Millions of Americans are not getting the second dose of their Covid-19 vaccines, and their ranks are growing.
More than five million people, or nearly 8 percent of those who received the Pfizer or Moderna vaccines for the first time, missed their second dose, according to the latest data from the Centers for Disease Control and Prevention. That's more than double the rate among people who were vaccinated in the first few weeks of the nationwide vaccination campaign.
Even as the country grapples with the problem of millions of people fearful of vaccination, the challenge that emerges for local health authorities is to ensure that those who are vaccinated do so in full.
The reasons why people miss their second shots vary. In interviews, some said they feared the side effects, which can include flulike symptoms. Others said they felt adequately protected with a single shot.
These attitudes were expected, but another hurdle was surprisingly widespread. A number of vaccine providers have canceled appointments for the second dose because they ran out of supplies or did not have the right brand in stock.
Walgreens, one of the largest vaccine providers, sent some people who were given a first shot of the Pfizer or Moderna vaccine to get their second dose at pharmacies where only the other vaccine was available.
Several Walgreens customers said in interviews that, in some cases with the help of pharmacy staff, they looked for a place where they could get the correct second dose. Others probably just gave up.
From the start, public health experts feared it would be difficult to move to a second shot every three or four weeks after the first dose. It is no surprise that with the wider adoption of vaccines, the number of those who skip their second dose has increased.
Even so, the trend worries some state officials who are rushing to keep the number of partially vaccinated people from swelling.
In Arkansas and Illinois, health officials have directed teams to phone, write, or send letters to people to remind them to get their second shots. In Pennsylvania, officials are trying to ensure college students get their second admissions after they leave campus for the summer. South Carolina has provided several thousand cans specifically for people who are overdue for their second shot.
Growing evidence, gathered from studies and from real-life vaccination campaigns, suggests the risk of people skipping their second dose. Compared to the two-dose regimen, a single shot triggers a weaker immune response and can make recipients more susceptible to dangerous virus variants. And although a single dose offers partial protection against Covid, it is not clear how long that protection lasts.
"I am very concerned because you need this second dose," said Dr. Paul Offit, professor at the University of Pennsylvania and a member of the Food and Drug Administration's Vaccine Advisory Board.
What You Need To Know About The Johnson & Johnson Vaccine Break In The United States
- On April 23, an advisory panel to the Centers for Disease Control and Prevention voted to lift a hiatus on Johnson & Johnson Covid vaccine and put a label on an extremely rare but potentially dangerous bleeding disorder.
- Federal health officials are expected to officially recommend states lift the hiatus.
- The vaccine was recently discontinued after reports of a rare bleeding disorder surfaced in six women who received the vaccine.
- The overall risk of developing the disorder is extremely low. Women between the ages of 30 and 39 appear to be most at risk, with 11.8 cases per million doses. There were seven cases per million doses in women between 18 and 49 years of age.
- Almost eight million doses of the vaccine have now been given. There was less than one case per million doses in men and women aged 50 and over.
- Johnson & Johnson had also decided to postpone the launch of its vaccine in Europe for similar reasons, but later decided to continue its campaign after the European Union Medicines Agency announced the addition of a warning. South Africa, devastated by a contagious variant of the virus found there, also stopped using the vaccine but later continued to use it.
Much is at stake as the US only legalizes one vaccine that is given as a single shot. Use of this Johnson & Johnson vaccine was discontinued this month after it was linked to a very rare but serious blood clotting side effect. Federal health officials on Friday recommended resuming use of the vaccine, but the combination of safety concerns and ongoing production problems should make this vaccine a viable option for fewer people.
The number of missed second doses of the C.D.C. lasts until April 9th. It only applies to people who received their first dose of Moderna by March 7th or their first dose of Pfizer by March 14th.
While millions of people have missed their second shots, overall follow-up rates, with around 92 percent fully vaccinated, are high by historical standards. About three-quarters of adults come back for their second dose of the vaccine, which protects against shingles.
In some cases, problems with broadcasts or scheduling can play a role when people miss their second dose. Some vaccine providers have had to cancel appointments because they did not receive expected vaccine deliveries. People have also reported that their appointments for the second dose were canceled or just turned up to find out that there weren't any available doses of the brand that they needed.
Some people can be flexible about rebooking. However, this is more difficult for people who do not have access to reliable transportation or who have jobs with strictly set hours, said Elena Cyrus, an infectious disease epidemiologist at the University of Central Florida.
