While Hawaii residents once clamored over who got first dibs for the COVID-19 vaccine, the lines these days are not necessarily as long, and appointments are wide open.

Having surpassed the 1 million milestone in vaccine doses administered, Hawaii health officials are now faced with the challenge of how to inject the second million needed to reach herd immunity — the point where enough people are immune that the spread of the virus is unlikely.

“We are seeing a decline in enthusiasm for the COVID vaccine,” said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii. “A lot of the people who really were anxious to get it have gotten the shot. We are at a transition point right now. (This) week is the first week since vaccines became available that we have enough supply to meet the demand. This is not because the supply has increased materially over the past few weeks, because it has not, but because demand is declining.”

About 50% of Hawaii’s population has received at least one dose of the vaccine, and nearly 40% have been completely vaccinated.

Now the race is on to reach those who are still on the fence about getting vaccinated.

Among them are remaining kupuna who have been eligible for months now but have not gotten around to getting the vaccine, as well as younger teens and adults on the other end of the spectrum not concerned enough about getting ill to get the vaccine.

Then there are vulnerable communities, including those who do not have easy access to transportation or technology needed to make online vaccine appointments. Also, there are those who can not afford time off from juggling multiple jobs and family duties to get to a vaccination clinic.

Ethnic groups disproportionately affected by the pandemic that still have low vaccination rates include Native Hawaiians, Pacific Islanders and Filipinos.

The state’s strategy is now to bring the vaccination to these harder-to-reach pockets of the population, as was recently the case in a pop-up vaccination clinic held at the Towers at Kuhio Park, a public-housing project in Kalihi.

Bringing vaccines to communities

With music playing, hundreds of residents ranging from teens to kupuna, lined up Thursday for free COVID-19 vaccinations near the Towers at Kuhio Park.

The clinic was organized by a Kalihi coalition of agencies and partners, including the Hawaii Public Housing Authority and the nonprofit Parents and Children Together.

Kaiser Permanente administered about 500 first doses of the Pfizer vaccine on a walk-up basis, with no appointments necessary. Language interpreters were on hand, with the ability to translate in Chuukese, Marshallese, Korean, Samoan and Ilocano.

The convenience was what brought Elina Kanaka‘ole, a working mother of four, to the clinic. She had been wanting to get vaccinated but did not have time to get to centers in town, much less bring all four of her children with her, while juggling her work schedule.

“Basically, for these folks it’s a mix of everything,” said Kaiser registered nurse and community outreach leader Kim Gibu. “There’s a language barrier, no internet, no laptops to sign up online, or they just don’t know about it. They don’t understand it.”

The clinics provide information for anyone who is curious and a little bit of “swag” as motivation, according to Gibu, whose team has also conducted outreach at Papakolea, the Filipino Community Center and Kau on Hawaii island.

On Thursday those vaccinated were offered reusable water bottles, HOLO (bus) cards and food giveaways on the way out.

Another clinic will be held in May to give the residents and surrounding community their second doses.

Remaining barriers

In a statewide survey conducted in January, the Health Department found that 55% out of those polled were likely to take the COVID-19 vaccine as soon as eligible, while another 36% preferred to take a wait-and-see approach.

Raethel said these numbers have since improved, with more people interested in getting vaccinated after witnessing friends, family and neighbors do so without major side effects.

According to federal data, only an estimated 10% of Hawaii residents are hesitant about the vaccine.

Health officials are not focusing resources on the outspoken anti-vaxxers, a small percentage of the population opposed to all vaccinations, because they are not expected to change their minds.

But some of the battle will include countering rampant rumors brought by anti-vaxxers, including that the vaccination push is a plot to plant microchips in people or that the vaccine can alter one’s genetics.

There are some who have philosophical or religious reasons for not wanting the vaccine, as well as mistrust of the government, in general, and fears over long-term side effects.

