DOH updates legislature on vaccination efforts, COVID variants

With Hawaii’s vaccination rate hovering just under the 60 percent benchmark Gov. Ige aimed to reach this month, the State Department of Health (DOH) recently provided an update on vaccination efforts to the Senate Committee on Health and the House Committee on Pandemic and Disaster Preparedness. The briefing also addressed legislators’ concerns about COVID-19 variants, vaccine approval for children, and expanding outreach to counties with lower vaccination rates. 

 

Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.

 

As of Friday, DOH reported 64.7 percent of Hawaii residents are partially vaccinated and 58.1 percent are fully vaccinated. These rates are higher than the national average of 55.1 percent and 47.6 percent, respectively. 

DOH estimates the state needs to vaccinate 169,000 more people to reach 70 percent immunity. At that point, the state will most likely reach herd immunity, and Gov. Ige plans on removing all COVID-19 restrictions. Travel restrictions in the state have started to lift, with the most recent update allowing travelers vaccinated outside Hawaii to bypass testing and quarantining protocols upon arrival. 

Vaccination rates have recently slowed, however, with DOH estimating 20,000 vaccinations occurring per week in Hawaii. At that rate, says DOH Director Elizabeth Char, MD, the state will reach 70 percent immunity in 8.5 weeks, or early September.

“Of that population we still need to get vaccinated, almost half of them have already received their first shot. In the next three weeks, we would expect that those that got their first shot will get their second shot. That will give us a five percent boost. And so, really it’s going to be another five percent that we really need to get two doses into.”

At the briefing, DOH presented an updated COVID-19 dashboard that showed variation not only between counties, but as specific as different zip codes. With more granular data, says Char, the state can pinpoint which communities have the lowest vaccination rates and focus outreach efforts there. 

Vaccination rates across state zip codes vary. For example, zip codes in Hilo have a high vaccination rate of 60 to 70 percent. However, Mountainview, the neighboring zip code, has the lowest vaccination rate of 35 percent or less.

 

Image: Hawaii State Department of Health

 

Rep. Linda Ichiyama, chair of the Pandemic and Disaster Preparedness Committee, asked the department to provide specific details about those targeted outreach efforts. Sen. Jarret Keohokalole also followed up, asking what specific issues are preventing people in certain zip code areas from accessing the vaccine. State epidemiologist Sarah Kemble, MD, responded: 

“We’ve also been working on the data side to provide information to the communities that helps them take the most appropriate action. For example, we’ve broken down these lighter zip code areas by language access issues to look at percentages speaking other languages. We’re also looking at some of the access issues and how well-aligned these are with pharmacy or community health center locations.”

Examples of successful outreach efforts include DOH’s close work with community leaders, says Char. In October 2020, DOH created a Pacific Islanders Outreach Team to support Hawaii residents for whom English is a second language. The team, lead by Contact Tracing Lead Investigator Chantelle “Tellie” Matagi, worked with other community leaders to provide accessible resources about the vaccine and long-term health solutions for Hawaii’s underserved communities. 

Looking forward, Sen. Rosalyn Baker suggested legislators help connect the department with other community contacts, such as Hawaiian Homestead Associations

Legislators also asked the department for an update on the variant strains of the virus, such as the more transmissible Delta variant, and the most recently designated Lambda variant. Kemble says DOH is actively tracking the variants at the State Laboratories Division (SLD):

“Our goal with surveillance is to pull a sample every week that is spread out throughout all of the counties and look for the advent of new variants that might be entering the state and track if those are expanding or remaining at low rates.” 

 

Image: Hawaii State Department of Health

 

With the variants in mind, DOH says reaching the 70 percent vaccination rate is crucial. Char said: 

“We don’t get to choose what constitutes herd immunity — that’s a function of the virus and it’s definitely linked to how transmissible the virus is. That’s why we’re so concerned about some of the variants, because if they spread more easily, then we will need a higher percentage of our community to be vaccinated in order to be protected.”

Even though breakthrough cases occur, where a fully vaccinated person contracts COVID-19, they account for only a small percentage of cases. As of the briefing, DOH reported 291 breakthrough cases out of 825,382 fully vaccinated residents — 0.036 percent of cases. 

DOH also updated the legislature on ongoing studies related to the vaccines, including expanding access to children. Pfizer currently has Emergency Use Authorization (EUA) from the FDA to distribute its vaccine to people aged 12 and up. Both Pfizer and Moderna are currently conducting studies for three different age groups under 12: six months to two years, two to five years, and five to 12 years. DOH expects the five to 12 year age group will be the next to receive access to the vaccines.

Legislators also asked for an update on whether people will need a vaccine booster shot in upcoming months. While studies are ongoing, there is currently no timeline of when a booster shot will be required. Kemble added that if a booster shot is recommended, it will mainly concern immunocompromised people or those with other underlying health conditions.