Georgia shifts COVID vaccine strategy as pace slows to a crawl

At the Fox Theatre, the parking and popcorn came free on a recent Friday evening, along with an exquisite violin performance — all in hopes of coaxing the hesitant to get a COVID-19 vaccine there.

In a conference room inside Truist Park, the Atlanta Braves offered two free game tickets in exchange for an on-site vaccine shot.

Mobile vaccination clinics are setting up before dawn at farms, and teams are vaccinating workers on their breaks inside poultry plants. They’ve given shots at churches, grocers and soccer matches. In the months ahead, the teams will hit nearly every county in Georgia.

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“We will go at 4 a.m. or 9 o’clock at night. We’ll go to a swamp,” said Jonathan Golden, with CORE (Community Organized Relief Efforts), which is heading up the efforts.

Across the state, an army of medical professionals, public health workers and volunteers for nonprofits like CORE are fanning out to reach millions more unvaccinated Georgians.

It’s a valiant effort that still may not be enough to protect Georgians against a new, more dangerous variant that threatens to undo the progress the state has made.

Credit: Steve Schaefer

Credit: Steve Schaefer

Only 52% of Georgia adults have received at least one dose of the vaccine as of Thursday, well below the national average of 63%. At the current rate of vaccination, Georgia will not reach 70% — a goal the Biden Administration hoped to achieve by July 4 — for at least another four months, an Atlanta Journal-Constitution analysis shows.

The state’s rate has been dropping since March, when almost 50,000 people were vaccinated each day. The most recent 30-day average is just under 14,000 vaccinations a day. If this decline continues, experts fear vaccination levels will hit a wall and Georgia may never reach the 70% goal.

As the pace of inoculations has tapered off, mass vaccination sites have given way to smaller-scale efforts to reach and persuade people to get shots. Experts say that’s likely the best way to reach those hardest to get.

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However, the strategy shift — from large facilities like the one recently closed at Mercedes-Benz Stadium, to targeted outreach where people gather — is extremely labor-intensive and often results in much smaller numbers of people, maybe even only a few at a time, being vaccinated.

At the Fox Theatre event, promoted with e-mail marketing and lit up on the iconic marquee, only five people showed up for a vaccine dose.

“Our efforts will keep getting us closer and closer to the goal,” said Kaiser Permanente of Georgia epidemiologist Dr. Felipe Lobelo, a former CDC officer. “But we are going at a much slower clip, and it’s going to take time.”

Credit: Steve Schaefer

Credit: Steve Schaefer

Vaccination is the safest way to acquire immunity and get the pandemic under control, said Amber Schmidtke, a public health researcher and former Mercer University professor who tracks Georgia’s epidemic in her widely read newsletter. Immunity also can come from past infections, but she called that “the more brute force path.”

To achieve herd immunity, 70% to 90% of the population would have to have either completed the course of vaccination or acquired immunity from previous infection.

Schmidtke warned that Georgia “might stumble” into herd immunity, at a high cost of hospitalizations and lives lost.

Vaccine carrots and sticks

Most who really want the shot and have ready access have gotten it. Now comes the thornier part. Some want it but can’t take off work or don’t have transportation to a vaccination site.

Others are fearful of the COVID shots or don’t believe in vaccines or have fallen prey to misinformation about the shots. The demographic group most likely nationally to say in polling they won’t get the shot is Republican men.

Some people don’t feel they need it, and plummeting rates of new infections and hospitalizations this year have likely given some a false sense of security that the virus is under control, Schmidtke said.

That takes away some urgency to get vaccinated.

“Our efforts will keep getting us closer and closer to the goal. But we are going at a much slower clip, and it's going to take time."

- Dr. Felipe Lobelo, Kaiser Permanente of Georgia epidemiologist

But new, highly contagious strains of the virus, including one first identified in India and known as delta, remain a threat. Delta overwhelmed India’s health system, leading to one of the worst waves of death of any country since the pandemic’s start.

