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How can Vermont reach the last 18% for vaccination?

Published: 7/4/2021 9:41:48 PM
Modified: 7/4/2021 9:41:50 PM

About 82% of the state’s eligible population is vaccinated against COVID-19 as of Friday, placing Vermont at the top of the country in its vaccine progress.

It also just reached another milestone. More than three-quarters of its adult population is fully vaccinated, one of the strongest measures the state has for curbing COVID-19 cases and deaths.

That high vaccination rate allowed Gov. Phil Scott to drop all COVID-19 restrictions in June, marking a symbolic end to that phase of the pandemic.

But even before Scott reopened the state, vaccinations had been falling. The number of Vermonters getting vaccinated for the first time has dropped significantly since May.

Experts and officials say it’s still important to reach those unvaccinated remnants of Vermont, particularly with other parts of the country reporting rising cases of the more infectious delta variant of the disease.

“(The) 82% vaccination rate is high — there’s no doubt about it — but with the delta variant, I am concerned about people who are unvaccinated,” Deputy Health Commissioner Tracy Dolan said.

Anne Sosin, a policy fellow at Dartmouth College focusing on health equity, said Vermont doesn’t want to have pockets of unvaccinated people going into the fall and winter, considering the seasonal trend of the disease.

Sosin said unvaccinated people tend to be concentrated in certain geographic areas or in certain demographics, “so anytime you see people who are in networks together, you have the potential for outbreaks or the emergence of new cases.”

The vaccination rate varies widely by age and location. Only 56% of 18- to 29-year-olds have received at least one dose of the vaccine, compared with more than 90% of people 65 and older, according to DOH data. Kids ages 12-18 also have a lower-than-average vaccination rate.

Vaccinations by county range from 85% in Lamoille County to only 58% in Essex County, one of the least populated and most rural areas of the state.

Vermont is not alone in its difficulties reaching the younger population. A recent CDC survey of 18- to 39-year-olds found that only 39% had received a vaccine, while 25% said they would probably or definitely not get vaccinated.

Respondents cited concerns over safety and effectiveness as common reasons against getting it, along with fear of the side effects of the vaccine.

“If you’re a young person and you perceive your threat of getting infected or getting seriously ill as low ... and maybe you see some of the downsides of it, you’re concerned about side effects or missing work or other things, then you’re probably unlikely to seek out a vaccine,” Sosin said.

People who were lower-income or had less education were more likely to be unsure or opposed to getting the vaccine.

“What we’re probably seeing is sort of our lower-paid workforce not getting vaccinated,” Sosin said. “Upwardly mobile young people have probably been vaccinated, and so we really need to think about: What’s the demographic that we’re trying to target, and then how do we reach them?”

Sosin said with the right approach, some unvaccinated people “could easily be moved.” Data from the Census Household Pulse Survey shows that Vermonters who have not gotten vaccinated are more likely to be unsure about getting the vaccine and less likely to say they will definitely not get it.

And Vermont is taking a new approach. For the past few months, the state has offered a wide range of pop-up clinics: Health centers, EMS headquarters, schools, workplaces, fairs, “barnstorming” events and even beaches have hosted walk-in vaccinations for Vermonters.

But the state is shifting away from that strategy, Dolan said.

The event-based vaccinations are “reduced a little bit because we are not seeing a lot of numbers at some of those events,” Dolan said. “So we’re really thinking about the events that draw a lot of people,” such as Fourth of July weekend.

Instead of pop-up clinics, the state plans to run permanent “COVID centers” in existing hospitals and health providers where people can get vaccinated and tested, she said. That’s in addition to pharmacies and primary care doctors that can continue to vaccinate Vermonters.

Sosin advocated for workplace-based clinics as a way to target younger Vermonters. But Dolan said the clinic requests for workplaces are now pretty small: “just two or three.”

“We try to connect them either to the local pharmacy or to another event that might be happening” she said. “But we still occasionally, if the demand is there, we will go to a workplace.”

Dolan said primary care-based vaccinations have a better chance of increasing trust because people feel more comfortable with the chance to talk with their doctor about getting the vaccine.

But younger Vermonters are less likely to have a primary care provider, Sosin said. So while it’s an “important element of reaching some,” the state has to recognize the limitations of it.

There’s some evidence that incentives to get vaccinated work as well. A recent poll from Kaiser Family Foundation found a quarter of unvaccinated Americans would get vaccinated to enter a million-dollar lottery.

It also found that workers whose employers provided paid time to get the vaccine or encouraged them otherwise were far more likely to be vaccinated, suggesting that employers could play a significant role in reaching the last unvaccinated Vermonters.

Employers can get a federal tax break for providing sick time for vaccination appointments or to recover from side effects. But Vermont, unlike California or New York, does not mandate that employers provide sick time to employees specifically for vaccinations.

Nor does Vermont provide any paid incentive or lottery, only a coupon for maple creemees at some locations.

Ultimately, reaching the final 18% may be the hardest push in the state’s vaccination strategy.

“My experience has always been that the last mile of care delivery takes the most resources,” Sosin said.

She still believes it’s worthwhile to have the highest vaccination rate possible in time for schools to reopen and the weather to change.

Dolan said as we watch other states, with lower vaccination rates, enter into a “difficult place,” she’s hopeful that Vermont won’t have to go there.

“If we don’t, that’s really because a lot of Vermonters, even those ... who might have been uncomfortable, who might have been worried, who might have been afraid of needles, all kinds of things — that they overcame and they did it for themselves, for their parents, for their kids, for their neighbors,” she said.

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