No one said vaccinating the majority of Bexar County adults against COVID-19 would be easy, but the challenge is more serious than first thought when the City released its COVID-19 Vaccine Implementation Plan in November.

“We are going to have to figure out ways to make it simpler for communities to gain access to the vaccine,” Mayor Ron Nirenberg said in a Wednesday interview. “Our messaging has definitely shifted to address vaccine hesitancy.”

Officials cite a number of developments, but the bottom line is not enough adults are lining up locally to reach herd immunity. So-called “vaccine hesitancy” is slowing local efforts to safeguard the general population from a future spike in the virus or a variant from potentially spreading among the unvaccinated.

“I see less vaccine hesitancy and more vaccine apathy,” said Colleen Bridger, assistant city manager and San Antonio’s lead official on the pandemic response. “When we had vaccine scarcity, everyone wanted it. Now that we have enough for everyone there is more apathy, which is why I think the community vaccine popups are important. It makes it easy for people to get vaccinated. It’s a challenge because the four mass vaccination sites can do four to five times the number of vaccinations as we do at community popups.”

City officials are expected to announce a new public outreach program on Friday.

For now, months of people scrambling to get a coveted appointment at one of the four mass vaccination sites in San Antonio has largely ended. Bridger said 25% of the people with first vaccine appointments are not showing up, while 10% of people with appointments for second shots are no-shows.

Meanwhile, getting vaccinated is getting easier. Pharmacies, H-E-B, Walmart, family medical practices, the County’s downtown and Eastside satellite sites, and the City’s vaccine popups launched in April are offering greater access to adults regardless of where they live and work.

Who needs a waiting list when there is no longer a wait?

The sudden shift is not just the result of more vaccine dosages becoming available to city and county health officials and medical professionals, who have been clamoring for more supply for months. The actual number of adult residents deciding to get vaccinated is falling off. That supply-demand curve, public health officials say, is not good.

The disturbing decline in demand among San Antonio residents age 16 and older is evident nationally, as reported Wednesday in the New York Times. Vaccination rates nationally dropped 11% last week, the worst decline since the winter storm in February disrupted efforts, according to a Washington Post article published Thursday.

“We’ve had four years of national leadership saying, ‘Don’t trust the media, it’s fake news,’ so it’s no surprise that the rate of vaccination in red states lags behind the rate in blue states,” said George Hernandez, CEO of University Health, which oversees the mass vaccine site at Wonderland of the Americas mall and satellite sites at the Robert B. Green Campus downtown and St Philip’s College on the Eastside.

“The decline in demand for vaccines is worrisome,” he added. “We do need a public outreach campaign, but it needs to be tailored to the groups we are trying to reach and the concerns they have. Perhaps new strategies are needed.”

One challenge cited by Hernandez is hesitancy among pregnant women.

“The data clearly shows pregnant women should get vaccinated and that any potential risk would be far less than the consequences of contracting COVID-19,” he said.

“Having spent half my career in public health, I can tell you that vaccine hesitancy is nothing new,” said Dr. Bryan Alsip, UHS’ chief medical officer, who noted the suspension of the Johnson & Johnson vaccine heightened public hesitancy, as did the requirement for two separate injections for the Pfizer and Moderna vaccines rather than a single shot.

The Centers for Disease Control and Prevention maintains a state-by-state tracking site, which Wednesday reported that nationally 51.5% of adults have received a single shot and 33.8% have received two shots. That mirrors local numbers. In Bexar County, Bridger said, 33% have been fully vaccinated, and just over 50% have received a single shot.

Public health officials hope at least 70% of the adult population will get the two-shot Pfizer or Moderna vaccine, or the single-dose Johnson & Johnson vaccine, if the CDC lifts its “pause” on the latter vaccine on Friday as expected.

“Some people believe the pandemic has passed, which is not true,” Hernandez said.

Robert Rivard, co-founder of the San Antonio Report who retired in 2022, has been a working journalist for 46 years. He is the host of the bigcitysmalltown podcast.