The U.S. is awash in vaccine supply. Its new concern: Will demand keep up?

With some U.S. states now boasting more than one dose of COVID-19 vaccine for every adult, the newest concern involves demand: Will enough Americans get shots to achieve herd immunity?

A growing gap in uptake between red and blue states raises issue of global concern in fight against COVID-19

Local 28 Sheet Metal Worker Demetrius Buttelman at the Belmont Park pop-up vaccination site in Elmont, N.Y., on April 14. Vaccine supply now exceeds one dose per adult in a nearly a dozen states in the U.S. (Mary Altaffer/The Associated Press)

On the road to mass-vaccination, the U.S. is so far ahead that it's detecting new obstacles that remain, for much of the world, an afterthought on a distant horizon.

The proportion of the population who've received at least one dose is almost twice as high as in Canada, and it's 10 times higher for the fully vaccinated.

The vaccine supply in most states has ballooned to more than one dose per adult — that's allowed half of adults and nearly 40 per cent of the total U.S. population to have received a shot. 

Nowadays when you text friends to tell them a local clinic has doses available, it's increasingly common to hear the reply: No thanks, I've already got mine.

"It's pretty damn good," Paul Goepfert, a University of Alabama researcher who studies vaccines, said of the rollout so far.

So he's optimistic, right? Not quite. 

In fact, Goepfert is worried that the U.S. might never cross that coveted threshold of herd immunity.

"I'm skeptical," he said of whether the country will reach herd immunity. "At least not anytime soon." 

Vaccine hesitancy ranks atop his causes for concern. The increasing abundance of U.S. supply is now shifting attention to that other half of economics' most fundamental model: demand.

Whether enough Americans take the vaccine matters not only here but elsewhere, as the world pursues that ill-defined immunity threshold, which most estimates peg at about three-quarters of the population.

Blue states, red states

The rate of vaccinations is still increasing across the U.S. but there's an emerging gap in how quickly different states are unloading supplies. And the gap is growing.

The states seeing the biggest daily increases in vaccinations are churning through their supply — led by New Hampshire, which has now delivered at least one dose to 71 per cent of adults.

Other states have used just two-thirds of their supply and the daily increases are smaller: Mississippi and Alabama, for instance, have delivered at least one dose to 38 per cent of adults.

There's an eye-catching political trend developing.

Of the states with the most doses administered per adult, 14 of the top 15 voted for Joe Biden. As for states administering the fewest doses, 14 of 15 voted for Donald Trump.

Wilbert Marshall, 71, looks away while receiving the COVID-19 vaccine from Melissa Banks, right, a nurse at the Aaron E. Henry Community Health Service Center in Clarksdale, Miss., April 7. Nearly half of American adults have received at least one dose of the COVID-19 vaccine, but there are some signs that rates are lower in Republican red states such as Mississippi than in Democrat-supporting blue states. (Rogelio V. Solis/The Associated Press)

Goepfert's own experiences attest to the trendline in his state of Alabama.

Just weeks ago, he was being bombarded with requests from people who hoped that, through his work, he might help them score still-rare vaccines. 

"I don't get those calls anymore," he said.

Meanwhile, he works at an HIV clinic and struggles to convince some patients to take the vaccine, including people with serious pre-existing conditions.

He describes a spectrum of vaccine hesitancy. Some skeptics can be convinced to get vaccinated, he says; others flat-out refuse. Some say no out of fear; others have no fear of COVID-19.

One patient casually brushed off getting vaccinated, Goepfert said, telling him: "I don't wear a mask. I haven't gotten sick. Why should I get a vaccine?" 

Blue states are ahead in vaccinations. Atop the list is New Hampshire, seen here with a mass vaccination event last month. A whopping 71 per cent of adults in the state, and 58 per cent of the total population, have received at least one dose. (Elizabeth Frantz/Reuters)

Pharmacy slots unfilled

Vaccination appointments are going unfilled in certain places.

There were vacant vaccination slots in dozens of CVS pharmacy locations on Thursday in Tennessee, Mississippi, Louisiana, Alabama and Wyoming. 

Yet the slots were all booked at its locations in Connecticut, Delaware, Massachusetts, New Hampshire and Minnesota.

One North Carolina county plans to shut its mass-vaccination site after this month because of dropping demand. 

After an initial rush, the site located in an old K-Mart is getting a fraction of its former use; a lengthy waiting list for vaccines has evaporated, and patients now have more places to get vaccines in Carteret County.

Herd immunity? Don't count on it anytime soon, says Paul Goepfert, a vaccine expert and doctor at the University of Alabama at Birmingham. (University of Alabama at Birmingham)

"I'm worried," said Ralph Merrill, an engineer who sits on the county board. His county has fully vaccinated one-quarter of its population, around the state average but far from the eventual goal.

