The Washington PostDemocracy Dies in Darkness

The Health 202: One hundred million eligible Americans still haven't gotten vaccinated


with Alexandra Ellerbeck

On the cusp of Independence Day, 100 million Americans eligible for coronavirus vaccination haven’t received even a single shot.

This holdout group — ranging from vaccine opponents to people merely waiting for the shots to be fully approved — isn’t made up of a single demographic. But being uninsured is their most common factor — an ironic reality considering the uninsured are least likely to be able to afford care should they become seriously ill.

At this point, there’s little reason to think anyone who wants a coronavirus vaccine hasn’t been able to get one yet. 

Daily vaccinations have been plunging since mid-April, signaling supply is higher than demand. According to The Post’s vaccine tracker, 179.9 million people in the United States have received one or more shots, with 46.4 percent fully vaccinated.

That leaves a gap of 100 million people age 12 and up. Understanding who's in this group and how to reach them is critical for public health officials now trying to attract the hardest-to-convince Americans.

The makeup of this vaccine-hesitant crowd is clearer than ever before.

In a poll released today by the Kaiser Family Foundation, 48 percent of the uninsured said they had received at least one dose. According to the poll, other groups with low vaccination rates included:

  • Republicans (52 percent)
  • Rural residents (54 percent)
  • People ages 18 to 29 (55 percent)
  • White evangelical Christians (58 percent)
  • People ages 30 to 49 (59 percent)
  • Adults without a college degree (59 percent)
But some vaccine-hesitant groups appear more persuadable than others.

There are two basic types of unvaccinated people: the “definitely not” group and the “wait-and-see” group. White Republicans are more likely to belong to the first group, while Black and Hispanic Americans are more likely to belong to the second.

This was true even before the vaccines were granted emergency use authorization by the Food and Drug Administration, and it remains true now.

“Throughout the rollout of the vaccines, larger shares of Black and Hispanic adults have reported they would want to ‘wait until it has been available for a while to see how it is working for other people’ before getting vaccinated,” Kaiser Family Foundation researchers wrote in a recent brief on the topic.

Local governments have closed most large-scale clinics.

They're homing in on the hardest-to-reach individuals, setting modest goals of vaccinating a handful of people at a time, The Post's Jenna Portnoy reports.

“Public health officials were already struggling with how to persuade coronavirus vaccination holdouts to get the shot,” Jenna writes. “But declining case rates and a highly contagious variant have made their work at once more difficult — and more urgent….The increasing prevalence of the delta variant, first discovered in India, underscores the importance of getting vaccinated, experts say, because the highly contagious strain could trigger outbreaks in still-vulnerable communities where vaccination rates are low.

“Officials are turning to behavioral health scientists to figure out the best way to persuade the hesitant, using cellphone data to identify places to send mobile vaccination units and relying on the tried and true: one-on-one conversations with trusted community leaders,” she adds.

“We have done such a good job of getting to the masses. We should just accept that the next few months of work will be slower and harder,” said Danny Avula, Virginia’s vaccine coordinator. “That’s how we chip away at the remaining portion of our population who are unvaccinated.”

The most obvious unvaccinated group is the nation’s 48 million kids under age 12.

The vaccines are unlikely to be approved for children this age until the fall or even early 2022 — and there’s spirited debate among health experts over whether kids should be prioritized at all for the vaccines, given their low risk of death and vaccine shortages in other countries.

As my colleague Tara Bahrampour reported last month, Pfizer is running a nationwide trial for children 6 months to 11 years old, with one of the sites at the Johns Hopkins Bloomberg School of Public Health in Baltimore. Moderna is running a trial in the United States and Canada for kids in that age range with a site at the University of Maryland’s School of Medicine that includes locations in Baltimore and Frederick.

“Both local trials have enrolled a small number of initial participants to receive lower doses — or in some cases, the same dose as adults — and be monitored for side effects and development of antibodies,” Tara wrote. “The goal is to find the dosage sweet spot by not provoking too strong a reaction while giving children the highest level of protection.”

But parents are less willing to immediately vaccinate their kids then they were to get the vaccine themselves.

In the Kaiser survey, 27 percent of parents said they would get their child a coronavirus vaccine as soon as it was available, while another 33 percent said they wanted to “wait and see.”

As with adults, vaccine acceptance varied by political affiliation; 45 percent of parents who are Democrats said they would get their kid vaccinated right away, compared with just 9 percent of parents who are Republicans.

Ahh, oof and ouch

AHH: Walmart is launching a new brand of low-cost insulin.

The retail giant will start selling a private-label version of its analog insulin for $73 a vial or $86 for a package of prefilled insulin pens as part of its ReliOn brand. 

The low-price offering comes as annual prices for insulin have soared, nearly doubling from $2,900 in 2012 to $5,700 in 2016, according to the Health Care Cost Institute. The lower-priced insulin could be a boon for patients who must pay for the drugs out of pocket.

It also underscores Walmart's move into the health-care industry. 

“Walmart, already the nation’s largest employer and grocer, has made a bigger push into health care as it tries to leverage its massive reach for other money-making opportunities,” CNBC’s Melissa Repko reports. “Yet the retail giant is treading in a complex industry that has tripped up other large, influential corporate players.”

OOF: The Supreme Court narrowly upheld the CDC’s eviction ban.

The Supreme Court voted 5 to 4 to leave in place the Centers for Disease Control and Prevention’s moratorium on evictions, which is set to run through the end of July, The Post’s Robert Barnes reports.

