As demand for COVID vaccine plummets, SC health officials scramble to figure out why

Zak Koeske
·10-min read

Only a couple months ago, South Carolinians were spending hours at their computers scouring Facebook groups for leads on COVID-19 vaccine doses and furiously refreshing their web browsers in a frenzy to score shots of the elusive elixir wherever they could find it.

Any increase in the state’s weekly allotment of doses, no matter how small, was cause for celebration when demand for shots far outstripped supply.

That’s not the case anymore.

In just a matter of weeks, South Carolina has gone from being starved for vaccine to having access to far more doses than it needs. The shift has occurred not because shots are now so plentiful — although available supply has increased — but because demand has slowed dramatically.

Vaccine providers administered first shots to roughly 8,000 residents a day over the past week, according to state Department of Health and Environmental Control data. That’s only about a third as many jabs as they were delivering at the beginning of April, shortly after everyone 16 and older became eligible for the vaccine.

Hundreds of vaccine slots now go unfilled — appointments are no longer even required in many cases — and DHEC only asks the feds for a small fraction of the doses set aside for South Carolina.

This week, the agency requested only about 47,000 of the 141,000 first doses it could have, a spokeswoman said.

“Remember the early days where people would talk about (how) they’d drive an hour, two hours to get to some place to get that precious appointment and get vaccinated?” assistant state epidemiologist Jane Kelly said Friday. “We may now be entering an era where people are not as willing or not able to do something as dramatic as that, so we need to bring vaccine to the people.”

Interest in vaccination has waned even as only 42% of eligible South Carolinians have gotten a shot and just 32% are fully vaccinated, a far cry from the 70-80% state health officials say is necessary to reach the goal of herd immunity and return to some semblance of pre-pandemic normalcy.

What’s more, about 10% of South Carolinians who got their first shot of the Pfizer or Moderna vaccine are late for their second doses, which are necessary for full protection against the virus.

As of Wednesday, roughly 172,000 people were at least one day past the 21-day mark for their second Pfizer shot or one day past the 28-day mark for their Moderna shot, DHEC spokesman Laura Renwick said.

DHEC studying reasons for decrease in demand

The dwindling demand for COVID-19 shots is not unique to South Carolina, although it is more acute here than in most states. South Carolina currently ranks 40th in the country in the percentage of residents who have received at least one shot, according to the U.S. Centers for Disease Control and Prevention.

Public health officials are well aware of the state’s lagging numbers and are working hard to reverse them, but don’t yet have a clear idea of what’s driving the drop in vaccinations.

“We’re concerned about a decrease in demand, but I think we need to parse out: Is it a decrease in people wanting to get vaccinated or is it a decrease in the people who were willing to travel or go to the big hospital?” Kelly said.

Vaccine hesitancy, she said, is a complex and multifaceted phenomenon.

“There are many people who take time to move from contemplation to action,” Kelly said. “And we need to address what their reasons are for (taking) a wait-and-see, for that contemplation step.”

Some people are scared of the unknown and just need more information about the safety and effectiveness of the COVID-19 vaccine before deciding it’s right for them. They may initially be staunchly opposed to getting a shot, but come around after seeing friends and family inoculated without incident, she said.

Others may not have gotten vaccinated yet because of logistical issues like a lack of transportation, family responsibilities or an inability to take time off work.

There are also people who are influenced by spurious information they consume on social media and delay or refuse vaccination for that reason, Kelly said.

“Don’t be fooled by pseudoscience and conspiracy theories,” she said. “There is information available through DHEC or CDC and other legitimate public health and scientific agencies. They are the best sources of information.”

DHEC recently conducted a survey to gauge vaccine interest levels across the state and determine how best to shape its future outreach efforts. The agency plans to release its findings early this week.

Its poll, which follows a vaccine interest survey the agency conducted in late January, will give state health officials another point-in-time snapshot of how South Carolinians feel about getting a COVID-19 shot.

Both surveys, which were conducted online and took only a minute to complete, asked respondents three questions about the vaccine and gathered information on each participant’s age, race, gender and region of residence. The second survey additionally asked residents about their occupation.

The earlier open-access survey, which received more than 30,000 responses, found that more than 80% of respondents said they planned to get vaccinated against COVID-19 when eligible.

Vaccine hesitancy was most pronounced among young people, Black residents and people who live in the Upstate, the survey found. Women, who participated in the survey at more than twice the rate of men, also were somewhat more hesitant to get a jab.

Those trends generally mirror what national polls about vaccine hesitancy have found, but appear to overestimate residents’ overall willingness to get inoculated against COVID-19.

In contrast to the 80% of South Carolinians DHEC’s survey found wanted a shot, national polls generally put that figure at about 60%.

The disparity is likely explained by the state health agency’s nonscientific methodology. DHEC’s survey did not seek a random sample of participants and is therefore likely not as reliable as surveys conducted by professional polling companies.

Many of the agency’s findings do, however, track with national polls and are thus still useful for informing the state’s vaccination outreach efforts, health officials said.

