In 13 States, Declining Demand for COVID Vaccines Threatens Herd Immunity

In 13 states, less than half of adults have received at least one dose of a COVID-19 vaccine, according to a recent Kaiser Family Foundation (KFF) analysis. And in many states, demand for vaccines is plummeting—leading to nationwide vaccine site closures.

Although children 12 through 15 are just starting to be vaccinated across the nation, the sharp drop off in adult vaccination rates in some states worries public health experts. 

“There are hesitant pockets,” Kathleen Jordan, MD, infectious disease specialist and senior vice president of medical affairs at Tia Clinic, tells Verywell. “What is it that can get this population on board? Being unvaccinated is a risk to them personally because herd immunity doesn’t exist right now. But also it poses a risk to their communities.”

Dwindling Vaccine Demand

In the U.S., more than 60% of the adult population has received at least one dose of a COVID-19 vaccine, according to Centers for Disease Control and Prevention (CDC) data. But vaccination rates aren't consistent across the nation. 

Less than half of the adult population in a quarter of states has received a COVID-19 jab. And those states' numbers have implications for the rest of the country and beyond. 

“I would very clearly say we’re not at herd immunity levels,” Jordan says. “We still have 30,000 cases a day, and they’ve plateaued in the U.S. They’re not continuing to decrease after we saw a steep drop as vaccinations increased.”

States with lower percentages aren’t simply behind on vaccinating people, however. The demand, and therefore the rate at which people are being vaccinated in these states, has simply dropped off. The KFF analysis shows the nation’s average daily first-dose vaccination rate is approximately 440 per 100,000 people. But for the 13 states where less than 50% of the adult population has received at least one dose, the average daily vaccination rates are far below the national average.

Those numbers aren’t promising for herd immunity goals. “I think because of the prevalence of the disease right now, and that it’s being passed at these rates, we would need extremely high percentages of people vaccinated to count on herd immunity," Jordan says.

Higher rates of vaccination reduce the chances for virus transmission, saving lives in the process. Waning demand ups the chances of prolonging the pandemic.

“The more cases you get, you’re giving the virus more rolls of the dice to generate a new variant,” Michael Haydock, senior director at Informa Pharma Intelligence, tells Verywell. “So you obviously try and keep vaccination coverage rates as high as feasible. The worst-case scenario is obviously a variant that can completely escape immunity, which hasn’t happened yet. But that would be the worst thing that could put you right back to square one.”

States of Concern

The states on the lowest end of the vaccine spectrum in the U.S. are Alabama and Mississippi. Only about 41% of the adult population in each of these states has received at least one dose of a COVID-19 vaccine. Mississippi has the lowest average daily rate of first-dose administration, at about 136 per 100,000 people. Alabama has an average first-dose vaccination rate of 229 per 100,000 people.

Nine of the 13 states with waning vaccine demand are located in the South. In addition to Mississippi and Alabama, Southern states with less than 50% of adults vaccinated and declining vaccination rates include:

• Tennessee
• Georgia
• Arkansas
• South Carolina
• North Carolina
• Louisiana

Two western states, Wyoming and Idaho, also have lower vaccination rates. Indiana and Missouri, in the Midwest, are following a similar trend.

States with Continued Demand

On the higher end of the spectrum, Rhode Island has vaccinated 64% of its adult population with at least one dose. It has the highest average daily rate of first-dose administration, at 889 per 100,000 people—more than double the national daily average. Massachusetts has vaccinated 68% of adults living there, and its rate is still going strong with a daily average of about 841 first doses per 100,000 people.

Vaccination rates have dropped off in New Hampshire, however, which now has an average of 189 first doses per 100,000 people per day. But the state has vaccinated nearly 74% of its adult population.

Despite its stalled rate, New Hampshire’s overall vaccination number is what experts like to see. “It seems like most of the estimates now have gone up to around 80% coverage is what is likely for herd immunity,” Haydock says.

He cautions that herd immunity estimates for a new virus can be hard to pinpoint, especially when there are still a lot of moving parts in the middle of a pandemic. “The more transmissible the virus is, the higher coverage you need to achieve,” he explains. “And that can differ hugely based on the location of the viral variant itself. Now that we’ve got new variants that are potentially more transmissible, I think that’s what’s largely boosted those estimates.”

Closing Vaccination Sites

With several states having reached their demand turning point, many mass vaccination sites have halted operations or are making plans to shutter their doors. 

One of the largest vaccine sites in Alabama, a drive-up clinic at Hoover Metropolitan Stadium, operated by the University of Alabama Birmingham, closed May 18. The state of Louisiana recently turned down vaccine doses from the federal government as a result of decreasing demand. Tennessee is closing its mass vaccination site at Nashville’s Music City Center, a downtown conference hub, at the end of May. And Georgia has shifted from mass vaccination sites to smaller outreach programs. Plenty more states and counties are following suit.

Jordan says even with these changes across the nation, individuals shouldn’t be discouraged from receiving their COVID-19 vaccine if they haven’t yet done so. “While the larger sites have closed, we've also seen access come through pharmacies, grocery stores, and now private clinics," she says. "So I would say the location is not what’s important; it’s that the vaccinations are happening.”

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