Geography, politics loom large as COVID-19 vaccination momentum wanes

Geography, politics loom large as COVID-19 vaccination momentum wanes

Bladen County, shown on this map in red, is the only county in North Carolina with “critical community spread.” Bladenboro accounts for 60% of the cases in the county. (Map: NC DHHS)

Lack of access, “Trump effect” both acting as roadblocks

COVID-19 vaccines are hard to come by in Bladenboro, the small southeastern North Carolina town that was the center of a COVID-19 cluster that pushed its home county into the red zone on a virus alert map.  

But even after the state publicized the infections and a vaccine clinic came to the middle of town for a day, almost no one wanted a shot.  

Vaccine refusal and lack of access are twin dilemmas health officials are trying to solve as vaccination rates decline and the highly contagious Delta variant gains a toehold.  

It was a jump in cases in Bladen County, 60% of which the state Department of Health and Human Services determined were in Bladenboro, that made the county the only one in the state determined to have “critical community spread.” 

Convenience is at the center of efforts to reverse the decline in COVID-19 vaccinations nationwide and in North Carolina. The strategy is to get vaccines into neighborhoods and places where people naturally travel, and make shots available during non-working hours.  

U.S. Secretary of Health and Human Services Xavier Becerra emphasized easy access to vaccines last Wednesday during his visit to a pop-up clinic at a Charlotte transit center. 

“It is great to see a vaccination site where the people are,” Becerra said, according to a WFAE report. “That is perhaps the greatest thing about this is that you don’t have to come to us, we will come to you to get vaccinated.” 

A DHHS census-district map shows a number of communities similar to Bladenboro – places with vulnerable populations where getting a vaccine requires a concerted effort and travel. And not only do rural areas have less access to vaccines, rural residents are more likely to say they don’t want them.  

The DHHS census district map shows that the closest places to Bladenboro for walk-in appointments are clustered in the county seat of Elizabethtown, about 14 miles away along two-lane country roads.  

An online vaccine search site shows one location in Bladenboro, a pharmacy called The Medicine Shoppe. The site also shows the pharmacy is “out of stock.” In truth, the pharmacy never had vaccines, said owner Mark Hester. He wanted to offer them, and still wants to in the future, but he had trouble getting through the provider enrollment process.  

“I’m sure we could have figured it out, but we have too much else to do,” he said.  

“We still hope to be able to give vaccine in the future here. I would expect that it’s going to be needed in the future,” Hester said. “We just couldn’t get it all in place and feel like we were ready to do it and could provide it in an appropriate fashion and have everything in place. We want to help and do what we can do help. We encourage people to get it.” 

A medical clinic in Bladenboro has vaccines for its patients, but it does not accept walk-ins, said Chaka Jordan, vice president for marketing and communications for the Cape Fear Valley Health System. 

Bladen County’s Department of Health and Human Services has walk-in appointments, free van rides to get there, and has sponsored vaccination events. (Photo: Lynn Bonner)

The Bladen County Department of Health and Human Services has walk-in appointments at its office in Elizabethtown, free van rides to get there, and has sponsored vaccination events at locations around the county, director Teresa Duncan said in an interview. The department offered shots at the Bladenboro Fire Department July 1 and May 24. In an effort to reach underserved populations, the department offered vaccines during a Juneteenth celebration in Elizabethtown. 

But the news in late June about the COVID-19 outbreak in Bladen triggered no corresponding rush for vaccinations.  

On June 25, 33% of Bladen residents were fully vaccinated, according to the DHHS. On July 8, the fully vaccinated count in Bladen had crept up to 34%. Statewide, 43% of the population was vaccinated, according the DHHS dashboard on July 8. 

“We’re trying to take out roadblocks,” Duncan said. “It’s just the hesitancy.” 

A statewide problem

The pace of vaccinations has fallen rapidly in North Carolina, despite incentives such as $1 million lottery draws, $25 cash cards and free admissions to the North Carolina aquarium.  

Healthier Together, a partnership between DHHS and the NC Counts Coalition, announced this month it had awarded a total of $500,000 in federal COVID-19 relief funds to 26 nonprofits that will work in underserved areas to distribute vaccine information and doses. The grants range from $7,000 to $50,000, according to a press release.  