"I'd be surprised if we get much above 50 per cent."

He pauses and chuckles in mid-sentence when asked why he's worried: "There's a lot of people around here who … I don't think they want to take the vaccine."

Like others, he describes vaccine hesitancy as coming in different varieties. At the Marine Corps base where he works, he said, some friends are cautiously skeptical; others offer wild conspiracy theories.

The Trump card

Trump won Carteret County, N.C., by 42 points.

Merrill is convinced politics is driving anti-vaccination sentiment, especially among people who generally distrust government.

The U.S. Congress anticipated that vaccine hesitancy might become a problem and set aside more than $1 billion in its new COVID relief law for a public awareness campaign.

Trump's administration funded the vaccine operation. But he hasn't talked much about getting vaccinated. (Tom Brenner/Reuters)

But Merrill sees a quicker, easier way to influence public opinion: get Trump to go on TV, talk about how his administration funded the development of vaccines, describe how he got vaccinated, and urge supporters to do the same.

"He's like the idol to a group of people," Merrill said. "That would be a good thing for him to do." 

A wealth of polling data backs up the idea that vaccine hesitancy is highest among Republicans.

Three polls released this month put the number of Republicans who don't want a vaccine in the neighbourhood of 40 per cent — that's roughly double the national average and multiple times higher than the ratio of anti-vaccine Biden supporters. Surveys also find higher-than average vaccine hesitancy among African Americans.

The tricky math on herd immunity

This is the kind of math that has Goepfert worried that herd immunity might prove elusive.

Adults comprise 78 per cent of the U.S. population, and because vaccinations are mainly going to adults, he figures that nearly all adults will need antibodies from a vaccine or recent illness to get there.

He doesn't see how that could happen with so many people hesitant to get vaccinated.

Some U.S. states are now expanding the eligibility pool to include 16-year-olds.

Mississippi Gov. Tate Reeves, seen at a press conference in Jackson, Miss., in January, says he's working to fight vaccine hesitancy and falling demand in his state. (Rogelio V. Solis/The Associated Press)

The governor of Mississippi, Tate Reeves, recently tried to convince some of the vaccine holdouts in his state by speaking forcefully about how he and his family have gotten vaccinated and announcing new mobile vaccination clinics in priority areas. 

"The next million shots are going to be harder to get than the last million. They're going be hard to get because of vaccine hesitancy," Reeves said at COVID-19 briefing in late March in which he announced that one million vaccine doses had been administered in the state. 

"We've got to get creative to get shots in arms. It was easy early on, in January, because we had a lot more demand than we had supply. We've always said that at some point, we're going to get to where there is as much, if not more, supply than there is demand. We're not there yet, but we're seeing the shift very, very quickly." 

U.S. President Joe Biden visits a vaccination site at Virginia Theological Seminary in Alexandria, Va., April 6. Virginia has vaccinated more than half of its adult population. (Evan Vucci/The Associated Press)

Politics: Correlation isn't causation

One infectious-disease expert and medical practitioner in the U.S. said it's simplistic to attribute vaccine hesitancy entirely to politics.

Krutika Kuppalli, a doctor and researcher at the Medical University of South Carolina, said several factors shape your risk assessment, and it so happens these factors might correlate to political preference: the population density of your area, your education level, and whether you have regular access to health care.

She agreed vaccination slots are filling more slowly in her area than before, and echoing other experts said hesitancy comes in different forms.

Some issues are purely clerical: people struggling to navigate an appointment website, she said. More surprising are the stories that stem from misinformation — like one patient this week who expressed fear vaccines might worsen his unrelated condition.

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What's the long-term outlook

"The amount of the misinformation is unbelievable," she said.

"It astounds me how much is out there." 

So what's next? 

Kuppalli suspects vaccines for adolescents are part of any solution for getting to herd immunity, and even then it won't be easy.

She worries about new variants popping up in the many countries where vaccines remain rare, and said it's unclear whether they will be easier or harder to manage.

We might need occasional vaccine booster shots to protect ourselves, she said. 

Goepfert also suspects we'll be getting booster shots, perhaps every couple of years. If things work out, he said, future variants will keep responding to vaccines, and COVID-19 might weaken into yet another form of the common cold.

That's his optimistic scenario.

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Alexander Panetta is a Washington-based correspondent for CBC News who has covered American politics and Canada-U.S. issues since 2013. He previously worked in Ottawa, Quebec City and internationally, reporting on politics, conflict, disaster and the Montreal Expos.

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