April 24, 2021, 10:42 p.m. ET
Walgreens booked some customers for their second appointment in places that weren't having the same vaccine they'd been given for their starting doses. The company said it fixed the problem in late March.
Susan Ruel, 67, was supposed to get her two doses of vaccine at various Walgreens stores in Manhattan. She said she received her first dose of Pfizer in February without incident, but when she arrived for her second appointment, she was told the store only had doses of Moderna in stock.
A Walgreens pharmacist told Ms. Ruel that there is another Walgreens pharmacy less than two miles away that stocks Pfizer doses. While Ms. Ruel was waiting for the subway to take her there, she got a call saying that this Walgreens store had run out of Pfizer cans too.
Ms. Ruel managed to get the Pfizer dose the next day from another Walgreen. But she said that many people probably wouldn't have tried that hard in their situation. "All you need is trouble like this," she said.
For example, in the Chicago area, pharmacists at two Walgreens locations said the problem was causing a headache. They said that Walgreens' appointment system was sending each pharmacy between 10 and 20 customers a week in need of a second shot of Pfizer, even though both pharmacies only stock the Moderna vaccine.
It's not clear how widespread the Walgreens dose adjustment problem was or how many people missed their second dose as a result.
Jim Cohn, a spokesman for Walgreens, said the problem affected "a small percentage" of people who booked their appointments online and that the company contacted them to reschedule "in accordance with our vaccine availability." He said nearly 95 percent of people who got their first shot at Walgreens also got their second shot from the company.
Walgreens has also come under fire for until recently scheduling a second dose of the Pfizer vaccine instead of the C.D.C. recommended three week break. Pharmacists were besieged by customers who complained, including about their inability to book vaccine appointments online.
In other cases, however, access to vaccines is not the only barrier. People's attitudes also contribute.
Basith Syed, a 24-year-old counselor in Chicago, grabbed a leftover Moderna vaccine from a Walgreens in mid-February. But when the time came for his second shot, he was busy at work, preparing for his wedding. After the first shot, he had spent two days feeling drained. He didn't want to risk repetition and was confident that a single dose would protect him.
"I didn't really have the urgency to get that second dose," said Syed.
At the beginning of April his schedule had calmed down a bit and he was looking for a second Moderna shot. But until then, the Walgreens he got his first shot on were only offering Pfizer shots. He couldn't find any slots in other Walgreens stores. Mr. Syed is no longer actively looking for a second shot, although he still hopes to get one at some point.
The C.D.C. According to the statement, there is limited data on the effectiveness of the vaccine when the shots are more than six weeks apart, although some countries, including the UK and Canada, fire shots up to three or four months apart.
Mr. Syed's experience is part of a wider Illinois shift. When vaccines were being given mostly to health care workers, residents of long-term care facilities, and people over 65, almost all of them got their second shots. In the past few weeks, however, the number has dropped below 90 percent, although it has since recovered slightly, according to the Illinois Department of Public Health.
In Arkansas, approximately 84,000 people missed their second shots, which is 11 percent of those eligible for those shots, said Dr. Jennifer Dillaha, the state epidemiologist. Recently, workers have started calling people who are due or overdue for their second shots.
College students present a particular challenge. Many have recently qualified for a vaccination and are getting their first shots, but they will have left campus by the time they are due for their second dose.
In Pennsylvania, health officials have directed vaccine vendors to give college students second doses even if they didn't get their first doses from that location.
Some vaccine providers have set up special clinics for people who need a second dose. In South Carolina, Tidelands Health started a program specifically for people who had received their first doses of Pfizer more than 23 days earlier but could not find a second shot. The state health department sent 2,340 doses to the health system for the effort.
Demand has been strong and Tidelands only has a few hundred cans left. The majority of buyers were people who "had difficulty navigating the various planning systems and providers," said Gayle Resetar, health systems chief operating officer.
In many cases, vaccine providers had canceled appointments for the second dose due to poor winter weather. "It was up to the individual to reschedule themselves on a web portal or platform and it just became difficult for people," said Ms. Resetar.
There are rare cases when people should skip the second shot, for example if they had an allergic reaction after the first shot.
Zvi Ish-Shalom, a religious studies professor from Boulder, Colorado, had planned to get fully vaccinated. Then, an hour after his first intake of the Moderna vaccine, he developed a headache that didn't go away until a month later.
It is not certain whether the vaccine caused a headache. After Dr. Ish-Shalom had weighed the risks and benefits of a second dose, he made a decision on how to proceed.
"At this point, given all the different elements of the equation, I feel very clear and very comfortable not going for the second shot," he said.