As all adults approach vaccine eligibility, Kansas and Missouri confront hesitancy
COVID-19 vaccine has gone unused at Missouri mass vaccination sites. Nearly 8,000 doses alone failed to get into arms during a one-week stretch last month.
In Kansas, officials decided earlier this month to expand eligibility for the vaccine and collapse two phases into one — in part because demand was slowing. Appointment slots that once filled up in minutes were open for hours.
Then on Friday, Kansas Gov. Laura Kelly expanded eligibility again, this time opening shots to all residents 16 and older beginning Monday.
Amid signs the clamor for shots is beginning to subside in some areas among priority groups, Kansas and Missouri are increasingly turning their focus to combating vaccine hesitancy. The attention to winning over skeptics comes as both states are on the verge of making all adults eligible. After Kansas opens the door on Monday, Missouri will follow on April 9.
Health authorities have an intense interest in finding an arm for every shot. Estimates vary, but upwards of 80% of the population may need to be vaccinated to achieve true herd immunity — which occurs when the proportion of a community that is immune is high enough to protect those who are not.
The percentage may be even higher to effectively stamp out more aggressive variants of the virus.
They are also racing to minimize or prevent altogether another wave of infection. While cases have plummeted from their December and January peaks, the number of new cases has begun to plateau.
At the same time, some legislators are growing weary of preventative measures. An influential faction of Republicans called the Truth Caucus has promised to fight Kelly’s statewide mask mandate. In Missouri, some Republicans want to limit the power of local health departments, though a bill to establish new restrictions failed in the Senate last week.
About 23% of Missouri residents have received at least one dose of vaccine as of Wednesday. In Kansas, the proportion is 24%. It means that both states will need to vaccinate another 50% to 60% of their population in order to achieve an ideal rate. They each face challenges in getting there.
“We’ve already experienced the hesitation on the part of people, even when we started with people in the health care world where, of all places, you might not expect as much,” Kelly said in an interview with The Star.
“We saw that from the beginning. We saw it in the prisons when we started the vaccinations programs there,” Kelly said, referring to a vaccine refusal rate of 40% among prison staff and 30% for inmates.
Government, civic and health leaders have been working for months to build confidence in vaccines. But the decision about whether to get a shot has been largely hypothetical for most Kansas and Missouri residents until now. With the majority now facing a real choice, efforts to combat hesitancy are ramping up.
People eager for shots will likely flood mass vaccination events and appointment websites in the first few days and weeks after eligibility opens to all residents. The scale of the demand will provide an early indication of whether authorities have been successful in rolling back hesitancy.
But the real test may come after the initial wave. Health leaders will be watching to see whether demand settles into a steady stream or shrinks to a weak trickle.
That may determine whether the states can achieve robust vaccination rates of 80% or more, or fall short, leaving communities vulnerable to continuing cases, hospitalizations and deaths.
Kansas this week launched “Roll Up Your Sleeve,”a public awareness program to encourage vaccinations. It includes TV ads with Kansans getting their shots as a narrator assures that the vaccine is safe, effective and soon to be widely available.
Missouri is expected to begin its own campaign, Gov. Mike Parson said last week, adding he hopes the Chiefs and Royals will participate.
Trusted relationships ‘crucial’
At least 25% of Kansans and Missourians say they would not get vaccinated, even if able to choose when, according to a nationwide survey released in March by researchers at Harvard, Northeastern and Northwestern universities. That’s above the national average of 21%.
Official estimates are bleaker. Parson’s administration has said roughly 40% of Missourians won’t want a shot, a rate of refusal that could make it more difficult for the state to truly tame the pandemic.
Vaccine hesitancy is driven by a range of fears and concerns, from worry about side effects to unfounded conspiracy theories. Health professionals say individual relationships with trusted figures — not official government assurances of safety and effectiveness — will be the key to winning over skeptics.
“It’s very crucial,” said Andrea Morales, chief program officer at Vibrant Health, which provides medical services in underserved areas of Wyandotte County.
Morales said staff at the clinic, which has three locations, have encountered some of the same concerns about vaccines as they did testing. Patients worry about what kinds of personal information, such as immigration status, will be gathered if they get vaccinated.
“For some of our community members that is a very big concern, that we make sure to let them know that the information is only for our use and statistics use and the information will not be given out about any particular person,” Morales said.
