to get the shot.

That’s according to a new Washington Post-ABC poll on how Americans feel about the vaccines and vaccine requirements.

Around 120 million American adults still haven’t received any of the shots. When unvaccinated poll respondents were asked whether they planned to do so, 41 percent said yes. But 56 percent said no.

That “no” group of people will receive increasing attention in the coming weeks, as public health officials puzzle over how to keep the country moving toward the goal of widespread immunity, where so few people are able to spread the virus that its transmission is dramatically stemmed.

There's broad mistrust in the Johnson & Johnson shot.

Fewer than 1 in 4 unvaccinated poll respondents said they would be willing to get the vaccine made by Johnson & Johnson, which federal health officials temporarily paused following reports of rare, severe blood clots. The government restarted administration of the vaccine late last week, accompanied by a new warning on its label about the remote possibility of the clots.

Trust in Johnson & Johnson is down compared with the two other coronavirus vaccines authorized for use in the U.S. Slightly fewer than half of adults overall said they consider the Johnson & Johnson vaccine very or somewhat safe, while more than 7 in 10 people say they regard the Pfizer and Moderna vaccines to be very or somewhat safe.

“The unwillingness of about 3 in 4 unvaccinated U.S. adults to get the Johnson & Johnson shot points to hurdles facing the Biden administration and state and local public health officials in restarting use of a vaccine that was once heralded for its convenience,” Amy Goldstein and Scott Clement write.

A Centers for Disease Control and Prevention advisory committee voted on April 23 to recommend the Johnson & Johnson vaccine for people over 18. (The Washington Post)
Younger Republicans are particularly vaccine-hesitant.

By now, the widespread opposition to vaccines among Republicans has been well documented. The Post-ABC poll reconfirms this; while 10 percent of Democratic respondents said they’re unlikely to get the shot, 40 percent of Republicans gave that response.

But Republicans' age appears to play a big role in how they view vaccines:

  • Twenty percent of Republican seniors said they won’t get the shots.
  • That rises to 40 percent of Republicans ages 40 to 64.
  • And 55 percent of Republicans ages 18 to 39.

Age is a less salient factor among Democrats who are hesitant. Three percent of seniors are hesitant, compared with 14 percent of those under age 40.

Views on vaccine requirements and passports break down along similar partisan lines.

Democrats were far more likely than Republicans to support vaccine requirements in a variety of settings. Here’s what the poll found:

  • Sixty-five of Democrats and 22 percent of Republicans said businesses should require employees to get vaccinated.
  • Seven in 10 Democrats support requirements for college students to get vaccinated before entering campus. Seven in 10 Republicans oppose it.
  • Seventy-seven percent of Democrats and 30 percent of Republicans support states issuing printed or digital certificates to vaccinated people that could be shown to businesses, employers and schools.

Ahh, oof and ouch

AHH: White House officials may scrap a drug pricing measure from the next big spending proposal.

President Biden is set to unveil his $1.8 trillion “American Families Plan” before his joint address to Congress on Wednesday. The plan includes hundreds of billions for child care, prekindergarten, paid family leave and tuition-free community college. Early drafts had included a major provision to lower drug prices by allowing direct negotiation between the government and drug makers, but that might be going by the wayside now.

“In a potential last-minute change, White House officials as of Friday were planning to include about $200 billion to extend an increase in health insurance subsidies through the Affordable Care Act exchanges, according to three people who spoke on the condition of anonymity to reveal internal discussions,” The Post’s Jeff Stein reports.

Republicans who voted to grow the national debt during the Trump administration are trumpeting fiscal conservatism again during a Democratic presidency. (JM Rieger/The Washington Post)

“Despite pressure from Democratic leadership, White House officials are also prepared to table a measure they had included in earlier drafts aimed at reducing consumer and government spending on prescription drugs, a measure fiercely opposed by the pharmaceutical industry, the people said. Aides stressed that discussions were preliminary and subject to change. The overall price tag of the measure could also wind up being lower than $1.8 trillion,” he writes.

Nor does the administration plan to include a provision lowering the Medicare eligibility age, despite pressure from Senate Budget Chair Bernie Sanders (I-Vt.) and other lawmakers. The spending plan will face an uphill battle in Congress, where Democrats have narrow margins and many Republicans are opposed to new spending.

OOF: A lobbying battle is heating up over implementation of the nation’s “surprise billing” ban.

Last year, Congress prohibited hospitals from sending unexpected, large bills to insured patients who had unwittingly received out-of-network care. Now, it’s up to the Biden administration to hammer out the details of the law, sparking efforts by the health-care industry and consumer advocates to shape upcoming federal regulations.

“The groups that have begun lobbying the administration include large hospital systems and health insurers, major trade associations, air ambulance companies and private equity-backed physician staffing firms, including at least one that was connected to a successful dark-money effort that poured tens of millions of dollars into killing an earlier surprise billing fix opposed by health care providers,” Politico’s Susannah Luthi reports.

