Maine may offer more walk-in vaccine clinics as demand softens, COVID-19 rates remain high

Apr. 21—Maine's top public health official said Wednesday the state is working to create more walk-in options for people to get COVID-19 vaccines amid a sustained surge in new cases, mostly among younger individuals.

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said the state's decision this week to offer no-appointment slots at its mobile vaccination clinic already has demonstrated interest in that option. Although he didn't offer specifics, he said the state is working with providers to see if other vaccination sites can make that switch, too.

"We're still seeing robust demand, we just need to make it more accessible," Shah said during a media conference call with other state health officials on the topic of vaccine hesitancy and supply. The call was hosted by the Association of State and Territorial Health Officials, of which Shah serves as president.

Maine continues to lead the nation in percentage of residents that have been fully vaccinated, according to a Bloomberg News state-by-state tracker, but there are small signs that demand is softening, especially in more rural parts of the state where vaccine hesitancy might be greater.

Shah said he's proud of the efforts Maine has made so far on vaccinations but said a shift in approach is likely going to be needed to reach individuals who weren't eager to get the vaccine as soon as it was offered to them.

"Certainly, challenges loom," he said.

John Porter, spokesman for MaineHealth, the state's largest health care provider, said officials there are "actively developing other ways of scheduling vaccines," but were not ready to announce those yet.

MaineHealth is still working through its vaccination waitlist this week, but Porter said that list has been shrinking in size.

At Northern Light Health, spokesman Chris Facchini said there are no immediate plans to offer walk-in acceess.

"With vaccine supplies still limited, offering walk-ins would likely lead to frustration for our community members," he said. "Prescheduling appointments reduces wait time for the public on site and ensures that doses are available when people arrive."

Concerns about reaching herd immunity have become more acute with the troubling rise in new cases in Maine. State health officials reported 500 new cases of COVID-19 on Wednesday, and one additional death. The seven-day daily case average has more than doubled in the last month, up to 442. Two weeks ago, the average was 310 cases and this time last month, it was 206.

Of the 500 new cases Wednesday, 338, or 68 percent were in those under 40, a group that has only been eligible for vaccinations for a short time.

Hospitalizations have been rising as well. The number of Mainers hospitalized with COVID-19 increased to 110 on Wednesday, the highest total since February 10. Of those, 39 are in critical care and 15 are on a ventilator. Hospitalizations, which ranged between 70-80 for more than a month, have ticked up over the last week two weeks and have crossed the 100 threshold in six of the last seven days.

Since the pandemic reached Maine more than 13 months ago, there have been 58,465 confirmed or probable cases of COVID-19 tracked by the Maine Center for Disease Control and Prevention, and 768 individuals have died from the virus.

As of Tuesday, Maine also had reported 107 so-called "breakthrough" cases of fully vaccinated individuals who subsequently contract COVID-19. These are expected as no vaccine is 100 percent effective, but those cases represent just 0.02 percent people who have completed their vaccination shots in Maine to date.

Although Maine leads the country in rate of residents who are fully vaccinated, vaccinations have slowed down this week, a function of fewer doses coming into the state and the pause in administration of Johnson & Johnson vaccines. On Monday and Tuesday, the state issued almost 4,000 fewer shots each day than last Monday and Tuesday.

Shah said he doesn't think demand is waning overall just yet. However, a report this week from the Kaiser Family Foundation suggested that vaccination enthusiasm is likely to drop off within the next 2 to 4 weeks.

"Once this happens, efforts to encourage vaccination will become much harder, presenting a challenge to reaching the levels of herd immunity that are expected to be needed," the report said.

On top of that, Maine will receive the same number of doses next week as it did this week — 36,460 combined doses of Pfizer and Modera vaccines. That total does not include doses that are sent directly to retail pharmacies or to federally qualified health centers. Those numbers won't be known until the weekend.

As of Wednesday, 1,021,208 total shots had been administered since vaccinations began in December. Of those, 579,498 were first doses, representing 51.5 percent of Maine's population over the age of 16, and 441,703 were second doses, accounting for 39.3 percent of the over-16 population.

Among the 390,908 Mainers over the age of 60 who are greatest risk of hospitalization or death from COVID-19, 74 percent are fully vaccinated, which is close to the threshold for herd immunity.

Whether Maine's younger population reaches the level of vaccination to achieve herd immunity remains to be seen. Shah did say this week that the Maine CDC is finalizing a new round of ads on Facebook, Instagram and other social media sites. The state also has worked with the Maine Medical Association and the Maine Osteopathic Association to film short videos of primary care physicians talking about why they got vaccinated.

Shah said as the state moves into the next phase of vaccinations, engendering confidence in vaccines is going to be paramount. He said people who are eligible to get vaccinated but haven't yet fall into one of three categories: not able, not now and not ever.

Those who are not able might be housebound or lack transportation. That state has been working to reach those individuals for weeks.

The not now category is made up of people who have "earnest questions about the safety, efficacy and applicability of being vaccinated," Shah said.

"We're trying to provide honest, science-based answers to this group," he said.

Anna Zink, chief medical officer for the state of Alaska, said on Wednesday's conference call called vaccines "one of the safest things we do in medicine," and said they are a way — the only way, really — to be on offense against the virus, instead of defense. She said one messaging strategy to persaude younger individuals is to remind them that there are economic benefits to getting vaccinated, namely that they won't be forced to isolate or quarantine if they get the virus or are a close contact of someone who did.

The "not ever" group is going to be harder to persuade, Shah conceded, but he's not giving up. He said the strategy there is to find trusted messengers to help connect with individuals.

"We need to have an attitude and tone of respect," he said. "Disdain has never changed anyone's mind."