Thrown off-stride to reach its COVID-19 vaccination goal, the Biden administration is sending A-list officials across the country, devising ads for niche markets and enlisting community organizers to persuade unvaccinated people to get a shot. The strategy has the trappings of a political campaign, complete with data crunching to identify groups that can be won over. Read: Asia welcomes US vaccine donations amid cold storage worries But the message is about public health, not ideology. The focus is a group health officials term the “movable middle” — some 55 million unvaccinated adults seen as persuadable, many of them under 30. “We’re not just going to do the mass vaccination sites,” said Health and Human Services Secretary Xavier Becerra. “It’s door to door. It’s mobile clinics. We’re doing vaccinations at church, the PTA meeting, the barber shop, the grocery store.” Officials have seized on a compelling new talking point, courtesy of the coronavirus. The potent delta variant that has ravaged India is spreading here. Now accounting for about 1 in 5 virus samples genetically decoded in the U.S., the more transmissible mutation has gained a foothold in Mountain West and heartland states. Many of those infected are young and unvaccinated. The White House has lent its top names to the vaccine push. Read: Who benefits? US debates fairest way to share spare vaccine President Joe Biden visited a mobile vaccination site in Raleigh, North Carolina, on Thursday. Earlier in the day, first lady Jill Biden held the hand of a woman at a drive-thru vaccination site in Kissimmee, Florida. Doug Emhoff, the husband of Vice President Kamala Harris, has racked up thousands of frequent flyer miles, visiting at least 18 or 19 states by his count. The administration also has recruited celebrities and athletes, including country music star Brad Paisley and the Tampa Bay Lightning hockey team. It has teamed up with Twitch and Riot Games to reach online gamers and with Panera and Chipotle to offer free food to those getting a shot. The message, as Surgeon General Vivek Murthy put it: “If you are vaccinated, you are protected. If you are not, the threat of variants is real and growing.” It’s unclear how well the levers of persuasion are functioning. Vaccination rates have dropped below 1 million a day, and there’s no sign yet of a turnaround. The administration has acknowledged that it will fall short of its goal of having 70% of adults vaccinated by July Fourth. At this point, about 170 million American adults have received at least one vaccine dose, representing roughly two-thirds of those 18 and older. An Associated Press analysis suggests that Biden’s self-imposed goal may not be reached until late July at current rates of vaccination. Analysts at HHS have developed a rough sketch of those in the movable middle. They tend to be younger, mainly 18-29. Most are not college educated, and political independents predominate. Black and Latino adults are more likely to fall in this category than people of other backgrounds. It can be a hard sell. After Jill Biden’s visit to Mississippi earlier in the week, Gulf Coast resident Sherie Bardwell was unimpressed. She said Biden’s comment that “vaccines might feel like a miracle, but there’s no faith required,” sounded to her like a dig at people with Christian beliefs. “She said shots are miracles that don’t require faith. The Bible says just live by faith,” said Bardwell, who followed news about the first lady’s visit. Bardwell said both she and her husband had COVID-19 and she was hospitalized. “My thoughts are, if you’ve already had the coronavirus, why do you need the vaccine?” asked Bardwell. “If the vaccine was the ‘miracle,’ then why are you still at risk of contracting the virus after receiving the shot? It just doesn’t make sense to me.” Doctors advise recovered patients to get vaccinated so as to maintain protection. Privately, some White House officials fret that the persuadable universe may be shrinking. Early success with vaccination has paradoxically made things more difficult. Now that cases and deaths have dropped to levels not seen since the onset of the pandemic, officials say it’s become harder to convince Americans of the urgency of getting a shot — particularly younger people who already knew they were at low risk of serious complications. Biden officials say they recognize that it’s going to take more than celebrity pitches to close the deal. In Knoxville, Tennessee, a retired hospice and home care administrator has become a volunteer COVID-19 response organizer in the Black community. Cynthia Finch is one of many around the country to whom federal health