To reach the younger set, the Health Department plans to work with schools to launch a social media campaign. To reach certain populations, the state is partnering with community groups that already have established relationships.

Retired state Sen. Suzanne Chun Oakland, now program coordinator of Lanakila Multi-Purpose Senior Center, said offering an on-site clinic worked well for kupuna who still had not gotten vaccinated.

Since February, Lanakila, in partnership with Kalihi- Palama Health Center, has offered several hundred vaccinations to its members and their families at the center every Tuesday.

“A number of the seniors just felt very comfortable at the center, and there was already the established, trusting relationship,” she said.

Also, some seniors who were hesitant felt more comfortable when accompanied by a younger family member who got the vaccine along with them.

Gibu, of Kaiser, said oftentimes, filling out forms also intimidates people wary of sharing their personal information or who might not have a permanent address or who might be undocumented. The COVID-19 vaccines are free for everyone in the U.S., regardless of immigration status, with or without health insurance.

There is also fear of the unknown.

The Pfizer, Moderna and Johnson & Johnson vaccines, as resisters like to point out, are being administered under emergency use authorization by the U.S. Food and Drug Administration and do not yet have full approval.

What Gibu said she often shares is that there is no long-term data on the vaccine, but it is 94% to 95% effective in preventing COVID-19 and 100% effective at preventing one from getting seriously ill.

“Really, what you’re doing is protecting your loved ones, your community,” she said. “You are contributing to make sure your community’s protected.”

Herd immunity

The state Health Department says there is no magical, agreed-upon number on the percentage of the population that needs to be vaccinated to reach herd immunity.

But at least 2 million more doses are needed if officials are aiming for 70% to 85% of Hawaii’s 1.4 million residents.

Raethel said the general consensus is that the state needs to get 80% to 85% of the population vaccinated, or 2.2 to 2.3 million doses total, to reach herd immunity due to variants present in the state.

Also, some 310,000 children in Hawaii ages 15 and younger do not yet qualify for a COVID-19 vaccine.

“As more contagious variants spread, we likely need more people vaccinated than first anticipated,” said DOH spokesman Brooks Baehr. “Our best strategy is to vaccinate as many people as possible as quickly as possible. Hawaii’s young adults will play an important role in whether we reach herd immunity and how quickly.”

Most of the vaccines administered in the state are the two-shot Pfizer or Moderna vaccines to be counted twice, while only 10% are the one-shot Johnson & Johnson vaccine.

Therefore, with 1.2 million doses reportedly administered in Hawaii on Friday, the state needs to administer at least another million doses to reach the 80% threshold of immunity.

When will it happen?

Lt. Gov. Josh Green often cites the Fourth of July as the target celebratory day when herd immunity will have been achieved in Hawaii, but the current pace needs to continue.

Unknown variables include knowing whether vaccinations for children ages 12 to 15 and younger will be available this summer, as well as the future influx of variants.

“It’s going to take a lot of work over the next couple of months to get that critical mass,” said Raethel. “If we don’t get to the critical mass, then we still have very high risk in the population. If we don’t have enough people vaccinated, it just gives variants more chance to spread.”

REACHING HERD IMMUNITY

Hawaii population: 1.4 million

Immunity thresholds

>> 70%, 1.9 million total shots needed*

>> 80%, 2.2 million total shots needed

>> 85%, 2.5 million total shots needed

Source: Healthcare Association of Hawaii

* Numbers rounded

COVID-19 VACCINATION APPOINTMENTS

More walk-in availability:

>> Pier 1 Vaccination Center, walk-ins available 8 a.m.-3 p.m. Monday to Saturday. Appointments also available 8 a.m. to 4 p.m. Visit HawaiiPacificHealth.org/COVID19Vaccine.

>> Kaiser Consolidated Theatre in Kapolei site will accept walk-ins after 11 a.m. Tuesday to Saturday. Appointments also available at kp.org/covidvaccine.

>> Find more options at hawaiicovid19.com/ vaccination-registration.