Despite a massive regional push to get 80% of Cincinnati area adults inoculated against COVID-19 by July 4, the region observed the holiday well short of that goal.
The region also lags behind the nation in the percentage of adults with at least one shot and in adults who are fully vaccinated, an Enquirer analysis of U.S. Centers of Disease Control and Prevention data shows. Roughly 3 of 5 adults in the region have had one COVID-19 vaccine shot. That's 967,000 of the 1.7 million adults in the 16 counties.
In addition, the region's path to reaching the herd protection that will block wide transmission of the novel coronavirus looks to be difficult, leaving the area with pockets of vulnerability. The reason: vaccine hesitancy, while continuing to drop in 2021 as people have become more familiar with the COVID-19 shots, remains above 20% in many areas.
In fact, vaccine hesitancy exceeds 20% in 10 of the Cincinnati region's 16 counties, a separate Enquirer analysis of residents' attitudes gathered by the Institute for Health Metrics and Evaluation at the University of Washington shows. In four of the region's most populous counties, hesitancy is 15% or higher. Hesitancy locally no longer is dropping as quickly as it did in the winter or spring, according to the second analysis. To see an animation of how vaccine attitudes have changed here over time, follow this link and click the all button on hesitancy.
COVID-19: Winning over the hesitant, one shot of tequila at a time
Organizers of the region’s Get Out the Vax campaign knew their goal wouldn't be easy to reach.
It was a hope, and concerted effort, driven by a coalition of public health, private health, business and community leaders. It was an attempt at equity in access despite economic status – providing free transportation to vaccine clinics, for example. It was also designed to be fun, with offers of discounted Cincinnati Reds tickets and other bonuses for getting vaccinated.
“We knew from the outset that it was an ambitious target,” said Kate Schroder, special adviser, vaccine coordinator for the Health Collaborative, a collaborative of Cincinnati-area hospitals. Getting 80% of adults vaccinated would bring the region closer to herd protection or immunity, although with inoculations of children when vaccines are available to those under age 12.
Here’s where we are now
In Northern Kentucky, Boone County had a high mark for the entire region: 62.7% of adults with vaccines started. Gallatin County had the lowest rate at 36.5%.
In Southwest Ohio, Hamilton County had 59.3% of adults fully vaccinated and 61.8% with one shot. Brown County had the lowest vaccine rate in the area with 38.3% of adults fully vaccinated.
Hamilton County Health Commissioner Gregg Kesterman says that although the county is not at 80%, he is happy with the progress made thus far. In late May, he said it would take additional months to reach the goal for July.
“You know, from a high-level perspective, I would love to see more folks vaccinated,” Kesterman said. “But I'm very excited to know that those over the age of 60 are nearly 75% vaccinated. We know that our senior population is most susceptible to COVID-19. And so, we've made the greatest strides in the population that needs it first, and we'll continue to work on the rest of the population to get them to the goal."
Warren County had the highest vaccination rate in Southwest Ohio with 61.7% of adults fully vaccinated.
“We provided outreach and education early, went to businesses, schools and other locations in the community and also offered walk-in and weekend appointments to provide easy access for individuals to receive the vaccine,” said Alicia Habermehl, assistant director of nursing and prevention. And, she noted, “Warren County also has a high percentage of healthcare workers living in our county.”
In Southeast Indiana, Ohio County had the best rate with 67.7% of adults fully vaccinated. It also had the lowest vaccination rate in the Cincinnati region, 28.8% in Franklin County.
Combating vaccine hesitancy
The counties had to push through levels of vaccine hesitancy as public and private health leaders tried to push the COVID-19 vaccine.
The University of Washington released a study examining vaccine hesitancy by county and ZIP code. In Southwest Ohio, Hamilton County had the lowest rate of vaccine hesitancy at just above 13%. Brown and Butler had the highest rates at 29.3% and 18.5% respectively. And in the Cincinnati region as a whole, Campbell County in Northern Kentucky had the lowest hesitancy rate, at 10.6%.
Butler County Health Commissioner Jenny Bailer said that recently her team has seen fewer people interested in getting the vaccine in their area. The health department has adopted a one-shot-at-time approach in hopes to immunize as many people as possible.
"There are a variety of reasons why some people are hesitant to get vaccinated, and we understand," Bailer said in an email to The Enquirer. "We are not forcing anyone, just making it readily available to those who want it. We have talked to many people and have been able to dispel the many, many myths that are out there, but it remains an individual's own choice at this time."
The region has moved away from mass vaccines and even some mid-size events, and toward primary care physicians, pediatricians and even emergency department and hospital inpatient healthcare providers, to primarily take up the effort on a more personal level with individuals who touch the health system.
Turning to family physicians makes sense, said Tara Jimison, director of nursing for Clermont County Public Health.
"Reducing vaccine hesitancy is all about meeting people where they are in their decision thought process as well,” said Jimison, whose department reached out to people early by going to businesses that residents frequented. “It is important for providers to build trust with their patients, be honest, discuss safety and answer any questions that a person may have. Primary care physicians are able to address patient-specific questions based on their current health status and health conditions.”
