Health officials are adding a dose of creativity in their push to vaccinate more Minnesotans and slow COVID-19.

In Duluth, they're offering vaccine shots in the downtown bus depot.

In St. Paul, volunteer physicians are working with a local brewery on a pop-up event that rewards those who get vaccinated with a free beer.

And in the northwest metro, an Elk River clinic is offering shots to patients as they seek help for other health care needs.

The strategies are meant to persuade Minnesota's unvaccinated to finally get their shots at a time when the pace of COVID-19 immunizations has slowed significantly. Since early April, the statewide average for first doses administered has fallen from about 40,000 per day to fewer than 14,000 at the end of last week, according to the Star Tribune's vaccination tracker.

"We're seeing a shift now from the earlier phases of vaccination, where there were folks very eager to get the vaccine and able to go to, sometimes, pretty extraordinary lengths to go find the vaccine wherever it was," said Jan Malcolm, the state health commissioner. "Now we're in a situation where we've got plenty of vaccine supply, and we need to reach those folks and make it more convenient for them."

On Saturday, the Minnesota Department of Health reported another 1,321 cases of COVID-19 as well as eight more virus deaths. The tally for Minnesotans with at least one vaccine dose increased to more than 2.64 million people.

Last week, Gov. Tim Walz announced the state's indoor mask mandate will end July 1, but could be lifted sooner if 70% of those age 16 and older receive first doses — just over 3 million people.

Health care providers outside the Twin Cities metro say the dwindling demand for immunizations has been dramatic. In south-central Minnesota, Mayo Clinic consistently provided 1,200 first doses per week in February and March but saw the tally drop to just 172 by the last week of April.

Supply wasn't the problem, so the decline likely stemmed from a number of factors, said Perry Sweeten, a pharmacist at Mayo. A surge of COVID-19 cases across Minnesota this spring could have played a role, since patients with recent infections are told to wait 90 days before getting vaccines, said Dr. Gregory Poland, a vaccine immunology specialist at Mayo.

"The demand ... just plummeted out of the sky," Sweeten said in late April. "All of a sudden, the phone lines aren't ringing."

In the Bemidji area, Sanford Health went from providing more than 800 first doses per week at the start of April to fewer than 200 per week by month's end. The drop came as federal regulators called for a pause in the use of the Johnson & Johnson (J&J) vaccine out of safety concerns.

Some who wanted the single-dose J&J because of its convenience might have held off to see if the vaccine returned, said Dr. Colleen Swank, the clinic vice president for the health system's operations in northern Minnesota. Others might have waited to "make sure that the other vaccines weren't going to have a pause as well," Swank said.

The J&J pause "certainly didn't help," but it's likely not a huge factor in the decline, said Dr. Abe Jacob, the chief quality officer at M Health Fairview. Health care providers were seeing less demand before the pause, Jacob said, adding that the safety issue is so rare that "there are many other things that we all choose to do in life that are more risky."

J&J is now back in use along with two-dose vaccines from Moderna and Pfizer.

Because some are reluctant to get vaccinated because of safety and effectiveness questions, doctors are highlighting how well the vaccines work, Jacob said. At Sanford's hospital in Bemidji, Swank said, all 12 patients with COVID-19 on Thursday lacked full vaccine protection when they got sick.

"I'm confident that we can get there," Jacob said. "It's just going to take a little more time."

Minneapolis-based Allina Health System went from providing about 12,000 first doses per week in April to 9,000 by month's end. Hennepin Healthcare expected to provide 1,181 first doses across nine vaccination sites during the last week of April, but wound up delivering just 712.

At HealthPartners, partial-week numbers put vaccine demand at about two-thirds of normal, said Dr. Mark Sannes, an infectious disease specialist. With more supply, the health system has launched a pilot program at clinics in Elk River, Minneapolis and St. Paul to routinely offer unvaccinated patients a COVID-19 shot as part of their visit.

At Allina, when patients call for an appointment, the health system's operators will offer to schedule a COVID-19 vaccination, said Dr. John Misa, chief medical officer for the health group. Over the next two weeks, Hennepin Healthcare will offer vaccine at more than 20 events planned at churches, schools, community centers and restaurants, said Dr. Deepti Pandita, chief medical information officer.

Children's Minnesota is dispatching a mobile clinic to provide vaccines in West St. Paul. Winona officials are pairing an immunization event with a free concert and screening of "West Side Story." Vaccine also is being offered Monday outside Lake Monster Brewing in St. Paul, where recipients will get a coupon for a free beer of their choice.

"The best way to get the hospitality industry back up and running is to get COVID under control, and the way to do that is to get people vaccinated," Matt Lange, the brewery's founder and brewmaster, said via e-mail.

Volunteer doctors in conjunction with a local pharmacy can offer up to 300 immunizations at the event, said Dr. Anne Griffiths, a pediatric pulmonologist at Children's Minnesota who is part of the physician group. The doctors have been providing vaccine at schools for those age 16 and older and plan to quickly expand the work if federal regulators this month clear use of the Pfizer vaccine for younger students. They've also been providing vaccine at a variety of workplaces.

"I find more and more people that are being described as anti-vaccine are not anti-vaccine — they wouldn't even describe themselves as necessarily vaccine-hesitant," Griffiths said. "Maybe [they're] apprehensive, but they want their questions answered, and they are looking for convenience and patience."

In Duluth last week, Alex Nikstad's lunch break had just started when a St. Louis County public health nurse told him about the vaccine event. He followed her across the street to a mobile clinic set up inside the Duluth Transit Authority's transportation center lobby.

"I have been on the edge about getting one and kind of dragging my feet at the same time," said Nikstad, 21. "It was a perfect opportunity."

West Duluth resident Patrick Farley arrived by bus to be inoculated. He'd been skeptical of the vaccine, but his daughter, a nurse, convinced him.

"I figured, it's time," he said. "I knew I was going to do it and I was coming through here anyway."

Staff writer Jana Hollingsworth contributed to this report.

Christopher Snowbeck • 612-673-4744