I keep a card in my wallet that says I have been injected six different times to protect against Covid.

So far, I have avoided the coronavirus and I want to keep it that way, especially when thinking about the life altering changes of long Covid.

One of my relatives has been battered by long Covid for almost two years.  Even a short walk down the block to her neighborhood park leaves her dizzy and exhausted. At home, she battles with brain fog. That is no way to have to live.

When each new Covid vaccination becomes available I embrace it, most recently, standing in line at  Kaiser’s Pensacola clinic for the updated Covid shot targeting the latest circulating omicron variants.

But not all people are as eager to protect themselves and others around them. Of all the Covid vaccines released so far, this new one has been shunned by more people than any before it.

The Centers for Disease Control and Prevention reports that since the new vaccine was released in September only 7.1% of adults 18 or older have received it and 2% of children. And more worrisome is that only 1 of 5 of the most vulnerable seniors age 75 and older have sought it.

Meanwhile, infections continue, with a seven-day positivity rate of 8% and three new Covid-related deaths in the last week of October, according to the state Department of Health. The official figures are considered an undercount because they don’t include home test results.

Kaiser Permanente Hawaii offers the new vaccine for free to all its members 6 months and older at convenient walk-in clinics.

Yet Kaiser said its vaccination rate for children and adults is down approximately 6% from this time last year. And thatʻ s not a good sign because Covid vaccinations last year were at an all-time low.

“We do not know why there is low interest in the updated vaccine, nor do we want to speculate,” Kaiser said in an email.

But other health care providers were willing to explain the lack of interest.

In an email, the DOH said the current slow uptake is part of a steady decline in demand for Covid vaccinations that started after people received the original two doses of the vaccine in 2021. The introduction of the vaccine also was accompanied by a major publicity campaign that has been absent with more recent iterations.

Health experts say many people want to forget Covid rather than deal with it, eager to put the pandemic behind them. Other vaccine reluctants wrongly think they are fully protected by the first two shots.

And, of course there are the Covid deniers. “They will not change,” says physician Scott Miscovich, founder and owner of the Premier Medical Group.

Payment Issues

In addition, a new factor this year has further slowed the vaccination uptake.

For the first time health care providers have to order and pay for doses of the vaccine themselves. The private sector became responsible after the Covid health emergency ended in May and the federal government stopped paying upfront for Covid vaccines.

Epidemiologist Dr. Tim Brown, an infectious disease expert and a senior fellow at the East-West Center, described the initial rollout by the private sector in September as “botched” and “a complete disaster.”

He said Longs and other Hawaii pharmacies either did not have enough doses to meet demand, or required people to pay up to $200 immediately out-of-pocket for a shot because HMSA initially refused to reimburse for it.

Dr. Kamal Masaki said itʻs been frustrating. First, her local pharmacy told her she would have to pay $190 for her new Covid vaccine because her health insurance provider HMSA wasnʻt reimbursing for it.

Then, when HMSA finally straightened out its codes to reimburse, the three different appointments Masaki made for the injection were canceled because of insufficient supply.

Masaki is a professor and the head of the Department of Geriatric Medicine at the University of Hawaii’s John A. Burns School of Medicine.

She finally ended up driving out to Ewa, many miles from her Makiki home to get the shot at a pharmacy there.

“We should make it easier for people to get vaccinated. There should not be these barriers,“ said Masaki.

High-Risk Patients

She sees getting updated Covid vaccinations as an important part of a social contract to protect those around us, especially the elderly who are at high risk for severe illiness and continue to succumb to Covid outbreaks in care homes.

The health department investigated 28 potential outbreaks of Covid cases in July in Hawaii’s long-term care and assisted living facilities and adult residential care homes. It investigated 33 potential outbreaks in August and 13 potential outbreaks in September.

The health department said it takes a conservative approach, viewing even a single Covid case in a group living facility as a potential outbreak to get moving fast to prevent a cluster of cases.

HMSA is Hawaiiʻs largest health insurance provider, serving approximately 700,000 Hawaii members. In an email, it explained its reimbursing issues for the vaccine saying other health plans on the mainland had the same problem.

“Since this was the first commercial product on the market, meaning that the federal government was not supplying it, it took us time to implement the new codes and reimbursement rates determined by the federal government into our system. We also needed to communicate these codes and reimbursement rates to the dispensing pharmacies so they could submit claims to us,” HMSA said. By Sept. 21, it said it was up to speed on its reimbursements.

HMSA said any pharmacy that wrongfully charged an HMSA member for the new Covid-19 vaccine is responsible for reimbursing that member for the vaccine, which was always covered by HMSA.

One problem with the bumpy, messed up rollout of the newest Covid vaccine is it gives people who are not deeply interested in getting vaccinated one more reason not to do it.

“Because there is not a sense of urgency to get Covid vaccinations now, if there is any obstacle, people will say, ‘I am not going to bother,’” said Hilton Raethel.

He called the slow uptake in vaccinations in Hawaii and across the country “very concerning, especially when there is a very effective vaccination available that’s fully covered by Medicare and Medicaid and private insurers.”

Raethel is president and CEO of the Healthcare Association of Hawaii, a trade association that represents every hospital in the state as well as every long-term care and assisted living facility and Hawaiiʻs hospices.

He said hospitalizations of people with Covid across the state decreased in October to 50 a day from 100 a day in mid-August with only five patients a day now in an intensive care unit, but he cautioned that the numbers are always fluctuating.

“With a high rate of vaccination, we could do even better,” he said.

I am with Masaki who says it is important to get vaccinated not only for yourself but to protect the others around you especially the vulnerable elderly who still can get very sick from it.

Civil Beat’s community health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, the Cooke Foundation and Papa Ola Lokahi.