officials have turned as “trusted messengers.” Finch dubbed her local vaccine strategy the “3 V’s.” She started with what she calls “vaccine partners,” such as local hospitals and universities, to create a framework. Then she organized volunteers to give shots by working with professional groups including a Black nursing sorority. Finally, she reached out to pastors and community organizations to provide venues where people could come to get their vaccines. Finch estimates those efforts have led to thousands of people getting fully vaccinated. She said she is used to dealing with skepticism, particularly given the history of substandard care in minority communities and the use of Black patients in medical experiments without their consent. She tries to listen carefully to objections and concerns, and respond with factual information that’s on point. “When you start telling them things they can relate to, it kind of calms them down,” she said. Her own motivation is personal. Finch said a close friend lost two brothers days apart to COVID-19, and that motivates her to keep working. “People are still dying,” she said. While applauding the Biden administration’s efforts to get Americans vaccinated, some public health experts say there are limits to what persuasion can achieve. The administration has ruled out vaccine passports that could become a ticket to benefits such as international travel. But Dr. Leana Wen, a former Baltimore health commissioner, said a federal verification system that people could use to prove their vaccination status could still be an incentive. “Setting an aspirational goal of 70% was the right goal for the Biden administration, but I wish they had not been so hesitant about vaccination requirements,” she said. “We are going to be in a position where the majority of the country is going to be vaccinated,” said Wen. “Why should they be held hostage by a minority of the population, who are potentially endangering everybody else?” Administration officials show no signs of budging in their position. “The federal government is not planning to create a database of people who have been vaccinated,” Murthy said.

How long does protection from COVID-19 vaccines last? Experts don’t know yet because they’re still studying vaccinated people to see when protection might wear off. How well the vaccines work against emerging variants will also determine if, when and how often additional shots might be needed. “We only have information for as long as the vaccines have been studied,” said Deborah Fuller, a vaccine researcher at the University of Washington. “We have to study the vaccinated population and start to see, at what point do people become vulnerable again to the virus?” So far, Pfizer’s ongoing trial indicates the company’s two-dose vaccine remains highly effective for at least six months, and likely longer. People who got Moderna’s vaccine also still had notable levels of virus-fighting antibodies six months after the second required shot. Antibodies also don’t tell the whole story. To fight off intruders like viruses, our immune systems also have another line of defense called B and T cells, some of which can hang around long after antibody levels dwindle. If they encounter the same virus in the future, those battle-tested cells could potentially spring into action more quickly. Also Read: Will children be able to get COVID-19 vaccines? Even if they don’t prevent illness entirely, they could help blunt its severity. But exactly what role such “memory” cells might play with the coronavirus -- and for how long -- isn’t yet known. While the current COVID-19 vaccines will likely last for at least about a year, they probably won’t offer lifelong protection, as with measles shots, said Dr. Kathleen Neuzil, a vaccine expert at the University of Maryland. “It’s going to be somewhere in the middle of that very wide range,” she said. Variants are another reason we might need an additional shot. The current vaccines are designed to work against a particular spike protein on the coronavirus, said Mehul Suthar of the Emory Vaccine Center. If the virus mutates enough over time, vaccines might need to be updated to boost their effectiveness. So far, the vaccines appear protective against the notable variants that have emerged, though somewhat less so on the one first detected in South Africa. If it turns out we need another shot, a single dose could extend protection of the current shots or contain vaccination for one or more variants. The need for follow-up shots will also depend partly on the success of the vaccination push globally, and tamping down transmission of the virus and emerging variants.

