For eight months, Gov. Phil Murphy’s administration has focused on what seemed at times like an insurmountable achievement: vaccinating 4.7 million residents — or 70% of eligible adults — against the coronavirus.
As that goal nears, with more than 4 million residents fully vaccinated, some experts said the state should keep its foot on the gas, pushing forward until as many people as possible are immunized against COVID-19.
“There is no magic number,” said Dr. Martin Blaser, a professor at Rutgers’ Robert Wood Johnson Medical School (RWJMS), in New Brunswick, and director of the university’s Center for Advanced Biotechnology and Medicine.
Blaser said the 4.7 million-person threshold, a level state officials determined would be sufficient to prevent significant viral spread, is based on a complex assessment of estimates and assumptions. Instead, he urged people to think about a sliding scale of risk, with higher vaccination rates leaving less room for the disease to spread.
“The bottom line is, if we throw away the term ‘herd’ immunity and we just use the term ‘community’ immunity,” Blaser continued, “that the more vaccines that are going into people’s arms, the stronger the community immunity is.”
But that immunity is not evenly distributed, Blaser and others caution. While COVID-19 cases, hospitalizations and deaths have declined steeply in recent months — a result of precautions, like masking and vaccinations, Blaser said — the disease is still circulating, with more aggressive variant forms. As restrictions lift, vaccinated individuals can reenter a more normal summer season, while those who aren’t immunized do so facing a higher risk of infection.
“Virtually everybody who is getting ill from COVID now — and everybody who is dying — are people who are unvaccinated,” Blaser said. “And that percentage will continue to grow.”
Analyzing unvaccinated infections
An analysis of COVID-19 infection data by the Washington Post excluded people who were vaccinated to better illustrate the risk among those who are not. By May 19, the infection rate among unvaccinated Americans was 69% higher than what was recorded for the public at large, and their death and hospitalization rates were also elevated.
In New Jersey, that analysis showed unvaccinated residents were being infected at a rate at least double that of their immunized neighbors. Unvaccinated people were also being hospitalized and dying at rates last seen statewide in late and mid-April, respectively.
State data shows that in mid-April, New Jersey was still reporting dozens of daily deaths and had just reached a grim milestone with 25,000 total COVID-19 fatalities. By the third week, hospitals here were on the downside of the latest surge but still treated nearly 2,000 COVID-19 patients daily. By comparison, on Friday, the state reported 572 hospitalizations and 12 fatalities tied to the coronavirus.
“If people want to protect themselves, protect their families, then the percentage play is to get vaccinated,” Blaser said, especially given the rise of variants. “It always has been the case, but it’s becoming clearer and clearer.”
While vaccinated people can also get sick, these “breakthrough cases” are extremely rare, data from the federal Centers for Disease Control and Prevention shows. Out of the more than 123 million Americans who were fully immunized by mid-May, fewer than 11,000 reported being infected by COVID-19 after their shots. Of these, roughly 1,800 were hospitalized and 353 died, the data shows.
Dr. Eddy Bresnitz, an epidemiologist and vaccine expert who advised the state on its pandemic response until last week, said the immunized individuals who died were at high risk for bad outcomes because of their health status and advanced age, which averaged nearly 80 years. “I think that gives you a sense that not many people get sick,” he said. “Not many people get sick enough to be hospitalized and very few die.”
After a strong start, vaccinations have slowed
New Jersey has made significant progress in its vaccination campaign, launched in mid-December at University Hospital in Newark. Some 8.6 million doses have been administered, and nearly 4.9 million people have received at least one shot. The most common vaccines involve two doses, spaced several weeks apart.
But after a frantic first few months, when public demand far exceeded vaccine supply, the pace of immunizations has slowed significantly in the state since early April. State officials have launched new initiatives to reach those who have hesitated to get vaccinated — either out of concern or lack of convenience — with a particular focus on Black and Hispanic communities, which suffered disproportional impacts under the pandemic.
This work is continuing, even as new COVID-19 cases decline and the state lifts more and more pandemic-related restrictions. “It’s important to recognize that there isn’t really a finish line for our vaccine efforts and our efforts to mitigate this pandemic,” said Christopher Rinn, president and CEO of the Central Jersey VNA Community Health Center. The center has partnered with the state, county and local organizations to host various events in underserved communities and deliver shots to homebound residents.
Data on adult vaccinations provided by the state Department of Health shows 72% of Asians in New Jersey have received at least one shot, along with 61% of whites, 48% of Hispanics and 39% of Blacks. These figures do not account for the immunization rate among residents younger than 18 years, as vaccinations just began recently for those between ages 12 and 16.
Immunization rates by age show New Jersey’s seniors are well protected, but many younger people still face greater risk of infection. DOH data indicates 87% of those older than age 65 have had at least one shot, along with 73% of those between ages 50 and 64, and 59% of residents in the 30- to 49-year-old group. But — while the numbers are steadily ticking upward — less than half (48%) of those 18 to 29 have been vaccinated, about one-third (35%) of 16- and 17-year-olds, and just 16% of those between 12 and 15 years, according to the department.
“My gut sense is with young people that most of them believe, ‘If I get it, I’ll be fine anyway. I’m young, I’m healthy,’ and therefore they just don’t” get vaccinated, said Dr. Denise Rodgers, a vice chancellor and professor at Rutgers RWJMS and a public health leader in Newark.
Vaccine hesitation across racial lines
“The challenge we face is there is no one group of people that are vaccine hesitant,” Rodgers said. “It’s really complex.”
Public attention has focused recently on trepidation within Black and brown communities — groups that have historically been mistreated by the health care system and suffered disproportionately under the pandemic. But Rodgers stressed that there are also “plenty of white Republican men who don’t want to take this thing.”
“I’ve given up on herd immunity,” Rodgers continued. “I’m convinced there is a subset of people who are never going to get vaccinated.”
Rodgers said she’s intrigued by some of the incentives states have offered to encourage immunization — like lottery tickets and four fully funded years at state college — but not sure these are enough to convince skeptics. New Jersey is offering free beer, wine and a chance to dine with the governor and his wife.
Part of that skepticism is due to the uniquely American focus on individualism, Rodgers said, while other cultures are more likely to feel a responsibility for their fellow citizens. That lack of regard for the greater good has hampered the nation’s COVID-19 response from the start, she added.
“The focus should always be on population health and immunity when dealing with a public health crisis like a pandemic,” Rodgers said, while infringing on individual rights as little as possible. And while the COVID-19 case count may be waning, it’s not too late to apply this lesson, she said.
“This isn’t a one-time event. We’ve been talking about pandemics for decades,” Rodgers said. “If we are stupid enough to think this is the only one, we are really stupid.”