The case stemmed from a challenge by a group of landlords, real estate companies and real estate trade associations, who alleged that the CDC exceeded its authority when it imposed the eviction ban. 

Chief Justice John G. Roberts Jr. joined fellow conservative Brett M. Kavanaugh and liberal Justices Stephen G. Breyer, Sonia Sotomayor and Elena Kagan in a vote to keep the ban in place. While the justices did not explain their reasoning in the short emergency order, Kavanaugh wrote separately to say that his decision came down to timing.

“Because the CDC plans to end the moratorium in only a few weeks, on July 31, and because those few weeks will allow for additional and more orderly distribution of the congressionally appropriated rental assistance funds,” the stay should remain in place, Kavanaugh said. He added that an extension of the eviction ban, however, would require new legislation.

The CDC issued the moratorium on evictions in September, citing the risk that evictions could contribute to the spread of the coronavirus if people ended up homeless or in overcrowded housing. 

OUCH: More doctors offices were bought up by big corporations during the pandemic.

The number of physician practices owned by hospitals or non-hospital corporations increased by 25 percent over 2019 and 2020, according to the Physicians Advocacy Institute. Meanwhile, more than 48,000 physicians left independent practice to become employees of hospitals or other corporations.

An analysis by Avalere Health for the group found a particularly sharp uptick in the number of practices owned by insurers or private equity.

As small and independent practices have faced cash crunches, many are selling to larger hospitals or private equity. Some experts worry this consolidation will lead to higher health-care prices.

“The pandemic's fiscal impact on doctors may have only reinforced or accelerated a trend that was already underway. But it certainly didn't stop hospitals from pursuing a lucrative business line, nor did it make the industry less attractive to investors,” Axios’s Caitlin Owens reports.

More in coronavirus news

Exam results are showing pandemic learning setbacks.

Texas became one of the first states to release the results from its spring standardized exams, and the report is troubling. The percentage of students reading at grade level slid to the lowest level since 2017, while math scores dropped to their lowest point since 2013, the Associated Press’s Collin Binkley and Acacia Coronado report

Setbacks have been greatest among children of color and those in low-income families. Districts with more in-person learning did far better than those where most kids were learning online.

Experts warn that low participation in standardized tests this year could impact their reliability.

“Still, the early results provide some of the firmest data yet detailing the effects of the March 2020 school shutdowns, the switch to virtual learning and related disruptions. They also line up with trends seen in national studies over the past year: Students are behind in reading and even farther behind in math,” Collin and Acacia write.

The spread of the delta variant is leading to stricter guidance worldwide.

In Los Angeles County, the rapid spread of the new, more transmissible variant has led officials to reinstate voluntary recommendations for everyone to wear masks indoors, regardless of vaccination status. The variant is on track to become dominant both in the United States and worldwide.

While the Pfizer and Moderna vaccines have been shown to be strongly effective against the delta variant, health officials stressed the need for maximum protection.

Sydney and some nearby areas began a two-week coronavirus lockdown on June 25, an attempt to curb an outbreak of the highly infectious delta variant. (Video: Reuters)

The World Health Organization has also reiterated its advice that everyone, even the vaccinated, continue to wear masks in areas where there is ongoing community transmission of the virus.

The guidance comes as many cities and countries are imposing new restrictions. 

  • Sydney imposed a lockdown over spiking delta cases.
  • Israeli authorities reinstated an indoor mask mandate after dropping it two weeks ago, although they declined to impose other restrictions.
  • Germany, Taiwan and Hong Kong have imposed travel restrictions on people coming from countries where virus variants are prevalent.
  • South Africa introduced a 14-day ban on gatherings, indoor socializing and alcohol sales.

Elsewhere in health care

Biogen used an FDA backchannel to gain approval for a controversial Alzheimer’s drug.

The Food and Drug Administration’s approval of Aduhelm set of a firestorm, with many scientists arguing there was not enough evidence the new Alzheimer’s drug even worked. Stat traces the unlikely approval of the medication, revealing a concerted campaign by executives at Biogen, the drug’s manufacturer, to build connections with the FDA.

“In spring 2019, when Aduhelm’s prospects appeared dead, the Cambridge, Mass.-based behemoth mounted a secret campaign, code-named ‘Project Onyx,’ to resurrect the drug and convince the FDA to give it the green light,” Stat’s Adam Feuerstein, Matthew Herper, and Damian Garde report.

“Central to their mission was an inside ally: Billy Dunn, the agency’s top regulator of Alzheimer’s drugs. For the plan to succeed, Biogen needed Dunn to become a supportive partner, more than an independent and potentially adversarial regulator. It worked. The FDA played an extraordinarily proactive role, even drafting a road map on how the company could win approval. Several experts said that relationship was not typical and raised serious concerns,” they write.

The fact that Biogen and the FDA worked together on the approval of Aduhelm was already known, but the Stat investigation found that a backchannel between top Biogen executives and the FDA was far more extensive than previously known.  

Healthy living

Los Alamos County is still one of the healthiest places to live.

The New Mexico county has topped U.S. News & World Report’s ranking of the healthiest communities for the second year in a row. The metrics look at healthy behaviors and outcomes, housing quality and education, among other factors.

The secret to success: The county has a relatively low prevalence of obesity and diabetes and high health insurance coverage. Incomes are also among the highest in the country, U.S. News' Tim Smart reports.

Los Alamos County had the 17th lowest rate of coronavirus cases in the country, a factor that residents attribute at least in part to a strong belief in public health measures backed by science. The county is home to the Los Alamos National Laboratory, which employs many scientists.

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