Focus groups held by the Missouri Foundation for Health found that for Black and Hispanic adults, distrust around COVID-19 vaccines is “deeply embedded in structural inequities in government institutions and a result of a long and continuing history of racism in health care,” the foundation said Wednesday.
“We’re trying to cut through the misinformation and deliver fact-based materials that resonate well,” Courtney Z. Stewart, the foundation’s vice president of strategic communications, said in a statement. “With the right information, those hit hardest by this pandemic can make the best choice for themselves and their families, and that’s what this is about.”
Health officials hope to direct more doses to doctor’s offices, where physicians enjoy trust built with patients, often over years. Kansas Department of Health and Environment director Lee Norman this week stressed the importance of getting vaccines into the hands of primary care and speciality doctors.
These physicians know the patients, he said, and can hopefully defuse hesitation and fear. Morales said at Vibrant Health, some patients have built relationships with doctors, adding “a lot of conversations” happen when they’re in the room together.
Still, relatively few doses so far have gone toward primary care offices in Kansas. Most doses have instead been administered by local health departments and hospitals.
Kelly said Kansas is getting ready to deploy doses to doctor’s offices and Chad Johanning, president of the Kansas Academy of Family Physicians, said his group has had good communication with KDHE and that his own clinic in Lawrence was given notice to expect some doses within a couple weeks.
“That’s a definite change in direction,” Johanning said. “It’s pointless to have the vaccine hesitant conversation unless you have a vaccine that’s ready to go.”
‘They have every right’
Missouri has often focused on mass vaccination sites, with the state effectively following a motto of “If you build it, they will come.” In some instances, that’s been true.
A “mega” event at Arrowhead Stadium last weekend inoculated 8,000 people, though it made scarcely a dent in the backlog of more than 100,000 in priority groups who want shots in Jackson County.
Previous reporting by The Star has shown that thousands of doses set aside for mass sites in rural areas around the state have gone unused. While the doses are reallocated and not usually wasted, the leftovers indicate the demand in rural areas hasn’t always matched supply, even while doses were limited to priority groups.
The five counties with the lowest percentage of population vaccinated were mostly rural, according to a March 15 report by Deloitte, the consulting firm hired by the state. Parson, who won at least 73% of the vote last year in all five counties, has been more vocal than many officials in talking about the need to respect individuals who don’t want a vaccine.
Asked during a news conference last week whether the right of residents to not get a vaccine jeopardizes public health, Parson responded, “I don’t think anybody knows that yet.”
Health officials have been clear the fewer people get vaccinated, the more likely the virus is to remain a threat.
“I want to encourage people to take the vaccine, I believe it is the right thing to do to take the vaccine. But again, I want to be clear about this. There’s still going to be a certain amount of people that’s not going to take the vaccine and they have every right to do that,” Parson said.
In Kansas, lawmakers are weighing a bill to wrest power to set the required series of vaccinations for schoolchildren away from KDHE and place it with the Legislature. Similar legislation has been considered in the past, but the measure has drawn a new level of attention during the pandemic and officials fear it may undercut confidence in the COVID-19 vaccines.
Sen. Mark Steffen, a Hutchinson Republican and anesthesiologist championing the bill, made a direct link between the proposal and the virus.
“As we exit an era where individual rights and freedoms have been assaulted like never before, it is critical that decisions regarding one’s health be afforded to only the individual and their legal guardian,” Steffen told a Senate committee on Monday.
The proposal has drawn fierce criticism from many medical and health leaders in the state. Rep. John Eplee, an Atchison Republican and a family physician, called the bill “a solution looking for a problem.”
Kelly said it sends the wrong message for lawmakers to consider the bill amid vaccination efforts. “It’s not the least bit helpful and not particularly good for the people of the state of Kansas,” she said.
Kelly expressed the hope that hesitancy will fade as people see others get vaccinated. She said that happened in earlier priority groups, such as inmates and prison employees.
“What we found with those kinds of groups is that once others (see) they didn’t drop dead, we saw more people coming on board and taking the vaccine,” Kelly said. “So we know that just organically that will happen.”
“But we have enough vaccines now that the more people we can get vaccinated the quicker, the more quickly we will be able to get back to normal.”
This story was originally published March 28, 2021 at 5:00 AM.
