Inside a Norristown church hall this week, Val Arkoosh lifted her cell phone in her right hand as a nurse rubbed her upper left arm with an alcohol swab, preparing the Montgomery County Commissioners chair for her coronavirus vaccination. Arkoosh, a physician, smiled behind her double mask as she recorded a video message for residents of Pennsylvania’s third-largest county.

“There’s one safe and simple thing you can do to get back to normal, and that’s to get vaccinated,” Arkoosh said, panning left to capture a nurse positioning a syringe of the Johnson & Johnson vaccine above her arm. The needle went in. “Now, it’s your turn.”

Arkoosh hoped her words would resonate with those yet to get vaccinated, in light of reports of increased hesitancy about the J&J shot, which is available again after a safety pause was lifted last week.

Arkoosh and fellow commissioner Ken Lawrence got the one-dose vaccines publicly on Wednesday in an attempt to keep up their momentum: Of Philadelphia’s suburbs, Montgomery and Chester Counties continue to see the steepest increase in percentage of residents vaccinated, according to an Inquirer data analysis.

Elsewhere, there are signs of plateaus. Delaware County, which is the most racially diverse of the four suburban counties and has the lowest median income, is battling access barriers, officials said, and it will likely be weeks or months before it even begins addressing hesitancy. Meanwhile, wealthier, more conservative Bucks County is up against misinformation and hesitancy, with many people saying they want to wait a little longer before getting shots.

» READ MORE: ‘The challenge to come’: Vaccinations are open, but demand is down, turning Pa. and Philly’s focus to fighting hesitancy

Overall, however, there’s promising news about Pennsylvania’s vaccine efforts, and progress has been swift since the state opened eligibility to everyone 16 and older earlier this month. As of Thursday, more than half of Pennsylvania’s eligible population had gotten at least one shot, according to Inquirer data analysis.

So have more than 60% of Montgomery and Chester Counties’ eligible populations, according to the analysis, and in Delaware and Bucks Counties, that number is hovering closer to 50%. It’s even lower in Philadelphia, where 43% of the eligible population is immunized, according to city data. By a federal measurement, Pennsylvania on Thursday ranked 10th among the 50 states for distribution.

Gov. Tom Wolf said Wednesday he was concerned about whether Pennsylvania would reach a rate of 70% to 80% of the population vaccinated, the estimated level needed to reach herd immunity. But he saw reasons to be optimistic, including high uptake among seniors and few people reporting in hesitancy polls that they never want to get the vaccine.

Philadelphia Health Commissioner Thomas Farley and other local officials said it was likely the number of daily vaccinations would continue at a steady, lower rate for weeks or months.

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“It seems like the demand has, in some ways, fallen off a cliff very quickly,” said Bucks County Health Director David Damsker. But he added: “As long as we keep vaccinating people, even if it’s not quite at the same rate, we’re still going to see cases drop. I’m still very optimistic.”

Access becomes key

While Philadelphia is working to increase outreach, Farley said last week he is encouraged that there has not been a significant drop in vaccinations at city-run neighborhood clinics, which are still vaccinating between 400 and 500 people per day.

“To me, that’s a lesson that putting vaccination closer to people’s homes is a way to get people who are still unvaccinated,” he said. “And I think that’s because those people are not opposed to vaccination, but just have many other things going on in their lives.”

That question of access becomes key as demand slows, said Harald Schmidt, a medical ethics and health policy professor at the University of Pennsylvania who has been studying vaccine allocation.

While stakeholders statewide are working to methodically reach people who are experiencing homelessness, have a disability, or are homebound, broader issues of access also persist for shift workers, people without transportation, those in nonwhite and low-income communities, and others.

» READ MORE: How a Philly health worker delivers leftover COVID-19 vaccines before they expire to homebound residents

“There’s a lot of talk about vaccine hesitancy that is very problematic, I think, because it can very quickly turn into victim-blaming. ... In many cases, it is still not that easy to be vaccinated,” Schmidt said. “Just because people aren’t requesting it doesn’t mean they don’t want it.”

Delaware County officials have seen that every time a pop-up clinic has opened in Upper Darby or other densely populated areas bordering Philadelphia, said Monica Taylor, vice chair of the County Council. When neighborhood clinics open, “they’re filling the appointments.”

That means the county’s current challenge is “making sure we’re getting into the pockets of the community that don’t have access,” Taylor said.

County officials have tried to tap into “trusted messengers,” such as church leaders who can advertise clinics to their congregations, Taylor said, and to locate sites in places that are walkable or accessible by public transportation.

And across the county, all clinics now allow walk-ins, making vaccination more convenient for people with unpredictable schedules and allowing families and friends to get vaccinated together.

Addressing hesitancy

In Bucks County — which has a similar vaccination rate to Delaware County — increased concerns after the J&J pause and unfounded fears about all coronavirus vaccines may be contributing to a no-show rate of about 10% for appointments booked with the county this week, Damsker said. But he believes, too, he said, that people may change their minds.

» READ MORE: Nervous about getting the COVID-19 vaccine? Don’t believe these myths.

“I do believe that many people can be [convinced] if they’re spoken to by someone at the health department or someone who knows what they’re talking about and isn’t going onto some random Facebook page,” Damsker said. “There’s a Facebook page that says Pfizer will change your DNA, and that’s not true. But if that’s all the information you’re looking at, that can clearly be scary for people.”

Damsker said the CDC should go bigger than its announcement this week that vaccinated people don’t need to wear a mask in many outdoor settings. Advertising what people can do when fully vaccinated, he said, will incentivize people still on the fence.

“There’s a solid group of people that are willing to get it but they’re not rushing to get it,” he said, “and I think we need to reach those people.”

» READ MORE: More coronavirus vaccinations are key to fully reopening Pennsylvania and New Jersey, governors say

Meanwhile in Chester County, the state’s wealthiest, 65% of its eligible population has received at least one dose, according to state data, putting it at the top statewide.

Yet having a large portion of the population with a strong desire to get vaccinated only helps decrease hesitancy through word-of-mouth for so long, said health director Jeanne Franklin, and only in the communities where vaccinated people live, work, and socialize.

“I think if the 60% to 70% [vaccinated so far] doesn’t look and sound like those that are waiting, it doesn’t matter,” Franklin said.

Reaching the last 30% — people for whom vaccination is not “their go-to decision” — can be achieved through “kitchen-table talks” or conversations with family doctors, Franklin said.

“Some of the hesitancy is ‘I want my own doctor to do this,’” she said, noting that many people distrust the government. So “let’s make sure that the physician’s office gets the vaccine.” (Wolf said Wednesday that Pennsylvania is expanding its provider list to include more family physicians.)

Arkoosh attributed Montgomery County’s success to diverse outreach, including televised town halls in multiple languages.

“We’ve just given people the facts,” she said. “I find as a doctor that when you give your patient the information … and the tools they need to make their own decisions, most times people will make the decision that’s going to protect their health.”

As for Farley’s assessment in Philadelphia that the “era” of mass sites is drawing to a close, suburban county officials said they also saw the end in sight for these high-volume clinics in favor of more targeted outreach.

“I don’t look at it as hitting a wall. We’re just moving, shifting,” Franklin said. “People come to us vs. we go to them.”