A new Covid dilemma: What to do when vaccine supply exceeds demand?

And now for a new and vexing quandary for states trying to vaccinate their residents against Covid-19: What to do when supply of the vaccine greatly outstrips demand?

Several states, long desperate for as many doses as they could get, are now awash in unused doses of Covid vaccines as demand dwindles and supply continues to ramp up. And many are having either to come up with new and creative ways to vaccinate the hard to reach and the hesitant or to start cutting back on supplies, even though 43% of Americans have not received any vaccinations.

About 112.6 million people, or 34% of the population, were fully vaccinated as of Saturday.

The slowing of demand was somewhat expected. During the initial rush of vaccine distribution over the winter and into the spring, appointments were coveted and often difficult to find. But today vaccines are more widely available, and officials have been left to target groups that may have missed out on shots because they are too poor, isolated or hard to reach, or because they’re either skeptical of the shot or convinced they don’t want it.

Of the 329 million doses shipped by the federal government to states, about 257 million have been administered, according to the Centers for Disease Control and Prevention. Several states are now sitting on surpluses, leaving officials to grapple with how best to find willing arms, and, in the meantime, telling the federal government to hold off on sending their full allotments.

While some states, including Colorado and Maryland, are still requesting their full allotments, others are cutting back on deliveries, according to The Associated Press. North Carolina reduced its deliveries by 40% last week. Connecticut asked for just 26% of its full delivery, and South Carolina requested just 21%.

At the end of last month, Arkansas asked to halt its shipment completely for at least one week, The Arkansas Democrat Gazette reported.

While demand for vaccines has slowed, the outlook for the pandemic in many parts of America seems bright. Hospitalizations in Michigan, which saw a drastic spike from mid-March through mid-April, have continued to fall since then. Gov. J.B. Pritzker of Illinois said last week that the state would fully reopen next month. In announcing his reopening plans, Mayor Bill de Blasio of New York said, “This is going to be the summer of New York City.”

Despite these signs of optimism, some public health officials are worried that the slowing demand for vaccines could lead to lingering problems from the coronavirus, including hospitalizations and deaths that are now preventable.

In a news conference last week, Gov. Jim Justice of West Virginia implored residents, particularly younger people, to “really step up.”

“If you can stand seeing one of your loved ones die, fine. I can’t stand that,” Justice said. “This thing’s a long way from being over.”

“I can’t stand these masks,” he added, tossing one onto his desk. “I want rid of them.”

The federal government distributes vaccines to jurisdictions based on population, but the Biden administration confirmed last week that it planned to change allotments based on how many vaccines were ordered by each jurisdiction.

In a news conference last week, Gov. Asa Hutchinson of Arkansas set a goal for vaccinating 50% of the state’s population over the next 90 days. If the state does not use the vaccines previously allocated to it by the federal government, he said, “those vaccines might go to Massachusetts, because there’s a higher acceptance rate there.”

This shift in vaccine allocations reflects a trend in many states: Fewer and fewer people are being inoculated as the weeks go on.

“It’s actually what we expected to happen,” said Dr Amesh A. Adalja, an infectious disease physician at the Johns Hopkins Center for Health Security, adding that the next phase of vaccines would present “a much more challenging prospect.”

Jennifer Nuzzo, the lead public health researcher for the Johns Hopkins Covid-19 Testing Insights Initiative, said that, in many cases, the easiest-to-reach populations had already been vaccinated.

The remainder largely breaks down into three groups: people who want the vaccine but have not been able to get it; people who are somewhat hesitant about the vaccine or are putting off getting a shot even though they could find one; and people who are opposed to being vaccinated, whether for religious or philosophical reasons, or because they trust disinformation that the vaccine is either dangerous, ineffective or part of a conspiracy.

“As much as I do think the demand is falling, I think there are still people who very much want to get it but haven’t been able to,” Nuzzo said. “I don’t think we have moved past the access issue.”

Among those populations are homebound older adults, who may not have been able to gain access to a vaccine site or who have been unable to schedule an appointment because of technology issues; and some working parents, or others who live in communities where vaccine providers are not close by, she said.

Numerous state and local governments are prioritizing access, propping up mobile clinics and eliminating appointment requirements at mass vaccination sites. The Biden administration is promoting similar policies aimed at increasing availability, including by directing pharmacies to offer walk-in appointments, and by shipping new allocations of the vaccine to rural health clinics.

Nuzzo said the effort to reach these groups might resemble a “get out the vote” campaign, where different networks, like pharmacies, primary care doctors and community organizations, reach out to people on an individual basis, either by going door-to-door or by contacting them some other way.

The second category – those who might be skeptical of the vaccine or are taking a “wait and see” approach before they get their own shot – presents other challenges. As the rate of new Covid-19 cases declines, motivations for getting the vaccine might decline as the perceived threat of getting sick diminishes.

The decline in vaccine demand has coincided with a significant decline in coronavirus cases from mid-April, from about 70,000 cases a day to 42,000 on Sunday.

Still, Nuzzo said the reasons for holding off on getting a shot, like some level of skepticism, could also reduce as time goes on. As more people get vaccinated, those who are unsure will see that serious side effects are almost nonexistent.

The third group – those who are outright opposed to the vaccine, and especially those who have become convinced by disinformation and conspiracy theories – might be less likely to be persuaded by the lack of side effects. “The spread of disinformation online, we have to address,” Nuzzo said. “Never in my career have I seen the scope as large as it is.”

Promoting the idea of freedom for vaccinated people could be one effective way to encourage more vaccinations, particularly among those who are open to persuasion and still making up their minds, officials say. As hesitant people look for side effects – and find few, if any – they will also see their vaccinated friends and family members enjoying the luxuries of a pre-pandemic life like going to concerts and seeing older relatives, and doing all those activities without the lingering fear of getting sick or getting someone else sick.

Adalja said that federal health guidance should take care to avoid “underselling the vaccine,” and that federal officials appeared to be “several steps behind what infectious disease doctors like myself are telling people that are fully vaccinated what they can do.”

It is still unclear how the remainder of unvaccinated Americans break down into these three categories. On average, providers are administering about 1.98 million doses a day, down from a high of 3.38 million on April 13.

While the Food and Drug Administration is set to authorize the Pfizer-BioNTech vaccine for adolescents next week, it is unclear how much demand will increase as a result. The soon-to-be approved age group, 12- to 15-year-olds, may represent fewer than 20 million people, according to data from the US Census Bureau.

Nuzzo said that if vaccination rates continued to lag, local communities could see significant outbreaks. While the nation as a whole will not suffer the way it did this past winter, certain communities with lower vaccination rates may continue to see higher numbers of hospitalizations than is necessary.

“So many people have lost their lives,” she said, “and all of that can be prevented now.” [The New York Times]