The U.S. Is Entering a New COVID-19 Vaccination Crisis

Supply is no longer the problem—demand is

The U.S. Is Entering a New COVID-19 Vaccination Crisis
has become eligible for COVID-19 vaccines, which are now widely available in most parts of the country. Yet there has been an alarming decline in the number of Americans showing up to get vaccinated, even though less than half of the population has received even a single dose. While data on the progress of the vaccine rollout are difficult to parse given the many moving pieces, this is almost certainly a sign that a large number of adults remain vaccine hesitant.

In the first several months of the rollout, as states debugged the complex logistics of distributing their allotted vaccines, the population of people eager for a shot vastly outnumbered the awaiting syringes. Now, supply clearly outweighs demand. After cresting at over 2 million on April 13, the number of people receiving their first dose of a vaccine each day—the best metric to show real-time vaccine hesitancy—has stood below 1 million for more than a week:

Before declaring a crisis in vaccine hesitancy, let’s consider an alternate explanation: Could there be a bottleneck in availability as a vastly larger population of people have become eligible? Unlikely. The total number of doses allocated to the states each week by the U.S. Department of Health and Human Services has remained steady at about 18 million since early April, and states have recently been using around 75-80% of the doses they have ordered. In fact, some states are now ordering fewer doses than they are being offered, as the New York Times recently reported, suggesting a drop in demand.

There’s another twist to the vaccination slowdown: the data strongly suggest that an increasing number of people are only showing up for their first dose of the two-shot Pfizer-BioNTech or Moderna vaccines, and forgoing their second shot. Through April 9, 8% of first dose recipients who were eligible for their second shot had not yet received it, the CDC said last month. That amounted to 5 million people at the time.

While the CDC doesn’t regularly report this figure, there’s another way we can estimate this halfway hesitancy. Given the typical three- to four-week delay between people’s first and second Pfizer or Moderna doses, the number of people who have received their second dose lags behind that of those who have received both. If 100% of first-dose recipients were showing up for their second dose on time, we’d expect there to be a lag time of around 25 or 26 days—an average of the typical 21-day and 28-day wait times for Pfizer and Moderna, respectively, weighted slightly toward 21 days since Pfizer accounts for more of the doses administered so far. This delay gets longer if more people don’t show up for their second dose, since those who only receive one shot do not contribute to the second-dose rate.

Considering this, we can estimate the “incompletion rate” by measuring how long it’s taking the completion rate to catch up to a given day’s first-dose rate. The longer that takes, the more people we can estimate are not following through. At its lowest point, on Feb. 11, the lag was 27 days. By April 9 it was 30 days. As of writing, it is 34 days. (This calculation does not include the one-dose Johnson & Johnson drug, which accounts for 9 million, or 3.4%, of the shots administered so far.)

Hesitancy, it seems, comes in a least two flavors: Those who are doubtful of the entire process, and those who figure one dose is plenty enough. While a single dose offers some protection, public health officials urge people to get both doses of the two-shot vaccines to ensure maximum efficacy and longevity.

Less clear is what’s driving the overall decline in first-dose recipients. Polls indicate that those who characterize their attitude towards vaccination as “wait-and-see” has declined from 39% in December to 15% in April. Meanwhile, the percentage of people who are entirely unwilling to get a shot or will only do so if required has barely changed, from 24% to 19%, in the same time span.

In theory, those data points are a sign that more people are feeling ready to get their shot—yet daily vaccinations are plateauing. The best explanation I have is what a good friend of mine, who is also the person editing this article, calls vaccine “meh-sitance.” It’s a hassle to get vaccinated, even if there’s a pharmacy down the street offering the shot. We’re all guilty of procrastinating on any errand that doesn’t feel urgent, particularly if it involves a process of suboptimal efficiency. COVID-19 case rates and mortality rates in the U.S. are way lower than they were during the holidays, and a lot of other people are already vaccinated, so what’s the rush?

We know the answer, of course: 46% of the population is not nearly high enough to push the pandemic to endemic levels, much less eliminate it altogether. Moreover, vaccination remains the best way for a given person to protect themselves from COVID-19. The best possible explanation for the decline is that there is a corresponding drop in motivation, not a core willingness to ever get the vaccine. No one likes waiting in line. Even if the line ought to be longer.

Note on the data: The first graph, tracking those who are receiving a first dose, isn’t quite the same statistic as those receiving an “initial dose,” which we update daily on TIME’s vaccination dashboard, since Johnson & Johnson recipients normally count toward the same column as those receiving both doses of either Pfizer-BioNTech or Moderna. This is a small difference, as nearly 152 million people have received at least the first dose of Pfizer or Moderna, which were approved three months earlier.

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Free COVID-19 Vaccines Are Luring Visitors to Dracula’s Castle in Transylvania

The legendary location is now home to a no-appointment-needed vaccination center

Free COVID-19 Vaccines Are Luring Visitors to Dracula’s Castle in Transylvania
getting vaccinated at a legendary location from horror history: Bran Castle.

Every weekend this month, the fortress that’s believed to be the inspiration behind Count Dracula’s lair in Bram Stoker’s 19th-century gothic novel Dracula will be home to a free COVID-19 vaccination center where Romanians can get a Pfizer-BioNTech shot without making an appointment—or, as a Facebook post announcing the event put it, “another kind of sting.”

Daniel Mihailescu—AFP/Getty ImagesA banner reading “Who’s afraid of the vaccine?” in Romanian and depicting syringes as vampire fangs advertises the vaccination marathon organized at “Bran Castle” in Bran village in the central Transylvania region of Romania on May 8, 2021.

The first of the castle’s weekly “vaccination marathons” began on May 7, reportedly resulting in nearly 400 people receiving a dose from Friday to Sunday. “We wanted to show people a different way to get the [vaccine] needle,” Alexandru Priscu, the marketing manager at Bran Castle, told the Associated Press, noting that people who get the shot also receive a fanged “vaccine diploma” and free entry to the castle’s medieval torture exhibit.

The Pfizer-BoiNTech vaccine is a two-dose vaccine, and was authorized for emergency use in the United States by the Food and Drug Administration last December.

Despite numerous requests from foreigners, only Romanian residents are eligible to be jabbed at the gothic site, Priscu said.

The so-called vaccination marathons are part of a series of initiatives implemented by the Romanian government in an effort to vaccinate 5 million people by June 1. Romania has recorded more than a million coronavirus cases and over 29,000 deaths since the pandemic began, according to data from Johns Hopkins University.

Bran Castle did not immediately respond to TIME’s request for comment.

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