Hard to herd

The goal has been set and often reiterated: 4.7 million New Jersey adults fully vaccinated by June 30. It’s the figure that state health officials under Gov. Phil Murphy contend is absolutely vital for the state to stop the spread of COVID-19 and return to pre-pandemic life. And it’s meant to align with a similar goal set by President Joe Biden of getting at least one shot into 70% of adult Americans by July 2, just before Independence Day. But events have conspired to make both numbers difficult to reach.

In the first stages of the vaccine rollout, hundreds of millions of Americans struggled to get a shot, waiting in virtual and physical queues for weeks or months. Now, interest has plateaued with most of those who want a vaccine able to get one.

And a variation of COVID-19 circulating in India could be far more infectious than another strain first detected in the U.K.

And the jury is still out on what degree of resistance this new strain might have against the vaccines.

“We are highly unlikely to reach a high enough level of vaccination in New Jersey considering the current full vaccination rate and the geographic variability in vaccinations,” said Sylvia Twersky, an assistant professor of public health at The College of New Jersey. “That is not to say that we will never be able to get back to normal, or at least a new normal, as long as most higher risk individuals are vaccinated and that everyone who wants to be vaccinated has access to the vaccine.”

As of May 12, nearly 117 million Americans have been fully vaccinated, of which over 3.7 million are from New Jersey – most with the two-dose Pfizer and Moderna shots. A smaller number of the doses came from Johnson & Johnson’s one-shot version.

But now public officials are practically paying people – with beer or tuition discounts, for example – to get the vaccine. And Murphy has unveiled his “Operation Jersey Summer” – an aggressive outreach campaign to reach that final 1 million or so arms.

“Over the next eight weeks, we are going to be doing everything we can to make sure that every New Jerseyan recognizes that the vaccines in our toolbox are safe and effective. We are going to make sure they know how easy it is to get vaccinated,” the governor said on May 3.

It includes hundreds of canvassers who will knock on doors across the state to promote the vaccine and available sites, coordination with local religious and community leaders, free beer from participating breweries for those who get a first shot in May, walk-ins at the six vaccination mega-centers, dosage supply to local officials and medical offices, and a focus on urban neighborhoods where vaccination rates have lagged the most across the state.

“Losing is not an option here,” said one senior administration official, who requested anonymity. “But at the end of the day,” things don’t stop on June 30, this official said. “If we meet our goal on July 15, we’re going to keep plugging away until we meet our goal.”

But Corey Hannah Basch, an associate public health professor at William Paterson University, described the June 30 goal as “arbitrary.” She said in an email that “even if this number is reached, this does not guarantee that herd immunity will be reached.”

“If I were to do levels of concern about reaching this herd immunity, I would say least confident about the world in the short run, less confident about the country and most confident about New Jersey, but that’s not necessarily going to solve our problem,” said Perry Halkitis, dean of the Rutgers School of Public Health.

According to data from the federal Centers for Disease Control and Prevention, New Jersey consistently scores among the best states in the rate of total doses administered. As of May 10, the state was delivering more than 90,000 doses per 100,000 residents. Mississippi and Alabama, among one of the worst states, logged less than 57,000 doses per 100,000 residents.

“The challenge with herd immunity is that you can’t just think about New Jersey in isolation, because it’s part of a country and part of a world,” Halkitis said. That means that surges or new outbreaks elsewhere in the world threaten New Jersey, especially given its connection to some of the world’s most heavily traveled airports.

Halkitis suggested that reaching herd immunity, or the goals laid out by Murphy, is possible. But “in the short-term we’re going to find ourselves in a place where we’ll need annual shots.”

With the Pfizer vaccine authorized for children ages 12 to 15, the immunity wall will be stronger. Halkitis said that “the kids get you over to the 80 to 90%” of the state population.

“[F]ormal plans to guide both parents and guardians, and practitioners, are being finalized by the Department [of Health] and we anticipate being able to transition to vaccinate eligible adolescents as soon as Pfizer receives its emergency use authorization,” Murphy said on May 10. “This fight doesn’t just end magically when we get to 4.7 million,” the governor said. “The 12- to 15-year-olds will be added as a separate category. The 4.7 million is 16 and up, we will then have other objectives with the 12-to-15.”

According to the governor, health officials are looking at partnering with schools, pediatricians, local pharmacies or one of the state’s six vaccine mega-sites. “We are also going to remain focused on ensuring that parents have access to information,” the governor said. “The broad-based outreach campaign … will be a large part of this. But we know we can also undertake this by working directly with, and within, our schools.”

Racial disparities

According to the New Jersey Department of Health, whites made up 57% of those who’ve gotten vaccinated, followed by Hispanic and Latinx who made up 13%, Asian Americans who made up 11% and Blacks who made up 8%.

Racial disparities have long been recognized not just in the vaccine, but in health outcomes overall. Hispanic and African-American communities across the nation were among the most devastated over the course of the COVID-19 pandemic.

New Jersey Health Commissioner Judith Persichilli said that mobile vaccination units will go into hard-to-reach communities where those vaccine rates have lagged – 16 municipalities with over 10,000 residents have less than 40% of their eligible populations vaccinated, many of them African-American and Hispanic-majority.

Given the less-stringent storage requirements for Johnson & Johnson’s shots, and that fact that it requires just one dose, state health officials are hoping to use it to go after these hard-to-reach populations missed by prior vaccination efforts, including urban, lower-income neighborhoods, the homeless and homebound seniors.

Stephanie Silvera, an infectious disease expert and Montclair State University public health professor, identified three unvaccinated groups. The first includes those who refuse to get vaccinated. The second includes those on the fence – what she called the “wait and see group,” which she noted has been shrinking over the past several months. Then there are “people who want vaccines but are experiencing barriers to getting vaccines.”

“That’s low-hanging fruit,” she said in a phone interview. “We just have to figure out how to get it to them.”

Hence outreach efforts launched under Operation Jersey Summer: to get vaccines to lower-income, urban and typically African-American and Hispanic communities.

Halkitis explained that given the characteristics of unvaccinated New Jerseyans, Murphy’s June 30 threshold and some amount of herd immunity is still feasible. But he estimated that the state would need to vaccinate between 30,000 and 40,000 people a day. The next two months boil down to an issue of “motivation” rather than “manpower.”

Persichilli estimated that the state will need to administer 280,000 first doses each week in May and 220,000 second doses in June in order to reach the state’s goals. “Our counties will have to administer, depending on where they are, between 3,000 and 35,000 first doses weekly in May and between 3,000 and 23,000 second doses through June, depending on how successful they have been to date,” she said on May 10. “We have a lot of work ahead of us.”

Patrick Murray, who heads the Monmouth University Polling Institute, cautioned that the reports of blood clots in a handful of J&J vaccine recipients did not help convince reluctant residents to get the shots. “It may have spooked people we characterize as vaccine-hesitant,” he said May 6 statement accompanying a poll in the vaccine issue. “While the overall population share represented by this group may be small, it matters when that percentage could be the difference between herd immunity and a continuing pandemic.”

The poll found that 63% of New Jersey adults got at least one vaccine, while 14% said they still want to wait for others to get it, and another 14% have no plans to get the shot. Republicans were more likely to fall into this “anti-vax group,” the poll found.

“For the type of people staunchly anti-vaccine, that’s a much harder wall to break,” Silvera said. “That’s what ultimately could be what keeps us from getting to herd immunity.”