“We’re definitely seeing a decline in the past week or so,” said Dr. Alastair Bell, chief medical officer at Boston Medical Center, where the number of first doses dipped to about 800 a day last week from about 1,500 the previous week at its South End hospital and five satellite sites in Boston neighborhoods.
Some vaccination sites in Central and Western Massachusetts have seen demand decline just as dramatically.
“It’s fallen off a cliff,” said Aaron Michelucci, senior director of pharmacy services at Baystate Health in Springfield, who oversees Holyoke and Greenfield sites where the number of shots totaled 600 on Wednesday, down from 1,096 a week earlier. “Appointments had been filling within minutes, but we just opened up a week’s worth and they’re not going fast.”
The new landscape is forcing vaccine providers to change their approach: They can’t just open the doors and count on a line of people anymore. That would lead to continuing vaccination drop-offs, undermining efforts to subdue the viral menace.
Instead, vaccine providers are pivoting to a new phase where outreach will become their top priority, with more mobile sites popping up in hard-to-reach communities. Some operators with plenty of doses have opened walk-in clinics where no appointments are required for vaccine seekers.
“Now it’s a ground game,” said Michelucci, whose sites welcomed walk-ins for the first time last week. “You’ve gotten the easy people. Now you have to get after the people without technology, the people who don’t have transportation.”
Nationally, the number of doses administered daily has fallen more than 20 percent, from 3.3 million to 2.6 million, over the past two weeks. Many places, especially in the South but also in rural states such as New Hampshire, have already reached the tipping point where supply outstrips demand.
But in Massachusetts, where surveys show less vaccine hesitancy than most other states, some sites report demand, which has been strong, is just starting to soften.
Daily doses administered at three mass vaccination sites operated by CIC Health — at Hynes Convention Center and Reggie Lewis Center in Boston, and Gillette Stadium in Foxborough — peaked at 18,000 on April 23, including shots given by vaccinators at “pop-up” locations. Last week, daily totals dipped below 16,000, and appointments booked through the state’s preregistration system are starting to slow.
“It used to be filled within seconds,” said CIC Health president Rachel Wilson. “There’s no doubt there’s a slowing down.”
In a telephone interview last week, Governor Charlie Baker said state officials are closely monitoring vaccination trends. But he said it may take several weeks to gauge whether residents who became eligible for shots on April 19, especially young people, are getting vaccinated at the same rates as older residents who lobbied for earlier access and registered for inoculations en masse as soon as they became eligible.
More than 2.5 million Massachusetts residents have been fully vaccinated, including three quarters of residents over 65. At the other end of the age spectrum, just 28 percent of 16- and 17-year-olds have gotten at least one shot; most have only been eligible for less than two weeks. The governor’s goal is to fully vaccinate about 4.1 million residents, more than 70 percent of the state’s adult population, by July 4.
Baker said Massachusetts remains on track to meet its target, but that will require a stepped-up push — not only by state officials, but by clergy, community leaders, and “hospital providers and the folks in white coats” — to persuade all eligible residents to get shots. In recent weeks, the state has launched a door-knocking campaign in neighborhoods and communities hardest hit by the coronavirus.
“We have to continue to encourage [vaccinations] through every channel that’s available to us,” Baker said.
Jen Kates, senior vice president at the Kaiser Family Foundation, said surveys suggest many states have reached their “outer edge” of vaccine enthusiasm while others, such as Massachusetts, are approaching it.
“Massachusetts may have the ability to vaccinate more people, but they will have to reach out to people now to make sure they come,” Kates said.
A Suffolk University/Boston Globe poll, released April 1, found that more than 78 percent of state residents surveyed had either been vaccinated or intended to get shots as soon as possible. Only 7.4 percent said they wouldn’t take the vaccine.
Some sites insist there has been no let-up in demand. At mass vaccination centers in Danvers, Dartmouth, and Springfield, “we’re seeing a very steady number of appointments, even now,” said Dean Shultis, senior vice president at Curative, the California company that operates the sites. The number of shots given in Dartmouth, its smallest site in the state, recently topped 1,000 a day and has stayed at that level, he said.
“There are places where we’ve been seeing a drop-off,” said Shultis, whose company operates other vaccination sites around the country, “but not in Massachusetts.”
Mass General Brigham, which delivers vaccines at 11 of its hospitals, clinics, and leased sites, has been sending out invitations to patients via texts, e-mails, phone calls, and letters. It expects to begin walk-in service in the coming weeks.
“It’s taking a little more effort to reach people for our scheduling,” said Dr. Tom Sequist, chief patient experience and equity officer at Mass General Brigham.
At most sites in Massachusetts, operators say obtaining vaccine is not the problem it was a few weeks ago.
“Right now we’re not hurting for supply,” said Rich Napolitano, senior vice president for the Greater Lawrence Family Health Center. “When we began this week, not all our schedules were filled, and that was unusual.”
Health center officials have begun bringing vaccine to Merrimack Valley manufacturing plants operated by New Balance and the Gem Group. “Some of their folks might not otherwise have sought out the vaccine,” Napolitano said.
State officials have been focusing education and outreach on vaccine-wary Black, Hispanic, and immigrant communities. But surveys show other pockets of vaccine resistance in rural areas, among political conservatives, and from newly eligible “young invincibles” who either don’t trust the vaccine or don’t think they’ll get seriously ill if they’re infected with COVID-19.
At vaccination sites in Central Massachusetts, “we’re not seeing too many [vaccine seekers] over 18 and up to 25,” said Olga Brown, vaccine program manager for the UMass Memorial Health system. “The majority of people are 30 and up.”
Brown said the Worcester-based UMass system has registered a slight decline in shots administered at its standing and mobile sites. But a third of its first-dose shots are now available one day after an appointment is made. And the no-show rate has recently doubled from 3 to 6 percent.
Michelucci at Baystate Health said some younger people were vaccinated before April 19 because they were essential workers or had health conditions that qualified them for early shots. But, “you’ve got Gen Z’s and millennials, and their acceptance rate is far lower” overall, he said. “We’re heading into warmer weather, and many people are being flip about it. They feel they’re going to be outside more so they don’t need this.”
Of special concern to the Wellforce health system, based in Burlington, are young people in the urban areas it serves.
“In Hispanic and Black communities, younger people have been a little more hesitant to accept the vaccine,” said Dr. Gabriela Andujar Vazquez, infectious disease specialist at Tufts Medical Center in Boston, the system’s anchor hospital.
At the Lawrence Family Health Center, which is trying to vaccinate a similar population, a new strategy is emerging.
“It may be us going to them,” said Napolitano.
Robert Weisman can be reached at robert.weisman@globe.com. Follow him on Twitter @GlobeRobW.