TOMPKINS COUNTY, N.Y.—The tone shift from the Tompkins County Health Department regarding the COVID-19 vaccine over the last six weeks or so has been stark. It has moved, gradually then more quickly, from an enthusiastic but measured push, hamstrung somewhat by supply provided by New York State, to a more frenetic effort featuring walk-in appointments and mass clinics throughout the county to reach more rural populations.

That shift is indicative of the county nearing a point that public health officials have warned about, though when exactly it would come has only recently become clearer: the vaccine plateau, or in other words, the point at which everyone who wants to get the vaccine has received it, and how far from the stated herd immunity figure of 75 percent that will be (though that appears to be an ominously moving goalpost).

Now, it seems Tompkins County has reached that stage. With 61.2 percent of county residents having received at least their first vaccine dose as of May 7, and 49.2 percent being fully vaccinated, the rate of people receiving a vaccination has greatly slowed since early April.

To further illustrate that: from April 1 to April 7, 5,839 Tompkins County residents received at least their first vaccine dose (April 1 is the first available data point of that kind). After one other high week, that weekly number has declined each subsequent week, until from April 30 to May 6, just 1,185 residents received at least their first dose.

Part of that is a naturally dwindling number of people who need the vaccine (since they’ve already received it), but a group remains that simply doesn’t want it and won’t take it. Even with the recent slowdown, Tompkins County still leads municipal counties in the state in vaccine rates.

According to Public Health Director Frank Kruppa, the county has officially moved to the point where local supply is outpacing demand. Looking on the bright side, though, Kruppa said he had been impressed by the initial uptake of Tompkins County residents, who had surpassed his expectations that a plateau would likely occur closer to 45 or 50 percent vaccinated.

“Since the beginning of the year, I had been thinking that mid-April we were going to make the shift to having more vaccines than people to vaccinate, and that’s about when it happened,” Kruppa said. “What’s been a positive surprise is the number of people we’ve been able to reach in that timeframe. (…) We’ve still got a ways to go, we’re still working to get the vaccine into more people, but so far we can be happy about our success.”

While supply was the issue early on, access has moved to the forefront of the vaccination efforts by the health department and Cayuga Health System. That’s taken shape in the form of rural pop-up clinics, informed by state data that breaks down vaccine rates by zip code, allowing county officials to see which municipalities are in need of either more access or more awareness.

“Ultimately, we’re going to have to do some work to convince those folks that are on the fence that we really need them to get vaccinated,” Kruppa said. “One of the best ways we can do that is on a one-to-one basis with our family and friends and those in our circles to talk about our experiences having gotten vaccinated and why it was important to us to do it.”

One idea that was under consideration was incentivizing receiving the vaccine. That wouldn’t be an entirely novel concept, as states like West Virginia have instituted programs to distribute bonds to those who receive vaccinations. Months ago, Tompkins County had assessed providing some sort of financial compensation to the homeless population, primarily to encourage that particularly transient group to return for a second dose after 3 or 4 weeks—but the emergence of the single-shot Johnson & Johnson vaccine rendered that moot.

Still, Kruppa said it was one approach that county officials have kept on their mind, even if it might be logistically difficult, or look different than a traditional incentivization program.

“Incentivizing is something that we definitely have to consider, and we certainly are, and it’ll depend on the populations and the vaccination numbers,” Kruppa said, touting the lifestyle changes that could entice people to receive the vaccine, particularly as proof of COVID-19 vaccination becomes a larger factor in society. “We’re talking about that in a very targeted way. We need to incentivize vaccinations, but it’s not always something tangible like money or something to that effect. There’s reasons to be vaccinated beyond protecting yourself and those around you from potentially getting sick, particularly as we reopen.”

There is, of course, a substantial amount of the population that isn’t currently able to receive the vaccination. Only Pfizer’s vaccine has been approved for people 16 and over (as opposed to 18 and over for the other available vaccines), meaning that the supply is lessened for that group, and that no vaccines are available for people under 16 years old. That could partially change as soon as next week, but until it does, 10-12 percent of the county’s population will remain unvaccinated through no choice of their own.

Independent of further eligibility expansion, Kruppa said this is clearly a different era of vaccine distribution in which it would be nonsensical to employ the same strategies that worked to vaccinate the first 50,000 or so residents of the county.

“The days of doing 1,100-1,200 doses up at the mall are behind us,” Kruppa acknowledged. “Now we’ve got to get out to the community to get to people and make it as accessible as possible so we can get that next phase of individuals.”

Matt Butler

Matt Butler is the Education & Public Health Reporter at the Ithaca Voice. He can be reached by email at mbutler@ithacavoice.com