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Justin, 53, owns a rental business in Austin and suspects he contracted COVID-19 after hosting a boat party on Lake Travis last June. One of his guests had recently come down with symptoms, and he later developed pneumonia. "I was pretty sick," he told Austonia.
Although Justin, who asked that his last name be withheld for privacy reasons, believes, "COVID is real, obviously," he is opposed to vaccines. The COVID vaccines, in particular, concern him because of their emergency use status and the possibility that recipients can still get sick. "(I'm) sure as hell not going to put that in my body," he said, adding that he likely has natural immunity and rarely gets sick.
When the U.S. Food and Drug Administration and Centers for Disease Control and Prevention issued new guidance to pause use of the Johnson & Johnson vaccine out of an abundance of caution, Justin felt like it was an inevitability. "I'm just not surprised," he said.
As vaccine eligibility has widened to all Texas adults and in the wake of the pause on Johnson & Johnson vaccine distribution, public health experts are focused on a new challenge: vaccine hesitancy. Local physicians are also working on the front lines to address their patients' concerns about the vaccine, which may be based on misinformation or political ideology, and could thwart efforts to achieve herd immunity.
A changing tide
Vaccine demand in the Austin area has remained strong in comparison to other Texas counties. But local physicians are encountering patients who are skeptical about, or downright opposed to, the vaccine.
Demand for the COVID-19 vaccine in Travis County has generally increased. (Texas Department of State Health Services)
Dr. James Marroquin, an internal medicine doctor at Capital Medical Clinic on West 38th Street, initially couldn't keep up with vaccine demand. Now he sees the occasional hesitant patient once every two or three days. (His daily patient load is around 15 to 20.)
In most cases, this hesitancy is fueled by political ideology. "I think it all kind of goes along with lack of trust in institutions," Marroquin said, citing his patients' concerns of government overreach and the defeat of former President Donald Trump. This tracks with February polling data from the University of Texas/Texas Tribune, which found 59% of Texas Republicans were either reluctant to get the vaccine or would refuse it outright.
If his patient is open to a conversation, Marroquin focuses on personal stories about how difficult it has been to see patients hospitalized with or die of COVID and how he and his wife feel so much more comfortable going out to dinner now that they are vaccinated. "Facts do not change people's minds," he said.
An ongoing conversation
This doctor-patient relationship may be key to addressing the issue. Dr. David Lakey, vice chancellor of health affairs at the University of Texas System and a member of the Texas COVID-19 Expert Vaccine Allocation Panel, anticipates that as the rollout continues, allocations will shift from hubs and large clinics to private practices and pharmacies, where patients may have a trusted doctor or pharmacist with whom they feel comfortable raising concerns.
Vaccine hesitancy is nothing new for family medicine physicians such as Dr. Puja Uppal, chief medical officer of Think Healthy, a podcast aimed at improving health literacy and equity. She tries to address misinformation patients may have come across head-on over the course of successive appointments.
A common concern is the CDC's evolving guidance regarding masking and what vaccine recipients can do safely, potential side effects and the newness of the vaccine. In such cases, Uppal stresses that the foundation of good medicine is adapting as new information becomes available. "If your actions don't change with new data, then that's not science," she said.
Another concern is the newness of the COVID vaccines, which were distributed quickly compared to the typical timeline but rely on mRNA and vector-based platforms that have been developed and tested for other diseases, including SARS, Ebola and Zika.
The federal government recommended the Johnson & Johnson pause on Tuesday after six recipients—out of more than 7.2 million—reported blood clots. Public health experts see the guidance as a double-edged sword: on the one hand, the pause is proof of an effective and transparent oversight process; on the other, it could exacerbate vaccine hesitancy. "It's a very hard thing to message, and it can put further doubt in people's minds," Dr. Steve Schrantz, an assistant professor of medicine at the University of Chicago who specializes in infectious disease, told NBC News.
Uppal tries to provide her hesitant patients with data: "Something that I say that patients are actually really appreciative of is that we all know that over 500,000 people have died from COVID (in the U.S.)," she said. "We don't know of a single patient who has died from the vaccine."
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A week after Texas added two congressional seats and California lost one, state officials reported a population decline in 2020 for the first time in the Golden State's history.
California fell by over 182,000 people from January 2020 to January 2021, dropping almost 0.5% to cap out at around 39.5 million people. It is still the nation's most populous state.
For over thirty years, California has seen more people leave than move in from other states, state officials said, with 6.1 million people moving out and 4.9 million coming in last year. Immigration and births kept California growing, but the state saw a shrink in international migration in 2020 due to COVID and the White House's hold on visas.
Of the steady flow of ex-Californians moving to other states, more are moving to Texas than any other state. Many are relocating to Austin, which has been labeled a "little California" by billionaire resident Elon Musk and continues to grow astronomically.
Meanwhile, California cities including Los Angeles, San Diego, San Jose and San Francisco saw a population decline.
With immigration and state migration on the decline, the Golden State was also hit with a spike in deaths- 51,000 people died from COVID in 2020, and all but seven of the state's counties saw death rates higher than the three-year average.
Still, the California Department of Finance said a "slightly positive annual growth" can be expected next year as the state recovers from COVID deaths and political repercussions.
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