With the delta strain now in Georgia, that could leave swaths of the state at considerable danger. Vaccination rates are staggeringly low in some rural counties. In Charlton County, only about 14% of residents have had at least one dose; in Long County, only 12%, according to state data.

And two doses of the Pfizer or Moderna vaccines are needed for good protection against the Delta strain.

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Over time, experts feel a combination of vaccine carrots and sticks could move the needle and prod more Georgians to get vaccinated. Free tickets, perhaps a lottery or removing onerous requirements like masking in workplaces for those vaccinated could help, they say.

Those who are hesitant also need to be able to get their questions answered, Lobelo said. Doctors and faith leaders, he said, are key trusted sources for information and can help allay concerns. Primary care doctors also can be particularly influential when they can have a conversation with a patient and when they have the vaccine available right then and there to administer.

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People can also be swayed by seeing friends and family getting vaccinated.

“If I convince a patient to be vaccinated, I say, ‘please be an agent for change for your family, your friends, your neighbors,” he said, “The word of mouth is really going to help with that last mile.”

Vaccine incentives

President Joe Biden announced a raft of new private-sector initiatives meant to encourage Americans to get vaccinated.

Calling it a “month of action,” The White House also announced a handful of community-based outreach initiatives, which include an effort to recruit 1,000 Black-owned barbershops and beauty salons in Atlanta and other cities across the country to provide accurate vaccination information and even provide vaccines where possible.

Grocery store chain Kroger announced anyone who gets vaccinated at a Kroger clinic now through early July will have a chance to win a $1 million cash prize or groceries for a year.

Medicare has promised providers a new incentive for vaccinating people who are homebound. Now, the agency will pay providers $75 per at-home vaccination. Previously, they were paid $40.

And more incentives are likely coming including from major insurers. Blue Cross recently announced they are offering eligible members in their Federal Employee Program $50 for showing proof of vaccination, starting June 11.

Brian Castrucci, an epidemiologist who once worked for the Georgia Department of Public Health and now runs the de Beaumont Foundation, a public health charity in Maryland, thinks getting full Food and Drug Administration approval of vaccines, which is expected sometime over the summer for the Pfizer shots, could be another boost among those who see the vaccine as experimental and are in the wait-and-see camp about getting it.

For now, Castrucci says getting the vaccine needs to be easy as possible.

“What’s it going to take? Think about how easy it is to get a Big Mac. It needs to be that easy,” he said.

Castrucci takes it one step further: “It is going to take making getting the vaccine super easy, the simplest thing you have done in your day.”

Upping the ante for vaccine incentives

To try to make vaccination easy, the Atlanta Braves has partnered with hospitals and the local Cobb & Douglas County Health Department among other organizations for about a dozen vaccination clinics inside the ballpark as well as just outside at The Battery Atlanta. In recent weeks, they’ve upped the ante by offering two free game tickets to anyone getting a dose.

Still, the number of takers has dwindled to only a trickle.

On a recent Friday, only a couple were getting shots before an announcement about vaccines being administered was made on the jumbotron.

Some who then stepped forward said they had simply been busy. Others, including professional dancers and a young woman who works at a bank, said they were soon returning to work and the only way they could ditch the mask on the job was to get vaccinated.

Credit: Steve Schaefer

Credit: Steve Schaefer

Jack MacLeod, a 22-year-old industrial designer and recent Georgia Tech graduate, said he had wanted to wait for full FDA approval.

“But I also want to help people out, and the more people who get vaccinated, the faster life returns to normal. I had to balance those two things,” he said.

So on Friday night, when he realized he could get vaccinated and back to his seat within minutes, “the convenience of this,” he said, “made this a no-brainer.”

Credit: Steve Schaefer

Credit: Steve Schaefer

Ryan Nelson, 28, works long hours at an auto body shop and hadn’t gotten around to getting a vaccine. But as he and his girlfriend stepped off an escalator at Truist Park, they saw a man smiling and enthusiastically waving a sign that said, “Get your Covid vaccine here,” and his girlfriend turned to him, and said, ‘Let’s do this right now.’

