Millions Are Skipping Their Second Doses of Covid-19 Vaccines

The Four Percent


Millions of Americans are not getting the second doses of their Covid-19 vaccines, and their ranks are growing.

More than five million people, or nearly 8 percent of those who got a first shot of the Pfizer or Moderna vaccines, have missed their second doses, according to the most recent data from the Centers for Disease Control and Prevention. That is more than double the rate among people who got inoculated in the first several weeks of the nationwide vaccine campaign.

Even as the country wrestles with the problem of millions of people who are wary about getting vaccinated at all, local health authorities are confronting an emerging challenge of ensuring that those who do get inoculated are doing so fully.

The reasons vary for why people are missing their second shots. In interviews, some said they feared the side effects, which can include flulike symptoms. Others said they felt that they were sufficiently protected with a single shot.

From the outset, public health experts worried that it would be difficult to get everyone to return for a second shot three or four weeks after the first dose. It is no surprise that, as vaccines are rolled out more broadly, the numbers of those skipping their second dose have gone up.

But the trend is nonetheless troubling some state officials, who are rushing to keep the numbers of only partly vaccinated people from swelling.

In Arkansas and Illinois, health officials have directed teams to call, text or send letters to people to remind them to get their second shots. In Pennsylvania, officials are trying to ensure that college students can get their second shots after they leave campus for the summer. South Carolina has allocated several thousand doses specifically for people who are overdue for their second shot.

Susan Ruel, 67, was scheduled to get her two vaccine doses at different Walgreens stores in Manhattan. She said she got her first Pfizer dose without incident in February, but when she arrived for her second appointment, she was told that the store only had Moderna doses in stock.

A Walgreens pharmacist told Ms. Ruel that there was another Walgreens pharmacy less than two miles away with Pfizer doses in stock. While Ms. Ruel was waiting for the subway to take her there, she got a phone call: That Walgreens store had run out of Pfizer doses, too.

Ms. Ruel managed to get the Pfizer dose at yet another Walgreens the next day. But she said many people in her situation probably wouldn’t have tried so hard. “All you need is hassles like this,” she said.

In the Chicago area, for example, pharmacists at two Walgreens locations said the problem was causing headaches. They said that Walgreens’ appointment system was sending each pharmacy anywhere from 10 to 20 customers a week who need a second Pfizer shot, even though both pharmacies stock only the Moderna vaccine.

It is not clear how widespread the Walgreens dose-matching problem has been or how many people have missed their second doses because of it.

Jim Cohn, a spokesman for Walgreens, said that the problem affected “a small percentage” of people who had booked their appointments online and that the company contacted them to reschedule “in alignment with our vaccine availability.” He said that nearly 95 percent of people who got their first shot at Walgreens have also received their second shots from the company.

Walgreens has also come under fire for, until recently, scheduling second doses of the Pfizer vaccine four weeks after the first shot, rather than the three-week gap recommended by the C.D.C. Pharmacists have been besieged by customers complaining, including about their inability to book vaccine appointments online.

In other cases, though, access to vaccines is not the sole barrier; people’s attitudes contribute, too.

Basith Syed, a 24-year-old consultant in Chicago, nabbed a leftover Moderna vaccine at a Walgreens in mid-February. But when the time came for his second shot, he was busy at work and preparing for his wedding. After the first shot, he had spent two days feeling drained. He didn’t want to risk a repeat, and he felt confident that a single dose would protect him.

“I didn’t really feel the urgency to get that second dose,” Mr. Syed said.

By early April, his schedule had calmed down a little, and he went looking for a second Moderna shot. But by then, the Walgreens where he had gotten his first shot was only offering Pfizer shots. He couldn’t find slots at other Walgreens stores. Mr. Syed is no longer actively looking for a second shot, though he still hopes to eventually get one.

Some vaccine providers have put on special clinics for people who need a second dose. In South Carolina, the health system Tidelands Health started a program specifically for people who received their first Pfizer doses more than 23 days earlier but hadn’t been able to find a second shot. The state health department sent the health system 2,340 doses for the effort.

Demand has been strong, and Tidelands only has a few hundred doses left. The majority of takers have been people who “were having difficulty navigating all the various scheduling systems and providers,” said Gayle Resetar, the health system’s chief operating officer.

In many cases, vaccine providers had canceled second-dose appointments because of bad winter weather. “It was up to the individual to reschedule themselves on a web portal or web platform, and that just became difficult for people,” Ms. Resetar said.

There are rare cases in which people are supposed to forgo the second shot, such as if they had an allergic reaction after their first shot.

Zvi Ish-Shalom, a religious studies professor from Boulder, Colo., had planned to get fully vaccinated. Then, an hour after his first shot of the Moderna vaccine, he developed a headache that hasn’t gone away more than a month later.

There is no way to know for sure whether the vaccine triggered the headache. But after weighing what he saw as the risks and benefits of a second dose, Dr. Ish-Shalom reached a decision about how to proceed.

“At this point in time, I feel very clear and very comfortable, given all the various elements of this equation, to forgo the second shot,” he said.


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