Ever since the COVID-19 pandemic arrived in Idaho, that two-word phrase has been the lofty goal for scientists, doctors, politicians and others — the achievement that would offer the best hope for stopping a deadly, fast-spreading virus that has crippled economies and killed more than a half-million Americans.
And now it’s clear herd immunity won’t happen in Idaho.
The state recently turned down 75% of its weekly COVID-19 vaccine allotment because of crashing demand — and it already owned one of the lowest vaccination rates in the country. Just over one-third of Idahoans have started the vaccination process despite widespread availability.
“We have missed our opportunity as a nation and a world to totally gain control (of) and eliminate this virus,” said Dr. Ted Epperly, president and CEO of the Family Medicine Residency of Idaho and a Central District Health board member, in a phone interview with the Idaho Statesman. “It will be with us and around us ongoing, permanently.
“Both Idaho and the nation will not get to herd immunity.”
With the help of three vaccines that were granted emergency use authorizations by the Food and Drug Administration, a “return to normal” was possible through a combination of those shots and the immunity that recovering from the virus provided, public health experts said.
Instead, vaccine hesitancy is preventing Idaho from chasing the threshold required for herd immunity.
And with COVID-19 caseloads dwindling, state and local governments are charging ahead with reopening even while more virus variants emerge.
It begs the question: What happens next?
Without herd immunity, Americans will have to adjust to a new reality, with the coronavirus a part of daily life — much as it has been for the past year, but with fewer preventative restrictions and mandates.
Idaho’s struggle with vaccination rates
Weekly vaccinations in Idaho have fallen 55% percent since the peak in early April, when all adults became eligible. Only 35% of the state’s total population is fully or partially vaccinated. This is despite the fact that starting in mid-March, Gov. Brad Little began accelerating eligibility because vaccine appointments were going unfilled.
The week of May 2, Idaho was offered a total of around 88,000 vaccine doses, but state providers requested only about 25% of that, according to Sarah Leeds, the state’s immunization program manager.
The week of May 9, state providers requested about 38% of the doses they were offered.
Residents 65 and older became eligible for vaccines at the beginning of February. All adults became eligible April 5, but some local health departments opened up appointments even earlier.
Instead of an acceleration created by the larger eligibility numbers, Idaho has seen a steady decline in vaccine uptake.
Providers administered about 96,000 doses the week of April 4-10, but only 78,000 the following week. That number has dropped for four straight weeks — hitting 43,000 the week ending May 8, the most recent week of data available.
Only 45% of the state’s 16-and-older population has received at least one vaccine dose, which is almost 13 points lower than the national average, according to the Idaho Department of Health and Welfare.
Overall, the state has administered about 65,000 doses of vaccine per 100,000 residents, according to the Centers for Disease Control and Prevention, which is considerably lower than the rate in many other states. In New Mexico, for example, more than 94,000 doses have been administered per 100,000 people. Only five states have a lower rate than Idaho’s: Wyoming, Arkansas, Louisiana, Alabama and Mississippi.
While initial estimates indicated that herd immunity might be possible if 60% to 70% of the population had immunity, Epperly pointed out that the rise of new variants, some of which may be more contagious than the original strain or able to partially evade vaccine protections, pushes the threshold higher.
Kimberly Link, the communicable disease control manager at Boise-based Central District Health, said the threshold could be over 80%.
The magic number is hard to pinpoint because it varies from disease to disease, according to the CDC and WHO. For measles, herd immunity required about 95% of a population to be vaccinated. For polio, the threshold was about 80%.
On Wednesday, the CDC recommended the Pfizer vaccine for use in 12- to 15-year-olds, after the FDA authorized it for that age group on Monday. For now, Idahoans 11 and younger — about 16% of the population — are ineligible for the vaccines, meaning that a maximum of 84% of the population could be vaccinated, if everyone got their shots.
If the virus continues to circulate and new variants continue to develop, plans to snuff it out entirely may never unfold.
Compounding the problem is the fact that a population already tired of public health restrictions may be disinclined to wait until enough of the population is vaccinated before returning to normal.
In Idaho, health officials have indicated they will tie reopening to the state’s infection levels. On Tuesday, health officials and Gov. Brad Little removed recommendations limiting gatherings to 50 or fewer people, citing the decline in cases and hospitalizations. On Thursday, after the CDC mostly dropped its mask recommendation for vaccinated people, Central District Health rescinded its public health advisory that provided recommendations like mask usage.
And on Friday, Boise Mayor Lauren McLean lifted the city’s mask mandate and gathering restrictions.
“Based on what we’re experiencing, the level of vaccination rates in our community won’t be a driving factor for (planning reopening) going forward,” said Russ Duke, the director of Central District Health, at a press conference on April 29. “Rather, what we see with the infection rate will be a major consideration.”
At a press conference on Tuesday, Dave Jeppesen, the Health and Welfare director, stressed that the state is closely following hospitalization numbers, rather than the vaccination rate.
Idaho was averaging 160 new COVID-19 cases per day over the past week through Friday. IDHW reported there were 82 patients hospitalized, with 33 in intensive care units, as of Wednesday.
Those numbers are down from an average of more than 1,600 cases per day and nearly 500 hospitalizations at their peak in December.
“The thing that has been our North Star from the beginning and will continue to be our North Star is really around the number of cases going into hospitals and whether our health care system is under strain,” Jeppesen said.
Following the CDC’s decision, major companies that do business in Idaho like Walmart, Costco and Trader Joe’s moved to stop requiring that shoppers wear masks.
Other local jurisdictions are easing precautions, too.
The Nampa City Council gave the Ford Idaho Center, an indoor arena that can hold up to 12,000 people, permission to “fully reopen.”
“I say open it up, let people make those decisions,” said Sandi Levi, a Nampa City Council member, at a public meeting on May 3. “We can’t be accountable for every single thing that happens. People are going to get sick, people die, these things just happen in life and we have to accept it.”
‘IT CAN BLOW BACK UP INTO A BIG FIRE AGAIN’
If the virus is never fully eradicated, it may shift the nature of the pandemic.
“This virus may become more endemic rather than epidemic,” Dr. Sky Blue, a physician at Sawtooth Epidemiology and Infectious Diseases, told the Statesman. “Endemic” refers to diseases or conditions that are regularly found in a population, versus an “epidemic,” which refers to a widespread disease at a particular time.
Especially for Idahoans who are unable to be vaccinated because of allergies to the vaccines’ ingredients, or those who are immunocompromised and upon which the efficacy of the vaccines are not yet known, continued circulation of coronavirus strains could be problematic.
“What it means for weaker people because of the inability to get enough of the population vaccinated is that they’re going to have to live a more cautious life,” Epperly said. “Those high-risk groups will have to live most of the rest of their lives being very vigilant about their social activities, about who’s around them. We’re going to be pivoting into a management phase of this, not a ridding from society phase.”
Link, the communicable disease control manager, told the Statesman that while achieving population-wide immunity will be “very, very challenging” given the amount of vaccine hesitancy in the state, every extra person who is vaccinated makes a difference.
“I don’t think this is an all-or-nothing approach,” she said. “Every step we take in that direction is going to be beneficial to us.”
Nearby, in Washington, the state is experiencing a fourth wave as many unvaccinated 40- to 59-year-olds are being hospitalized.
“We cannot become complacent about this virus and we cannot become complacent about not getting vaccinated,” Epperly said. “If we let this smolder, it can blow back up into a big fire again.”