Quynh Tran, a pharmacist with The Public Health Commission Corps, prepares a vial of Moderna vaccine on Tuesday, April 13, 2021, at a mobile vaccination unit that was stationed at the Oxford Casino. Credit: Andree Kehn / Sun Journal via AP

Maine saw a 20 percent decrease in weekly COVID-19 vaccinations this week, a development that will challenge public health officials as they pursue more flexible options.

The vaccination effort is slowing as more doses and ways to get vaccinated have become available. States, including Maine, opened up vaccines to the general public, creating an initial burst of interest. That was then complicated by a federal pause on the one-shot Johnson & Johnson vaccine, an option that was heralded as a way to solve access issues.

The drop is the first time vaccines declined in Maine since mid-March, shortly before Maine extended eligibility to residents in their 50s. It came on the heels of a record-setting week when Maine administered more than 120,000 doses in the week after all adults became eligible.

The steep decline presents a challenge for the Pine Tree State, which has otherwise been ahead of the pack in vaccinations — Maine has fully vaccinated 35 percent of its population, more than any other state, according to a New York Times tracker. Some smaller clinics have paused giving doses altogether, while larger ones are working on ways to keep shots going. Providers say the decline seems to be tied to the paused vaccines and waning interest.

Nirav Shah, the director for the Maine Center of Disease Control and Prevention, put the decrease largely on last week’s pause of the Johnson & Johnson vaccine on Thursday. The pause happened after federal health agencies said more information was needed after six women developed exceedingly rare but serious blood clots after getting the shot. The U.S. resumed the use of the vaccine on Saturday after the 11-day pause.

Shah said the pause happened when Johnson & Johnson allocations were “quite high” in the state. Maine received more than 32,000 doses of the one-shot vaccine the week before it was paused. The move initially dropped vaccination rates from a seven-day average of 18,200 doses per day to 13,600 per day, he said, adding that the development could have caused hesitancy among those already distrustful of the vaccines.

“Certainly there’s a lot of factors going on at once, so I’m not discounting the possibility of a little bit of softening of demand,” he said. “We shall see.”

But the pause may not be able to account for the dropoff entirely. The state was allocated only 230 fewer vaccines this week than the 36,690 allotted the week prior after federal health officials scrambled to replace Johnson & Johnson shots with two-shot options.

MaineHealth, the state’s largest health care provider, announced Friday it would be soon providing walk-up appointments in certain locations. Its Farmington location, Franklin Memorial Hospital, already rolled out the option this week. Northern Light Health’s usually busy Cross Insurance Center mass clinic saw a slower week than usual, and the system is redirecting vaccines to its southern locations, said spokesperson Suzanne Spruce.

Benjamin Okafor, who founded Family Pharmacy in Eastport and Machias, said he gets two responses from patients when they are called to ask if they want to get vaccinated: they are either willing to wait for the one-shot vaccine to be restarted, or they have already gotten a shot somewhere else.

“One of their issues is logistics,” he said. “People don’t want to come back for the second shot. They prefer the Johnson & Johnson and want to wait it out.”

Okafor said he encourages people to not wait. His pharmacies still have a list of people who indicated they wanted to get vaccinated, but it is steadily decreasing. He was calling people on Friday, trying to see if he could muster 10 people for next Friday, the number needed to tap a Moderna vial and hold a clinic.

Noah Nesin, the chief medical officer of Penobscot Community Health Center, said the Federally Qualified Health Center opened appointments to the general public for the first time this week after running through interested patients. He said it was unclear how much benefit that decision would have, given its proximity to the huge Cross Insurance Center site in Bangor.

The center may eventually scale back efforts to model typical flu-season immunizations, he said, which could mean fewer, more targeted clinics. It could also mean having primary care doctors supplement those clinics to provide doses, noting those who are more hesitant might trust their providers more. The challenge to not waste doses would still remain, he said.

“There will come a time when all organizations switch to a practice-based method,” he said. “But I don’t think we’re there yet. I think we have several more weeks of this kind of effort.”