Health-care providers could circumvent the law’s protections if federal authorities fail to implement strict rules. Among the issues the administration will consider are how to ensure that patients don’t unknowingly sign away their protections, how to monitor for violations of the law and how to settle disputes.

“The outcome will provide an early sign of how aggressively the Biden administration will regulate an industry that’s readying battle against Democrats’ more ambitious health care reforms, including on drug pricing and lowering the Medicare age,” Susannah writes.

OUCH: Rural ambulance crews are in danger of shutting down.

“The ambulance crews that service much of rural America have run out of money and volunteers, a crisis exacerbated by the demands of the pandemic and a neglected, patchwork 911 system,” the New York Times’s Ali Watkins reports. “The problem transcends geography: In rural, upstate New York, crews are struggling to pay bills. In Wisconsin, older volunteers are retiring, and no one is taking their place.”

At least 10 localities in the heavily rural state of Wyoming are in danger of losing ambulance service.

The ambulance business model is rarely self-sustaining. Many states do not consider ambulances to be “essential services,” and only a handful require local governments to provide ambulance services. 

More in coronavirus news

The CEO of a troubled vaccine-maker made major stock sales earlier this year.

Emergent Biosolutions’s chief executive, Robert G. Kramer, sold $10 million worth of his stock in the company in January and early February, according to securities filings. Those same stocks now would be worth only $5.5 million amid a troubled vaccine rollout, The Post’s Jon Swaine reports.

Disclosures at the end of March revealed that the firm’s Baltimore plant had ruined more than 15 million doses of Johnson & Johnson’s coronavirus vaccine. Since then, AstraZeneca has moved production of its vaccine out of the facility and the FDA has told the company to pause all production at the plant.

Kramer’s stock sales were part of a trading plan adopted on Nov. 13. But investors who are suing him and the company in a federal court in Maryland contend that the company failed to disclose problems at the Baltimore site. The New York Times has reported that a batch of AstraZeneca vaccine was discarded in October 2020 because of suspected contamination, and that a separate batch of Johnson & Johnson vaccine was discarded the following month.

  • The National Security Council said the United States will provide vaccine materials, drugs, test kits, ventilators and personal protective equipment to India, which is facing a devastating coronavirus outbreak. But some are calling on the administration to do more: Rep. Ro Khanna (D-Calif.), the vice chair of the Congressional India Caucus, has called on the United States to share its stockpile of AstraZeneca vaccines, which have not been approved domestically, The Post's Claire Parker, Paul Schemm and Sean Sullivan report.

Ashish Jha, dean of the Brown University School of Public Health:

  • The CDC recommends pregnant women receive a coronavirus vaccination, The Post’s Ariana Eunjung Cha reports. CDC director Rochelle Walensky noted at a White House briefing on Friday that vaccination surveillance systems have not shown any safety concerns for more than 35,000 women in their third trimester.
  • States with springtime surges in coronavirus cases appear to be turning a corner, as average daily cases in Massachusetts, Minnesota, New Jersey, Illinois and Michigan have started to decline, Stat’s Andrew Joseph reports.
  • Individuals who caught the coronavirus between their first and second shots are urging others to remain cautious. A Washington Post review estimated that 21,000 of 470,000 people who tested positive for the virus last week already had their first dose. It’s not a sign that the vaccines don’t work, experts say, but rather that the immune system needs time to ramp up its protections, The Post’s Fenit Nirappil and Dan Keating report.

Elsewhere in health care

The Food and Drug Administration will scrutinize unproven cancer drugs.

A three-day meeting starting on Tuesday represents the first time in a decade that the agency will consider rolling back approvals for certain cancer drugs that have failed to prove that they can extend or improve life. It will consider drugs from Merck, Roche and Bristol-Myers Squibb. 

“The agency says it has used innovative research shortcuts to speed up the availability of medicines for desperately ill patients. But many researchers say it has failed to crack down on medications that don’t deliver on their early promise, leaving a glut of expensive, unproven cancer drugs on the market,” the Associated Press’s Matthew Perrone reports.

Spending on cancer drugs has more than doubled since 2013, and some experts say that the increase in prices is not in line with health benefits. The FDA is prohibited from considering cost, but it is charged with keeping ineffective drugs off the market. 

Biden signed a law making sesame the ninth major food allergy.

The law will also ramp up allergy research amid a steady rise in life-threatening childhood food allergies. Experts blame the rise in part on increasingly sterile environments, which may affect how the immune system reacts to allergens, as well as on decades-old guidance that parents delay introduction of potentially allergenic foods — advice that turned out to be wrong. Pediatricians now recommend introducing peanuts to babies at high risk of allergy by four to six months, The Post's Laura Reiley reports.

The law will require sesame to be clearly labeled on food packaging by 2023.  Sesame joins eight other major allergens: peanuts, tree nuts, fish, shellfish, soy, dairy, eggs and wheat.

Sugar rush

After 17 years underground, three species of the Brood X cicadas will emerge this spring on the East Coast. Here's everything you need to know. (Amber Ferguson/The Washington Post)