'We’re entering the harder phase' of coronavirus vaccination

The U.S. COVID-19 vaccine rollout has led to roughly 145.3 million Americans receiving at least one dose and 104.8 million who are fully vaccinated.

But the country is now approaching an impasse, with a large share of adults who are now eligible for the vaccine simply choosing not to get it.

“The last three months were people who really, really wanted the vaccine and were going to do anything to get it,” Dr. Anand Swaminathan, an NJ-based emergency medicine physician, said on Yahoo Finance Live (video above). “Now we’re entering the harder phase where we have people a little bit more reluctant. We have plenty of supply, which means that our focus, our biggest challenges have to be on access and demand.”

“The pace has definitely slowed down,” Swaminathan reiterated. “We were at a pretty high level, so we’ve slowed down. But we’re still vaccinating a substantial number of people. I don’t think we like to admit it — that was the easy part.”

Vaccine hesitancy poses more of a challenge as the first wave of eager recipients are now inoculated.

“The last three months were people who really, really wanted the vaccine and were going to do anything to get it,” Swaminathan said. “Now we’re entering the harder phase where we have people a little bit more reluctant. We have plenty of supply, which means that our focus, our biggest challenges have to be on access and demand.”

'We don’t know what July 1 is going to look like'

The number of COVID deaths and hospitalizations in the U.S. are steadily decreasing as more and more people receive vaccinations.

States are increasingly announcing full reopenings, and New York City Mayor Bill de Blasio stated that the country's largest metropolitan area will fully reopen by July 1.

“Now we don’t know exactly what the level that we need for vaccines to get herd immunity is,” Swaminathan said. “We know it’s a lot more than 36%. So yes, July 1 might be fine. But instead of that, we should set guidelines based on what transmission looks like at the time, what the disease looks like at the time. And we don’t know what July 1 is going to look like.”

The initial goal was for the country to reach herd immunity, which is estimated to be between 75-80%. However, some public health experts are now saying that herd immunity in the U.S. is unlikely because of the slowdown in vaccinations.

“What we should be doing is instead of setting a date that we’re going to go back to full, what we need to be looking at is: What are the dynamics of transmission?” Swaminathan said. “What’s the percent positive rate? What’s the vaccine uptake? Right now, the vaccine uptake in New York City is about 36%. That’s far below what we would need to get herd immunity.”

According to Dr. Cedric Dark, an assistant professor at Baylor University, the focus should be on the "now" rather than long term.

"What everybody's focus needs to be is trying to get as many vaccines in arms as we possibly can," Dark said on Yahoo Finance Live. "Whether or not we achieve herd immunity may not become the goal long term. This may be something that could linger around for a while, but the goal right now should be focusing on can we vaccinate our local communities, our cities, and then after that, worry about our entire country."

Public health experts have criticized the actions of leaders who are prioritizing full reopenings above other crucial steps such as ensuring everyone is vaccinated and maintaining safety guidelines.

“We can’t just eschew those public health recommendations,” Swaminathan said. “We can’t abandon them. We need to keep it. This reopening, this false creation of a deadline, that’s a disastrous issue. We can’t say July 1st we’re going to reopen everything because we don’t know what July is going to look like.”

'The second dose is absolutely, 100% necessary'

Another challenge is the fact that reportedly 5 million Americans haven't returned for their second doses, which are required for the Pfizer (PFE) and Moderna (MRNA) vaccines.

Pfizer’s vaccine is roughly 52% effective after one dose (95% after both doses), while Moderna’s is about 80.2% (94.1% effective after both doses).

“The second dose is absolutely, 100% necessary for these mRNA vaccines,” Swaminathan said. “They’re not nearly as effective with a single dose. There’s some reduction, we think maybe in the 50% range. But that’s not nearly enough. If you get that second dose, wait two weeks after that, we’re up to 94%, 95% reduction in cases. So you really need that second dose.”

It’s unclear what exactly is keeping these individuals from returning for their second doses.

“A lot of this is messaging,” Swaminathan said. “There are some studies showing that the vaccinators are not always telling people you have to get a second dose, so we need to reiterate that over and over again. Every time I give a first dose, I tell people ‘We’ll see you back in three to four weeks for your second dose,’ depending on which vaccine I’m giving. And then the center is making that appointment immediately.”

Swaminathan recommended getting the Johnson & Johnson (JNJ) vaccine if there’s a chance you won’t go back for your second appointment.

“These are things that we can do to make this as easy as possible for people,” Swaminathan said. “That’s really the phase that we’re in at this point. Make it easy for people. Make it a no-brainer to not only get your first dose, but to know exactly when that second dose is. And then we can support people by doing things like paid time to get your vaccine. People shouldn’t be losing an hour or two of their paycheck because they’re going to get a vaccine. That should all be paid for. These are other things that we can do to make it easier for folks.”

Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter @adrianambellsand reach her at adriana@yahoofinance.com.

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