Kestmerman said the concerns he’s heard regarding vaccine hesitancy have not been based on science.
“I've heard people concerned that if the government's giving away money or lotteries to get me vaccinated, then it must be unsafe," he said. Those "types of things we just need to continue, as a public health agency, to help provide the facts, and to help share information so folks at least have access to accurate information and can make their own decision.”
Ayaz Hyder, assistant professor at the College of Public Health at Ohio State University, said the rates and reasons for vaccine hesitancy in Ohio vary.
“It looks different in different parts of Ohio. In rural Ohio, it may reflect the lack of access and the lack of investment. Historically, the lack of investment in providing transportation, or access to services in the way that it’s needed to be to help people when they needed it the most,” Hyder said.
In urban settings such as Cincinnati, he said, the hesitancy may be based on an individual’s encounters with public and private agencies and providers.
“In urban settings, it probably just stems from that while there might be a clinic that is just down the street, you may have had an individual who may have had a bad experience at a clinic, or at that pharmacy or at the hospital for, you know, any number of other health concerns,” he said. “And so when it comes to vaccinations, those same kinds of factors come into play. And you're often left with concerns about lack of trust, or mistrust.”
For example, the Hamilton County ZIP code with the second-highest level of vaccine hesitancy (at 22.6%) is 45232, which includes the Cincinnati neighborhoods of Spring Grove Village and Winton Hills, the University of Washington data shows.
Only ZIP code 45030 (which includes Harrison and Crosby and Harrison township in the western end of the county) is higher at 24.5%. The other Hamilton County ZIPs above 20% are 45225 (the Cincinnati neighborhoods of East Westwood, Villages at Roll Hill, North Fairmount and Camp Washington) and Norwood (ZIP 45212).
The pause in the Johnson & Johnson or Janssen vaccine also may have played a role in a lower vaccination rate, some officials said. The U.S. Food and Drug Administration and U.S. Centers for Disease Control and Prevention paused the distribution of the vaccines for 10 days in April because of a rare blood clotting problem.
Schroder was uncertain what the general response in the region was toward the J&J vaccine, and said she has no data on the response. However, she offered one anecdotal observation: She attended a Cincinnati Health Department event on June 27 at Lick Run Greenway park in South Fairmount that offered both J&J and Pfizer vaccines. There, 16 people asked for a Pfizer shot and 10 requested J&J, she said.
Kesterman said he hasn’t seen much of an impact.
“So, about two months ago when that when that pause on the Johnson & Johnson happened. There was actually, that was kind of the saturation of the vaccine uptake, all across the board.” he said. “We saw kind of from that moment on, the decrease in the number of folks each week getting the vaccine. I don't believe it to be attributed to the Johnson & Johnson and vaccine, but rather the folks that really wanted to get the vaccine had already been vaccinated. And so now we're starting to work with a more difficult group to help get access to them and to help make them understand the safety of the vaccine.”
Officials: The effort will not stop
Even now, there is no shortage of pop-up or standing health clinics, health officials say. And there is a new effort to make sure people know about them.
Nonprofit health equity organization Interact for Health, of Kenwood, has funded campaigns to promote COVID-19 vaccine availability that started in June, will continue through the next few months and may go through the end of the year.
“We are doing a targeted digital media campaign with two objectives: one is to reach people in areas where vaccination rates are lagging behind the region, and the other to let people know that they are near a vaccination site,” said spokeswoman Emily Gresham Wherle. The campaign promotes both standing vaccination sites, such as pharmacies and health departments, and pop-up events, she said. It’s a regional campaign and uses the Get Out the Vax branding. Interact’s investment was $100,000.
The organization is also funding projects to reduce disparities in vaccination in the region, Gresham Wherle said. “We have 18 projects in various stages of implementation with total commitment of just under $500,000.” The nonprofit has partners in Northern Kentucky, Southeast Indiana and Southwest Ohio.
In Hamilton County, Kesterman said, public health worked to get residents vaccinated by setting up mobile locations and have even gone door to door to provide vaccine information to people. He also said he’s worked with churches around Hamilton County and in low-income neighborhoods.
“I serve 45 communities as a county public health agency. Nobody knows the community better than the folks that live in that community,” he said.
In Northern Kentucky, special vaccination events have targeted pockets of the region with lower inoculation rates.
On June 5 at the Ninth Street Baptist Church in Covington, St. Elizabeth Healthcare and the Northern Kentucky Health Department partnered on one such event. The Rev. Richard Fowler, the church pastor, was instrumental in promoting the clinic. More than 300 people were vaccinated there, hospital officials said.
As vaccine clinics continue, OSU's Hyder emphasized the importance to concentrate the efforts.
"The other thing to realize is that it will never get 0% hesitancy. We will always have that because there are so many reasons why people are concerned," Hyder said. "I think what's more important is to break those hesitancy numbers down by age group, because that is what's going to tell us the real story. And where we need to target our efforts."
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