“We knew we wanted to it, we’ve both just been busy,” said Nelson after getting the first dose of a Moderna vaccine. “This just made it so easy, we had to do it now.”

A staffer with the U.S. Department of Veterans Affairs, the federal agency administering the vaccine, not only helped Nelson and his girlfriend set up an appointment for their second dose, but gave them his card to call him directly if they had any trouble scheduling and getting it.

Hitting the streets

The state has an agreement with CORE to operate mobile and pop-up vaccination sites, and the organization and its health care partner, Curogram, have nearly three dozen mobile units. They also have more than 125 additional vaccination sites statewide.

Golden, the CORE co-director in Georgia, said his teams and volunteers from partner organizations often devote much of their time just talking to people to try to earn their trust.

Still, the outreach doesn’t guarantee success.

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“We might only vaccinate five individuals in a day, but if we can do five a day that’s rolling that snowball in the right direction,” he said.

Recently, at Impact Church in East Point, hour after hour a brightly colored children’s ministry room turned into a vaccination site sat empty.

“What's it going to take? Think about how easy it is to get a Big Mac. It needs to be that easy."

- Brian Castrucci, an epidemiologist who runs the de Beaumont Foundation

Dacia Spencer, outreach specialist, for CORE in metro Atlanta, busily tapped away at her computer, working on a program to recruit more volunteers.

About a month ago, CORE was hosting a vaccination site at Vine City church, and Spencer noticed on the eve of the event that fewer than five people were registered. So she hit the streets, iPad in hand, and approached strangers in parks, outside a MARTA stop and along the streets.

Credit: Steve Schaefer

Credit: Steve Schaefer

She found many assumed they needed insurance to get the vaccine, or they didn’t have a phone or other device to register in advance. Some were concerned about immigration issues. And some simply had questions about the development of the vaccine and about the side effects.

“There was one woman who was yelling at me, irate and screaming at me, saying we were killing people,” she said. “But there were four people next to her who listened to me, and they wanted more information.”

The next day, 46 people showed up for vaccinations.

Building trust

Gigi Pedraza, founder and executive director of Latino Community Fund Georgia, said for many Hispanic communities, wariness about the vaccines isn’t a major problem. Demand is high.

Those without insurance might not know the shots are free, she said. Hourly workers who struggle to support their families might be reluctant or unable to take time off to get a shot or fear missing additional days if they have side effects.

Some undocumented residents fear being turned away for not having insurance or a driver’s license, or, worse, being turned over to federal immigration authorities. Others believe taking the government-funded vaccine might get them labeled under “public charge,” a Trump administration policy no longer in effect, which considered people who received certain public benefits ineligible for legal status. The Biden administration rescinded the policy.

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Pedraza said her organization has encountered other concerns, such as language barriers at vaccination clinics. LCF Georgia worked with local health departments to post Spanish signage.

For several weeks, the group helped organize vaccination events at the Mexican Consulate, a place many Latino residents know and trust. It also helped organize weekend events at the El Salvadorian and Guatemalan consulates and pop-up events in Doraville and Dunwoody.

At a recent event in Tifton, patients who got their shots spoke to a physician who was a native of Mexico. The doctor answered all their questions in Spanish, which helped build trust and led to some vaccine recipients calling family and friends to get their own shots.

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LCF Georgia has also worked to counter misinformation, in Spanish, Portuguese and Mayan languages, a family of indigenous languages spoken primarily in southern Mexico and Central American countries including Guatemala and Honduras.

On social media, LCF Georgia posts photos and testimonials of Hispanic residents getting shots and addressing issues like side effects. Now, the group is working on a mass media campaign and is purchasing billboards and ad space on MARTA buses.

The most effective message, Pedraza said, is explaining why vaccination is necessary.

“This is how we hug those we love,” she said. This is how we keep working to provide for our families.”

Data specialist John Perry contributed to this article.

Editor’s note: This story has been changed to fix an error in the name of a community organization.