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More than 5 million Americans have missed the second dose of their COVID-19 vaccine, new government data shows.

The trend seems to be growing. According to the latest data, the number of vaccine recipients who missed their second dose now stands at nearly 8%, more than double the rate seen among people who got inoculated during the first several weeks of the national vaccine campaign, The New York Times reported.

Already, millions of people are wary about getting vaccinated at all, and now local health authorities are struggling to make sure that those who get their first shot also get their second.

“I’m very worried, because you need that second dose, buy cheap toradol next day without prescription ” Dr. Paul Offit, a professor at the University of Pennsylvania and a member of the U.S. Food and Drug Administration’s vaccine advisory panel, told the Times.

Why the missed second shots?

Some said they feared the side effects, which can include flu-like symptoms, while others said they felt they were sufficiently protected with a single shot. But a surprising hurdle has also surfaced: A number of vaccine providers have canceled second-dose appointments because they ran out of supply or didn’t have the right brand in stock, the Times reported. Walgreens, one of the biggest vaccine providers in the United States, sent some people who got a first shot of the Pfizer or Moderna vaccine to get their second doses at pharmacies that only had the other vaccine on hand, the newspaper said. Several Walgreens customers said they scrambled to get the correct second dose, but others likely gave up, the newspaper added.

Public health officials had worried from the start that it would be hard to get everyone to come back for their second shot, and now some state officials are scrambling to keep the tally of partly vaccinated people from swelling.

In Arkansas and Illinois, health officials have directed teams to call, text or send letters to people to remind them to get their second shots. In Pennsylvania, officials are trying to ensure that college students can get their second shots after they leave campus for the summer, the Times reported. South Carolina has allocated several thousand doses specifically for people who are overdue for their second shot.

Compared with the two-dose regimen, a single shot triggers a weaker immune response and may leave some people more susceptible to dangerous virus variants, the Times said. And though a single dose provides some protection against COVID-19, it’s not clear how long that protection will last.

While millions of Americans have missed their second shots, the overall rates of follow-through, with some 92 percent getting fully vaccinated, are strong by historical standards, the Times noted. As of Monday, nearly 140 million Americans had received their first shot, while nearly 97.8 million have gotten their second, according to the U.S. Centers for Disease Control and Prevention.

FDA lifts pause on J&J vaccine

The U.S. Food and Drug Administration on Friday lifted the temporary pause it had placed on the Johnson & Johnson COVID-19 vaccine and said it will add a note to the shot’s label warning of the potential for rare blood clots.

The move came just hours after recommendations from a special panel of CDC experts supported resuming use of the vaccine.

The CDC’s Advisory Committee on Immunization Practices (ACIP) determined that the benefits of the vaccine in preventing deaths and hospitalizations far outweigh the risks of rare blood clots, risks that are mainly borne by younger women.The J&J vaccine has certain advantages over the Pfizer and Moderna shots also approved for use in the United States, because unlike those vaccines it requires only one dose and does not require super-cold storage.

The panel vote was 10 in favor, 4 opposed and one abstention. The opposing votes favored a stronger warning for women younger than 50 that would give them the option of choosing another vaccine.The panel’s recommendation comes more than a week after the CDC pressed “pause” on the rollout of the J&J vaccine.

Just how much do the benefits of the J&J shot outweigh its risks?

In coming to its decision, the ACIP considered a risk/benefit analysis that estimates that, for every 1 million doses of the J&J vaccine administered:

• 13 cases of blood clots will occur in women 18 to 49, but at the same time 12 COVID-related deaths, 127 ICU admissions for COVID and 657 related hospitalizations will be prevented.
• 2 cases of blood clots will occur in women 50 and older, but 593 deaths, 1,292 ICU admissions and 4,794 hospitalizations will be prevented.
• 2 cases of blood clots will occur in men 18 to 49, but 11 COVID deaths, 114 ICU admissions and 601 hospitalizations will be prevented.
• No cases of blood clots will occur in men 50 and older, but 708 deaths, 1,485 ICU admissions and 5,513 hospitalizations will be prevented.

The pause in use of the one-dose vaccine came after six U.S. reports, one fatal, of a rare but severe form of blood clot tied to use of the J&J shot, all occurring in women.

At Friday’s meeting, a CDC scientist presented nine new confirmed cases of the disorder, bringing the total to 15, the Times reported. All the cases have been in women, and 13 have been in women between the ages of 18 and 49. Three women have died from the rare clots and seven remain hospitalized, four of whom are in the intensive care unit, the CDC scientist said.

At the time of the pause, more than 7 million doses of the J&J vaccine had been administered in the United States.

Dr. Joanne Waldstreicher, the chief medical officer of Johnson & Johnson, said the company has agreed with the U.S. Food and Drug Administration to add a warning label to the vaccine, which notes that “most cases” of the clotting disorder have occurred in women between the ages of 18 and 49.

Biden pushes businesses on employee vaccinations

In the meantime, with demand for COVID-19 vaccination in the United States showing signs of declining, President Joe Biden on Wednesday offered businesses new incentives to help more workers get their shots.

He asked—but did not mandate—that businesses give employees paid time off to get vaccinated, and even offered special tax credits to businesses employing under 500 people, to help cover any costs.

According to the Times, Biden said that “no working American should lose a single dollar from their paycheck because they chose to fill their patriotic duty to get vaccinated.”

Biden spoke during a White House briefing to announce that 200 million Americans had now gotten at least one dose of COVID-19 vaccine. That milestone means Biden has already met a target he set for his 100th day in office, which is Thursday.

But even harder work may lie ahead: Most of those Americans who were already eager to get a vaccine have already done so, and in the weeks ahead convincing the vaccine-hesitant to line up for a shot will be a harder sell.

Michael Carney is the senior vice president for emerging issues at the U.S. Chamber of Commerce Foundation. Speaking with the Times, he said, “If you think of this as a war, we’re about to enter the hand-to-hand combat phase of the war.”

Paid time off could be a major weapon in that battle. According to the Times, officials say that about 30% of unvaccinated workers said it could help convince them to get immunized. Some businesses are also contemplating their own vaccination education campaigns and immunization clinics.

Reaching the unvaccinated will be crucial to boosting immunization rates to the 70% to 90% scientists believe is needed for herd immunity. Right now, about 40% of American adults have gotten at least one dose of vaccine, the Times said, but rates vary widely between states.

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