Half of all adults in the U.S. have received at least one COVID-19 shot, the government announced Sunday, marking another milestone in the nation’s largest-ever vaccination campaign but leaving more work to do to convince skeptical Americans to roll up their sleeves. Almost 130 million people 18 or older have received at least one dose of a vaccine, or 50.4% of the total adult population, the Centers for Disease Control and Prevention reported. Almost 84 million adults, or about 32.5% of the population, have been fully vaccinated. Also Read: Vaccines to be made available at Alaska airports The U.S. cleared the 50% mark just a day after the reported global death toll from the coronavirus topped a staggering 3 million, according to totals compiled by Johns Hopkins University, though the actual number is believed to be significantly higher. The country’s vaccination rate, at 61.6 doses administered per 100 people, currently falls behind Israel, which leads among countries with at least 5 million people with a rate of 119.2. The U.S. also trails the United Arab Emirates, Chile and the United Kingdom, which is vaccinating at a rate of 62 doses per 100 people, according to Our World in Data, an online research site. The vaccine campaign offered hope in places like Nashville, Tennessee, where the Music City Center bustled Sunday with vaccine seekers. High demand for appointment-only shots at the convention center has leveled off enough that walk-ins will be welcome starting this week. Read South Africa scraps AstraZeneca vaccine, will give J&J jabs Amanda Grimsley, who received her second shot, said she’s ready to see her 96-year-old grandmother, who lives in Alabama and has been nervous about getting the vaccine after having a bad reaction to a flu shot. “It’s a little emotional. I haven’t been able to see my grandmother in a year and a half almost,” said Grimsley, 35. “And that’s the longest my entire family has ever gone without seeing her. And we’ll be seeing her in mid-May now.” The states with the highest vaccination rates have a history of voting Democratic and supporting President Joe Biden in the 2020 election: New Hampshire at the top, with 71.1%, followed by New Mexico, Connecticut, Massachusetts and Maine, CDC data show. Also Read: A rapid COVID-19 vaccine rollout backfired in some US states The demand has not been the same in many areas of Tennessee — particularly, rural ones. Tennessee sits in the bottom four states for rates of adults getting at least one shot, at 40.8%. It’s trailed only by Louisiana, Alabama and Mississippi — three other Southern states that lean Republican and voted for Donald Trump last fall. Vaccination rates do not always align with how states vote. But polling from The Associated Press-NORC Center for Public Affairs Research has shown trends that link political leanings and attitudes about the vaccines and other issues related to the pandemic, which has killed more than 566,000 people in the U.S. A poll conducted in late March found that 36% of Republicans said they will probably or definitely not get vaccinated, compared with 12% of Democrats. Similarly, a third of rural Americans said they were leaning against getting shots, while fewer than a fourth of people living in cities and suburbs shared that hesitancy. Read Ghana is first nation in world to receive COVAX vaccines Overall, willingness to get vaccinated has risen, polling shows. In January, 67% of adult Americans were willing to get vaccinated or had already received at least one shot. The figure has climbed to 75%, according to the latest AP-NORC poll. Nationwide, 24% of Black Americans and 22% of Hispanic Americans say they will probably or definitely not get vaccinated, down from 41% and 34% in January, respectively. Among white Americans, 26% now say they will not get vaccinated. In January, that number was 31%. Dr. Anthony Fauci, the nation’s top infectious disease expert, said the goal is to get community figures, from athletes to clergy, to encourage vaccinations, particularly as the seven-day national average of cases remains over 60,000 new infections per day. Read Coronavirus vaccines: How’s my country and the rest of the world doing? “What we are doing is we’re trying to get, by a community core, trusted messages that anyone would feel comfortable with listening to, whether you’re a Republican, a Democrat, an independent or whomever you are, that you’re comfortable,” Fauci said Sunday on ABC’s “This Week.” Fauci also indicated Sunday that the government will likely move to resume use of Johnson & Johnson’s COVID-19 vaccine this week, possibly with restrictions or broader warnings after reports of some very rare blood clot cases. In a series of news show interviews, Fauci said he expects a decision when advisers to the CDC meet Friday to discuss the pause in J&J’s single-dose vaccine. Read Japan begins COVID-19 vaccination drive amid supply worry “I would be very surprised if we don’t have a resumption in some form by Friday,” he said. “I don’t really anticipate that they’re going to want it stretch it out a bit longer.” Fauci, who is President Joe Biden’s chief medical adviser, said he believed federal regulators could bring the shots back with limits based on age or gender, or with a blanket warning, so the vaccine is administered in a way “a little bit different than we were before the pause.” The J&J vaccine was thrown into limbo after the CDC and the Food and Drug Administration said last week that they needed more evidence to decide if a handful of unusual blood clots were linked to the shot — and if so, how big the risk is. The reports are rare — six cases out of more than 7 million U.S. inoculations with the J&J vaccine. The clots were found in women between the ages of 18 and 48. One person died. Read J&J vaccine to remain in limbo while officials seek evidence