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A 'tough nut to crack': States race to vaccinate young adults against Covid-19

(CNN)With more than 84% of all eligible people in Vermont having had at least one Covid-19 vaccine dose, no one would blame health officials if they wanted to take it easy, but the easy path is not a part of Dr. Michael Levine's pandemic plans.

The Vermont health commissioner says he's proud of the Green Mountain state ranks first in the US for Covid-19 vaccinations, but with the variant threat, Levine wants even more people protected. To do that, he's going to have to figure out how to reach the one demographic that's holding out, not just on him, but on public health leaders throughout the country -- Gen Z.

"They're a tough nut to crack," Levine said.

President Joe Biden's administration acknowledged Tuesday that it would fall just short of its goal of getting 70% of adults in the US at least partially vaccinated by July 4. Wide swaths of the South have been slow to vaccinate. Three Southern and one Western state still have fewer than half of their adult population protected with one dose. But across the country, the one demographic that's dogged health officials are people in that 18-to-29 age range.

"The trouble is they feel like they are invincible and that makes them a tough group to reach," said Lori Tremmel Freeman, the CEO of the National Association of County and City Health Officials (NACCHO).

The Biden administration said it will beef up its efforts to get this group vaccinated. Freeman said it will take a variety of efforts from federal, state, and local governments to do it.

She's seen the challenge in her own household. Her own twins who just graduated from college haven't gotten the Covid-19 vaccine.

"I'm still working on them and I shame them every day," she jokes.

Young adult vaccinations by the numbers

Generally, vaccine coverage among young adults has been lower and increasing more slowly over time, compared to other age groups, according to a report published by the US Centers for Disease Control and Prevention on Monday. Their intent to get vaccinated is also lower. If the weekly pace of vaccinations continues at the rate from the week of May 22, only 57.5% of people under the age of 30 will have received at least one dose of Covid-19 vaccine by the end of August.
States are trying a wide variety of tactics to reach this population. In many states like Hawaii there are cash incentives. California is vaccinating people at McDonald's and offering food coupons. In New Jersey, there's Rock the Shot a vaccination event at a balloon and rib festivals. West Virginia offered $100 savings bonds for residents 16 to 35 who get vaccinated.

The more traditional approach

States are also trying techniques straight out of the classic public health handbook. In Colorado, the health department is calling all residents 18 and older who haven't received the vaccine yet, providing them information and scheduling an appointment.

In Arkansas, where 51% of adults have had just one dose, the health department is tackling vaccine misinformation common on social media where many young adults get their information.

"We do not go head to head with the misinformation. We try to make messages available for people to provide accurate messages that are easily understood," said Dr. Jennifer Dillaha, the department's medical director for immunizations.

Flood the zone

Even with Vermont's success, the public health commissioner says there has to be this extra effort to vaccinate the 18 to 29 year olds who've been tricky to get, but not impossible.

"Most of them are not a truly vaccine resistant group," Levine said. "They don't have that strong polarized view. They're mostly in the category where it's just not at the top of their list right now."

The vaccine is available at nearly all pharmacies in the state without an appointment and Levine said Vermont plans to put the vaccine "everywhere it can be."

"So that literally they could stumble over it," Levine said, "And then they'll say, 'oh, well, sure, I'm here, why not.' "

North Dakota, where little more than 55% of adults have had one vaccine, is taking a similar approach. Vaccinators are everywhere this younger demographic may be, Molly Howell, the department of health immunization program manager, said. She's sent vaccinators to concerts, college campus events, a food truck festival, and to the LGBTQ Pride event on the Capitol lawn.

"I think bringing vaccine to the people can work," Howell said.

Awareness about the vaccine and the disease

To raise vaccine awareness, they've recruited local influencers like college athletes. Howell thinks it's also important to raising awareness about the disease itself. Even a year into the pandemic, she thinks some young people don't take Covid-19 seriously. Since they typically experience milder symptoms, they may not be as motivated to get protection.

"I think there is a bit of denial there," Howell said. North Dakota is creating a memorial wall and a campaign about long Covid.

For people with vaccine safety concerns, North Dakota has worked with colleges to help educate younger people. They've also sent more vaccines to local doctors, so people can get questions answered from providers they trust.

In Louisiana, where less than half the adult population has had one dose of the vaccine, Dr. Joseph Kanter, the state health officer, said the state has grown its presence on social media. He expects its Shot at a Million lottery initiative with $2.3 million cash prizes and scholarships will increase young adult interest. Louisiana also paired up with 25 community organizations to go door-to-door to answer questions and sign people up for vaccine appointments.

"This is a more deliberate process, this is a slower process, but it's every bit as important," Kanter said.

Making it mandatory

What ultimately may speed efforts with this age group is college. More than 500 universities and colleges are requiring students to get the Covid-19 vaccine before they come back to class, according to a tally kept by The Chronicle of Higher Education.
"My feeling is that the requirement is going to be a positive piece of this puzzle," said Gerri Taylor, co-chair of the Covid-19 task force of the American College Health Association. In April, her association recommended all colleges and universities require the vaccine for all faculty, staff, and students, except for those with medical or religious exemptions. With in-person school starting in back in the fall, more students will need to start the vaccination process in July, if they haven't already.

For colleges that don't require the vaccine, students will see more campaigns that encourage them to protect their friends on campus.

"Messages that emphasize that they may not be doing it for themselves, because maybe they feel invincible, but if they can do it for their families, their grandparents, their friends," Taylor said.

Unfortunately, the experts say, there's no one magic formula to reach this population.

"I don't think there is just that one grand thing that we have, because everyone has their own reason for not getting vaccinated and some of this is out of our control," Howell said. "I think it's just for some people going to take some time, but I also think that's where the struggle is, since a lot of us feel like there isn't time."

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