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News >  Health

Hesitation, resistance and convenience: The real work to get more of Washington vaccinated against COVID-19 starts now

UPDATED: Thu., May 6, 2021

Carey Williams planned on going to Gonzaga University on Thursday to get his first vaccine shot. But commencement ceremonies postponed the clinic.

Then he saw on Twitter there was a pop-up clinic at David’s Pizza. He was in the neighborhood, so he stopped by. And there was free pizza, too, if you got the shot.

So Williams got the single-dose Johnson & Johnson vaccine on his lunch break, then got a free slice. The convenience of being able to walk up to David’s Pizza, instead of needing an appointment or having to sit in long lines in his car, worked for Williams, and could work for lots of other Spokane County residents.

There is a distinction between people like Williams and people who are resistant to getting the vaccine at all.

“I’m not an anti-vaxxer,” Williams said. He had always planned on getting the shot, as soon as people like his parents had an opportunity.

He added that he also had a friend who kept texting him about getting the vaccine.

“Sometimes bullying works,” he joked.

The clinic at David’s Pizza on Thursday reflects change in the tone and direction of vaccination efforts locally and statewide.

Washington state, much like many parts of the country, has hit a wall, or as family physician and vaccine advocate Dr. Gretchen LaSalle prefers to call it: a mountain to scale.

Demand for the COVID-19 vaccine has appeared to wane statewide, especially in Eastern Washington and in some rural regions. Low vaccination rates are not necessarily all due to hesitancy , however.

Real challenges exist for some people to access the vaccine, whether they live in a remote area, don’t have a health care provider or cannot find transportation to get to clinics.

LaSalle points to surveys and studies that show the most important person who can influence someone to get a vaccine is their health care provider.

She added that taking the vaccine to where people are, and partnering with community and faith-based organizations, is also vital.

“Making it convenient is hugely important,” she said.

The state Department of Health has recognized this need and announced changes to its efforts and distribution in the coming weeks.

“We’re in a transition too, and working towards having more vaccine in refrigerators, so when somebody comes in, there is vaccine available and they can make that offer,” Michele Roberts, assistant secretary of health, told reporters this week.

Pharmacies receiving doses through the federal government are now offering walk-up vaccinations, including at Safeway and Albertsons pharmacies in the Inland Northwest.

The Spokane Regional Health District is sending mobile teams to homebound seniors, and statewide there is a new emphasis on supporting mobile vaccination teams.

Finding appointments that fit work schedules, getting a ride to clinics and being able to take time off from work all matter if a person is going to get the vaccine. Roberts said state and local public health departments, as well as community partners, need to start doing the work to bridge that gap.

“Our polling data still says our state has one of the highest (percentages) of people who want to be vaccinated or are open to being vaccinated,” Roberts said.

Beyond the strategy of bringing vaccines to where people are, some businesses are incentivizing employees to get vaccinated.

Ferry County Hospital is paying every employee $500 to get the vaccine. On Thursday, it was a free slice of pizza if you got vaccinated at David’s Pizza.

LaSalle said there is definitely a place for a carrot-and-stick approach, with incentives and even vaccine mandates eventually to bring a quicker end to the pandemic.

“I don’t like that; I hope we can get people immunized without the stick – but it works,” she said.

The Spokane Regional Health District in conjunction with the Spokane Hospitality Coalition sent out email invitations to workers with food handlers permits in the county about the Thursday clinic at David’s Pizza. The clinic ran from noon to 5 p.m., and about two hours in, 45 people had come .

Celeste Shaw, owner of Chaps, planned to drive any of her crew members who wanted shots to David’s after their shifts ended at 3 p.m. She brought her son to get his shot in the afternoon on Thursday.

“It feels more approachable, or maybe more comfortable,” she said of the pizza parlor environment.

Shaw plans to host a similar clinic at Chaps later in May. Some of her employees will likely wait to get vaccinated until that clinic , she said. Chaps has been open occasionally during the winter holidays, but Shaw said they reopened officially in early April. She said open dialogue and supporting her staff is what matters.

“I’ve told my staff, if you want (the vaccine), I’ll take you,” she said.

Breaking down hesitancy

The COVID-19 vaccines available to U.S. residents are preventing severe cases of COVID-19 as they were intended to do. While efficacy rates are not 100% and breakthrough cases are possible, they are rare.

Real-world data collected by the federal Centers for Disease Control and Prevention show that vaccines are keeping people out of the hospital and from dying, particularly in the older age groups who had access to the vaccines first.

In contrast, low vaccination rates in communities, combined with variants circulating, can lead to situations like the outbreak in Ferry County. Two people who tested positive in that outbreak were vaccinated, but they were not hospitalized, public health officials there said.

Getting the virus itself, including the various strains rapidly circulating, might not mean hospitalization, but it could mean life-altering symptoms and long-term consequences.

Dr. Aaron Bunnell at the University of Washington has treated a steady stream of people of all ages who had COVID-19, including young and healthy people, and who have persistent symptoms ranging from brain fog and inability to focus to abnormal heart rates or gastrointestinal issues for months after getting the virus.

The majority of patients he sees in the clinic that the UW dedicated to long-COVID patients had mild to moderate infections. They were patients who didn’t feel great at the time but didn’t have the go to the hospital – but then had these late effects.

COVID-19 could mean someone who used to run marathons is now struggling to run a quarter mile or climb the stairs.

“I think there’s been a misjudgment of risk in our society and that’s been helped along by people with poor opinions that shouldn’t be talking about it,” Bunnell said.

Answering questions and concerns from the community is a key part of running vaccine efforts, Liv Stecker, public information officer of the incident management team in northeastern Washington, learned in the last couple months.