Like DHEC, the Kaiser Family Foundation, which has been conducting an ongoing research project on Americans’ attitudes about the vaccine, found that people ages 18-29, African Americans and Republicans were the groups least likely to have been vaccinated or want to get vaccinated against the virus. Unlike South Carolina’s health agency, the Kaiser Family Foundation found no difference in vaccine interest between genders.

People who identify as Republican, Kaiser found, are the subpopulation most resistant to getting a COVID-19 shot. Nearly 30% of Republicans surveyed by the organization in March said they would definitely not get the vaccine. No other demographic subgroup had more than 15% of members who responded similarly.

Along those same lines, 14% of residents living in the Upstate, South Carolina’s most politically red region, said they would decline a jab compared to 9% of residents in the Pee Dee and Midlands regions, and 6% in the Lowcountry, according to DHEC’s January survey.

Health officials get creative to reverse dip in vaccine demand

South Carolina health officials are using information gleaned from their attitude surveys and the statewide immunization registry to target outreach efforts to populations with low interest or uptake of the COVID-19 vaccine.

For months, DHEC has linked up with faith-based and civic organizations and leaders across the state in an effort to make inroads with rural and underserved minority communities.

The agency has outreach specialists and support staff in all four regions of the state whose primary focus is to form relationships with groups like the Office of Rural Health, the Commission on Minority Affairs, the AARP, the Department of Education’s Migrant Education program and Hold Out the Lifeline, among many other groups at the regional, county and neighborhood levels, spokesman Derrek Asberry said.

DHEC has translated educational pamphlets and public service announcements into multiple languages, including Spanish and Chinese; directed outreach specialists to hold regular interviews on Spanish-language radio stations and social media; and recently began sending postcards with vaccine information to residents in rural and underserved parts of the state to ensure that even people who may be disconnected from social media or the daily news cycle get the information they need to make educated vaccination decisions.

Brannon Traxler, South Carolina’s public health director, said she wasn’t aware of any specific outreach being done along partisan lines, given the higher rates of hesitancy seen among Republicans nationally, but said it would work like any other outreach the agency does.

“For this group, it still is a matter of working with local trusted leaders in their community,” she said. “It’s just that the organizations — who those local trusted leaders are — may be different than when we were working with other groups.”

More recently, as young people have become vaccine-eligible, DHEC has worked to create messaging aimed at them and has encouraged young adult leaders to message their peers about the importance of getting vaccinated.

“What we’ve been doing is increasing our social media ads, our PSAs, promotional materials,” Kelly said. “Just trying to get information out that informs and features young people.”

State health officials also have begun encouraging all vaccinated individuals to talk with friends, family members and coworkers about why they got a shot.

“Word of mouth is critically important,” Kelly said. “Your friends, your family trust you. They want to hear your message, your experience about vaccine.”

Spreading the word about the importance of getting vaccinated is one thing, but making the inoculation process as simple and seamless as possible may be even more crucial.

That’s why DHEC recently modified its guidance about mass vaccination events, which until a few weeks ago had been largely by appointment only. The agency now encourages providers to hold walk-in clinics that don’t require appointments or proof of identification and is taking that approach at the mass vaccination site it helps run at Columbia Place Mall.

Enhancing the ease of vaccine access is also behind the agency’s future plans to deliver shots at fairs, festivals, sporting events and along beach boardwalks.

“We want to start moving towards having vaccine at events, instead of (having) vaccine events,” said DHEC director Edward Simmer, who envisions vaccine tables being deployed like concession booths where people can grab a jab during halftime of a football game or on their way to the funnel cake stand.

“We’re working at really trying to get vaccines to where people are instead of asking them to come to us,” he told a Senate panel last week.

DHEC is still working through the technical obstacles of slinging doses like hotdogs, which can be challenging due to the vaccines’ stringent storage requirements, but hopes to begin piloting event-driven vaccination opportunities in the weeks ahead.

“There are some logistical hurdles that have to be overcome with some of these vaccines,” Traxler said during a recent media briefing, “though having the Janssen (Johnson & Johnson’s one-dose vaccine) back available and in use again certainly can help with some of those.”

Another creative initiative to enhance vaccine uptake that state health officials are considering is using giveaways to incentivize people to sit for a shot.

Officials said monetary incentives, as some lawmakers have discussed giving vaccine recipients, aren’t off the table, but aren’t necessarily the preferred means of rewarding the newly vaccinated.

“I think there’s a preference of being a little bit more creative and not just giving people money,” said Kelly, who floated the possibility of holding a back-to-school vaccination event where families could get shots and free school supplies. “Right now we’re still formulating plans.”

The agency is committed to doing whatever it takes to increase the percentage of residents inoculated against the virus and remains open to any innovative approaches that help move the state closer to herd immunity, officials said.

“We can and we must reduce the number of deaths, hospitalizations and new cases if we’re going to get out of this pandemic,” Kelly said. “And the best way to do that is via vaccine.”