Fresno County Is Diverting COVID Vaccine Due to Low Demand. Why Don’t People Want It?

Celia Maldonado has made three appointments to get a COVID-19 vaccine since late March, and she’s canceled each one of them.

“I canceled an appointment just this week,” the 31-year-old second-grade dual Spanish/English language immersion teacher said. “I’ve been feeling super, super anxious about this whole vaccine thing because I feel like there’s no clear answer to my concerns. It’s sort of driving me crazy.”

Maldonado fears what unforeseen long-term side effects there could be to getting vaccinated, especially for pregnant women. Although guidance from the Centers for Disease Control and Prevention indicates there is no evidence that getting vaccinated causes problems with pregnancy – and notes that pregnant people are actually at increased risk for severe illness if they get COVID – Maldonado's feelings of uncertainty are stopping her from keeping an appointment.

“I just fear that unknown. I know [what] can happen to me if I get COVID. I don’t know exactly what can happen to me from getting this vaccine,” Maldonado said. “I’m not saying I don’t want to get it ever, I’m just saying I would prefer to wait until there’s more data.”

Maldonado’s concerns predate the CDC and the U.S. Food and Drug Administration’s temporary recommendation to pause administration of the Johnson & Johnson vaccine, she said. And as a Latina, female, registered Democrat, she doesn’t fall into the categories typically associated with vaccine hesitancy, she said.

“I was listening to NPR the other day, and there was a report of, the people who are not vaccinated are right-wing, evangelicals, and this and this and that, and of course they put Latino people in there. And I’m like, well, that is the group of people I’m in,” said Maldonado. “But I’m not by any means, a Trumpist. I am a liberal. I feel like I should be on the side of getting a vaccine, but I’m just not.”

Maldonado, who lives in Fresno, is one of thousands who have not been vaccinated in that county, either because of hesitancy, barriers to access or some other reason. And now in response to the low demand, Fresno County’s Department of Public Health is diverting a portion of their allocated vaccines elsewhere, after local health officials were concerned the coveted doses they had once fought tooth and nail for would suddenly go to waste.

“We’ve kind of flipped from having all of our emails reflect, ‘Hey, when am I going to get my vaccine?’ to now having these other conversations about how do we reach out to people who aren’t necessarily in a rush,” said Dr. Rais Vohra, Fresno County’s interim health officer, in a recent county health briefing.

“For the first few months, we really were just focusing on trying to cater to that population that really wanted the vaccine and were in a rush to get it,” Vohra said. “And just in the last couple of weeks, it’s really flipped. And now we have a lot more open appointments and we’re actually reserving less than our full allocations just because that’s really what the local demand is at.”

In an effort to get more people vaccinated, local health officials are switching their strategy to focusing COVID-19 vaccine education and outreach in neighborhoods where people haven’t gotten a shot. Officials are also using social media to target young people, moving billboards urging people to get vaccinated to ZIP codes where less people have received the vaccine and preparing a survey to better understand people’s concerns.

“There’s still a lot of the same comments we’re hearing, and that is: 'I can wait for it. It was developed way too fast. I’m not going to take it. It’s not safe,' ” said Joe Prado, community health division manager for the Fresno County Department of Public Health.

San Joaquin Valley, Rural Counties Among Least Vaccinated

California’s San Joaquin Valley is home to some of the least vaccinated counties in the state. Rural counties also have a higher percentage of their populations not yet vaccinated, according to data from the California Department of Public Health, although those figures also include kids ages 15 and younger, who are not yet eligible to be vaccinated.

It’s unclear whether the higher rates of unvaccinated people are due to hesitancy, barriers to access, both, or some other reason.

Data shows a greater proportion of white, and in some cases Latino residents in some San Joaquin Valley counties, have not been vaccinated compared with the state as a whole. The same goes for people ages 18-49 in some parts of the region.

But simply looking at demographic data might be an oversimplification of the problem, according to some public health experts.

Dr. Rishi Goyal, director of medical humanities at Columbia University and an assistant professor of emergency medicine and comparative literature, is leading a team that’s looking at the language used around vaccine hesitancy on social media and online forums to figure out what drives it.

“There’s Somali immigrants in Minnesota that are vaccine hesitant, right?” Goyal said. “There are rural GOP populations that are hesitant. There are left-leaning, natural healing aficionados that are vaccine hesitant. And I think the one size fits all, or the blaming one group for the phenomenon will end up kind of putting us in the problem that we’re in, because we don’t know how to tackle the problem because we don’t even understand it.”

Dr. Kirsten Bibbins-Domingo, professor and chair of epidemiology and biostatistics at UCSF, strongly prefers not to use the term "vaccine hesitancy."

“Because, in the end, I think most of the people who we put that label on are people who want to get their questions answered, right?” said Bibbins-Domingo. “And I think it is a little bit of a cop-out for us to label people as hesitant when all of the issues we are talking about are ones that we in public health should be thinking harder about overcoming.”

'People Are Just Scared'

Heather Olson, a 37-year-old clinical dietician in Fresno, said she isn’t planning to get the vaccine either, at least for now. She works in the ICU unit at a local hospital handling alternative nutrition for patients who are placed on ventilators, including those hospitalized with COVID-19.

While health care workers were encouraged to get a COVID-19 vaccine early on, Olson said she wanted to wait and rely on her own immune system because she has already been exposed to COVID multiple times and hasn't contracted it.

"I feel like my immune system has been doing a pretty good job on its own," she said. "I figure there's a lot of other people who need [the vaccine] a lot more at this time."

“Most of the patients in the ICU with COVID have other comorbidities, too. That’s something I keep in mind,” Olson added. “Thankfully, I don't have any of those comorbidities. But it is definitely something that I watch and see and think, you know, maybe I could be one of those people who just randomly gets a really bad case of it and it doesn’t matter how healthy I am,” she said. “I don’t want to have that attitude, where, like, ‘Oh it won’t happen to me.' But at the same time, I kind of have that attitude.”

“I question my own decision all the time. But I don’t think my decision is right for everyone, by any means,” Olson said.

“People are just scared,” said Dr. Lisa Rosenbaum, a cardiologist at Brigham and Women's Hospital and an assistant professor at Harvard Medical School.

“They are scared of what’s not known, and that fear of the unknown for some is greater than the fear of the virus,” Rosenbaum said, adding that what health care providers and the public health community miss when they focus only on messaging is people’s need for what she calls “active listening.”

“It’s just so intuitive to us, when you’re trying to convince people to do something, to craft a message,” Rosenbaum said. "I think that the real work has to be done on the ground, talking to people, making them feel heard, making them feel understood and I don’t think any messaging campaign can overcome that."