An incident management team took over vaccine efforts in the Northeast Tri-County region on March 1. After two months, the team disbanded due to waning demand.

Stecker said their goal was to vaccinate 50% of the community. At press time, every county in the region had 30% or less of eligible residents getting at least one dose of the vaccine.

The team’s efforts were not all a loss, however. Stecker and the group of firefighters and EMS workers, including some from Spokane County, learned how to effectively coordinate vaccine clinics in a spread-out and rural region, as well as respond to community concerns.

The first thing the incident management team did was set up a call center, which at one point required nine people to keep up with the pace. The team used calls and requests for vaccines to build clinics, so if enough people from Ione or Colville had expressed interest, they could plan a clinic there. Stecker and the team also inherited vaccine wait lists from all of the counties’ health care providers, so they made lots of calls to people anxiously awaiting the vaccine.

Community members had a lot of questions, and Stecker said “being willing to answer questions and being as transparent as we could with the knowledge we had” went a long way.

The Johnson & Johnson pause

When the Food and Drug Administration paused use of the Johnson & Johnson vaccine last month, public health officials worried that already wary people might use the move as a further excuse to not get a shot.

Pauses for safety are common in vaccine development, however, albeit not normally in the public eye like this one was.

“This is the normal course of vaccine development. We monitor for adverse effects, and if there’s a signal of concern, there’s a pause,” LaSalle said.

“This has always happened, but the average person in public hasn’t been paying attention to that,” she added.

Some people prefer the single-dose vaccine because they don’t have to schedule another dose, and Washington residents who get the Johnson & Johnson shot in the next week will be considered fully immunized by Memorial Day.

The mass vaccination site at the Spokane Arena is going to start offering Johnson & Johnson vaccines starting May 15. They will finish out second-dose clinics for those who have received the Moderna vaccine, but the switch will enable a one-and-done approach going into the summer.

In mid-June, the Spokane Arena site also plans to offer both walk-up and drive-up vaccines.

Robert Queen, regional manager of Safeway pharmacies in the Inland Northwest, said the Johnson & Johnson doses are great for young people who only want to sit down once and be done with it. He said settings like the pop-up clinic at David’s Pizza also work better for people who don’t want to formally schedule appointments.

“We know that this removes barriers,” he said.

How the vaccines were madeOne of the most common concerns Dr. Sam Artzis, health officer of Northeast Tri County Health District, hears about the vaccine is how quickly it was developed.

“The number one thing I have heard is, ‘We don’t trust it because it was done in an unusual fashion,’” Artzis said.

He explains to them that production was underway while trials were happening, which is one main reason why the supply was ready to go in under a year’s time.

This was made possible due to the immense financial resources and support from the U.S. government, which is distributing those shots for free to all citizens now.

Additionally, mRNA technology, which Pfizer-BioNTech and Moderna vaccines use, was in clinical trials for use against other viruses when COVID-19 hit the world. Due to the technology, which has been developed by scientists tirelessly in the last few decades, they were able to plug-and-play the SARS-CoV-2 genetic sequence into their mRNA vaccine platform and start trials almost immediately.

Unpacking herd immunity

Nationwide, public health officials are predicting that herd immunity, an already daunting goal, is virtually out of reach at this point.

In Washington state, more than 80% of currently eligible state residents would need to get vaccinated in order to reach calculated herd immunity, according to the Department of Health.

Currently, 55% of eligible Washington residents, those 16 and older, have received at least one shot.

In the northeastern part of the state, Stecker said the idea that herd immunity will work to naturally end the pandemic if enough people get infected is popular, including among some health care providers.

Artzis pushed back against this, pointing to the outbreak in Republic last month that sent many people to the hospital, including younger people, and led to the death of one resident there.

“I would like to have those people come spend a few days in the ER with me and visit with the families whose loved ones are in the hospital,” said Artzis, who is an emergency room physician too. “A lot of these patients aren’t doing well, and then patients come home and things are not the same.”

Not hesitance, resistance

Northeast and southeast Washington have some of the lowest vaccination rates in Washington, including among residents who are 65 and older.

As of April 28, just 35% of residents 65 and over in Garfield County had received one dose of a COVID-19 vaccine. In Stevens and Ferry counties, about 41% of the population 65 and older had received one dose.

State data show that Ferry, Stevens and Pend Oreille counties, as well as Garfield, Columbia and Asotin, have some of the lowest vaccination rates among those most at-risk of severe disease, should they get COVID-19. Skamania County in western Washington is also one of the seven counties statewide with 53% or less of residents 65 and over receiving at least one dose.

While access and convenience to the vaccine are real factors driving low vaccination rates in some regions, vaccine hesitancy, or in some cases, flat-out resistance, is impacting communities as well.

Artzis and other health officers are up against misinformation campaigns spreading like wildfire on the internet, and he thinks the public health community got behind the 8-ball initially.

“We’ve got an uphill battle, and a lot of it has to do with religious beliefs and politics,” he said.

Dr. Bob Lutz, the Asotin County health officer, is encountering similar opinions in southeastern Washington.

“I no longer call it vaccine hesitancy; I think it’s vaccine resistance,” Lutz said. “And I think as so much of the pandemic has played out and continued to be politicized, it’s politicized the role of vaccinations.”

Sometimes, death and real consequences in a community are what will eventually push people toward vaccines, Lutz said. In Republic, the hospital is seeing a spike in vaccine interest following the outbreak there.

“You hate to say paradigms change one funeral at a time,” he said, “but sometimes it takes something really drastic for someone to realize ‘This could affect me.‘”

Arielle Dreher's reporting for The Spokesman-Review is primarily funded by the Smith-Barbieri Progressive Fund, with additional support from Report for America and members of the Spokane community. These stories can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.

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