Dr. Chris Bush, a veteran family physician in the Detroit suburb of Riverview, put out a call on social media recently. Under the modest Spanish tile roofed office building, a basic white kitchen refrigerator holds 90 doses of the Moderna COVID-19 vaccine.
Once in hot demand — in March, eager people were driving hours to vaccine appoints and sometimes out of state — Bush struggles to find willing arms to place the shots.
"We're open to anyone in the public," said Bush, a soft-spoken doctor who has practiced family medicine for more than 30 years. "We're so blessed to have the vaccine and I'd hate to see it go to waste, but demand seems to have trickled off."
Family doctors are viewed as the last line offensive in pushing vaccine totals higher in Michigan, which is largely plateauing around 60% of the adult population 16 years and older with at least one dose as of June 10. Roughly 76,600 people received a dose in Michigan between June 1-9, according to Michigan's vaccine tracker website, down from nearly 180,000 receiving a dose over the prior nine days.
Vaccine hesitancy remains a major hurdle to reaching the desired 70% vaccinated goal set by the Centers for Disease Control and Prevention. About 20% of the U.S. public remains vaccine hesitant, saying they will not get a COVID-19 vaccine or will only do so if required, according to a January survey by the Kaiser Family Foundation.
Another 31% wanted to wait and see how it's working before getting a dose. While it's logical that some of those waiting have moved to get a vaccine, convincing the last remaining naysayers and fence sitters to get inoculated will not be easy.
"The low-hanging fruit is gone and we're entering this critical phase where primary care doctors, who people trust, are tasked with getting the next 10% to 15% of people vaccinated," said Srikar Reddy, a family physician for Ascension Medical Group at a practice in Lyon Township and president-elect of the Michigan Academy of Family Physicians. "We are here to convince them and get them to buy in to battle the virus."
Tactics in tact
The convincing part is the uphill battle physicians face against COVID-19. With more than 172 million people who have received at least one dose in the U.S. and nearly 5 million in Michigan, the remaining skeptics will likely require all the bedside manner the doctors can muster.
Robert Jackson, physician and medical director of the 12-physician family practice Western Wayne Physicians PLC, said talking a patient into getting vaccinated doesn't always work, but it relies on trust doctors have built up over years of treating individual patients.
"I've known some of my patients for 35 years. That's a relationship," Jackson said. "I care about them and don't want anything to happen to them. It's genuine and they know that."
Western Wayne hasn't received doses yet, but is expected to receive them in the coming weeks. Jackson is still asking patients to get vaccinated, either through a future visit at his office or at a clinic or pharmacy.
Jackson uses an example of one of his practice's former patients: a woman in her 20s with very few co-morbitities who died of COVID-19, leaving behind a 6-year-old child.
"It breaks your heart," Jackson said. "I share that story with my patients. I don't think they should be shielded from the anxiety us in the health care setting have had to face with patients who die. Patients I see who used to be healthy are now coming in after a hospital stay with COVID dragging oxygen tanks. I try to put this on them and in terms of their friends and family to do the right thing."
Reddy, who is offering the Pfizer and Johnson & Johnson vaccines at his practice, said much of the reluctance comes from patients who have already contracted COVID-19 and believe they are currently immune. He uses the vaccines' efficacy against new, potentially more contagious variants as a tool to sway reluctant patients.
"There are variants that are emerging and are impacting people whether they've already had the virus or not," Reddy said. "If it's been over 90 days (since they've had the virus), I urge them to get the shot. I've had patients get reinfected. We're trying to stop these variants from replicating. I tell them Pfizer is above 80% after two doses against the Delta variant (first discovered in India). It's hitting the younger patients, so they need to be aware, otherwise we are all at risk. We're trying to not have to go back in time and go through these painstaking restrictions we've had for our families."
Jackson's office also leans on the element of expediency.
"My medical assistant, she has a line she used with flu vaccines by asking the patient, 'Do you want to get your flu shot now while you're waiting for the doctor? I'm just going to come back later when he talks you into it,'" Jackson said. "He is almost 100% on that. They acquiesce right then and there. I suspect we'll have some success with the COVID vaccine using this tactic."
Bush said the most reluctant patients tend to be adversarial against his advice, so he treads lightly as the issue has become political.
"I tend to bring it up with a little trepidation, I've had a patient tell me (COVID-19) is a hoax," Bush said. "I'm nearly 70. We, those that are older and have had the vaccine, find it life changing and it's like revitalizing your chance to live again. That's what I tell them. And I hope they change their mind and when they are ready, we have the vaccine."
Jackson said he's experienced much of the same on the political divide. But he reminds patients of the bipartisanship of the vaccine.
"I try to remind them President (Donald) Trump pushed to have these vaccines developed," Jackson said. "Biden and Trump both have taken the vaccine. They both agree on this part. There's no divide there."
More options, more waste
But dividing the doses is a resounding issue for physicians struggling to convince patients.
Bush recently wasted eight of a 10-dose Moderna vial. Once removed from the ultra-cold freezers — Moderna's vaccine can be stored at -58 degrees Fahrenheit to 5 degrees Fahrenheit for up to six months — the refrigerated doses have a 30-day shelf life. Once punctured for a dose, the vaccines can only be used for 12 hours before expiring. Bush was only able to inoculate two patients from the one vial.
"If someone wants a vaccine, I am not turning them down," said Bush, whose practice has 1,000 patients. "But once they are opened, there's no going back. I know I have patients out there that are thinking about it, but unless they get into the office or respond to our webpage or our portal announcements, there's nothing I can do."
Paul Thomas, a direct primary care physician and operator of Plum Health in Detroit's Corktown, used three of the six doses in a Pfizer vaccine vial, which lasts six hours after the vial is punctured, on June 9.
"Obviously, we always hope to be able to use all the doses, but it's not always going to happen," he said.
As many as one in 850 doses were being trashed from going unused, spoiled, expired or wasted through March 29, according to data from the CDC. Of the nearly 183,000 doses wasted at that time, nearly 70% were from CVS and Walgreen's.
The wasted doses are likely to rise as distribution pushes into doctors' offices, Jackson said.
Jackson believes his practice, which has 8,000 active patients, could likely inoculate up to 100 people a day, a testament to his physicians' ability to convince naysayers, especially in the 12- to 15-year old range. But only for a few days.
"I suspect we won't be able to keep that pace for very long," Jackson said. "They're going to have to forgive us if we have unused vials. It's where we're at in the pandemic. Until they create single dose vials, we (physicians) will be wasting doses. It's a shame."
For Reddy, any wasted doses are merely a small price for progressing toward eradicating COVID-19.
"It's worth it," Reddy said. "The vials getting wasted, in the big picture, are minuscule compared to those that are being used. The benefits outweigh the risk even if that's only using 30 percent or 50 percent of those doses. That's a win. That's fewer people able to spread this deadly virus. That's more people alive."
This story first appeared in our sister publication, Crain's Detroit Business.