One of the nonprofits, Duplin Christian Outreach Ministries, will work in Bladen and seven other counties.  

That work has not begun, said ministries Executive Director Jeralene Merritt. The group plans to begin distributing information and offering vaccines next month and is looking for a partner in Bladen County, she said.  

NC Central University conducted surveys last year on vaccine hesitancy and health communications in rural counties where it offered free testing. That work has continued to reveal how vaccine hesitancy has changed over time.  

Vaccine hesitancy among Black residents declined quickly, said William Pilkington, director of NCCU’s Hope program. But in recent months, the interest in the COVID-19 vaccine has waned, he said.  

At an event in Pamlico County last month, only eight people got shots, Pilkington said. At a vaccination event in Rowan County, four people did.  

The cash cards have motivated some people to get shots, he said. But while someone in a vehicle gets vaccinated, others riding along often won’t. 

Pilkington said some who have refused vaccinations repeated falsehoods they’ve heard about the vaccine. One person repeated a widespread myth that the vaccine changes people’s DNA. 

“I’ve read a lot of misinformation that we’ve not done a very good job of addressing from a national perspective,” he said. “I think it may be too late.” 

Partisan, regional, racial divides

A Kaiser Family Foundation survey from April found that 17% of rural residents said they would definitely not get a COVID-19 vaccine, compared with 9% of urban residents. There’s a higher resistance to vaccines in rural areas that results from the disproportionate share of Republicans and white Evangelical Christians living in those areas, the Kaiser Family Foundation reported. Recent national polls have shown that Republicans are less likely than Democrats to be vaccinated. And states that voted for President Joe Biden generally have higher vaccination rates than states that went for Donald Trump.  

According to a Washington Post-ABC News Poll released this week, 47% of Republicans said they would probably not or would definitely not get vaccinated, compared to 6% of Democrats.  

NPR reported in June that Biden won 22 states with the highest vaccination rates, and Trump won 17 of 18 states with the lowest vaccination rates. The analysis counted adults who had received at least one dose. The Kaiser Family Foundation reported Thursday that the partisan divide in vaccinations is growing.  

The county-level picture in North Carolina is more mixed. Biden won urban counties, and most of them have greater percentages of their populations fully vaccinated. But two of the top counties for COVID-19 vaccinations — Dare, where 60% of people are fully vaccinated, and Hyde, where  55% are — went for Trump. Hoke County, which has the lowest percentage of fully vaccinated people, voted for Biden.  

Michael Bitzer, a political scientist at Catawba College, wrote about politics and vaccinations in North Carolina on the blog Old North State Politics 

Trump’s county vote seems to be only one factor impacting vaccination percentages, Bitzer wrote. According to his statistical analysis, per capita income, county racial demographics, the percentage of the population that had COVID, and ruralism also affect vaccination percentages. Vaccination rates rise with per capita income, he wrote. Urbanism doesn’t have an effect.  

Countering national poll results, rural North Carolina counties are more likely to have higher vaccination rates than suburban counties.  

Bitzer said his model explains about 60% of a county’s vaccination percentage. “It’s likely something else is going on we may not be able to quantify or have not thought of capturing,” Bitzer said in an interview.  

Hyde is an outlier. It went for Trump and has a lower per capita income and an above average vaccination rate.  

Rural northeastern counties that went for Biden have higher percentages of Black, Latinx and Native American residents, who may want to “wait to see how this thing plays out because of past historical dynamics,” Bitzer said. 

Politics and misinformation

Lawrence Kenley, a 57-year-old Bladenboro resident, said he was eager to be vaccinated and has been for months. He’s heard about the spike in COVID-19 infections in Bladen, and said local residents’ allegiance to former President Trump is at the core of the low vaccination rate.  

“Most people around here are Trump supporters,” said Kenley, who is Black. They listened when Trump downplayed the risk of the virus and the severity of COVID-19, he said.  

“They see people dying around them, and they’d rather believe him than believe the science,” Kenley said.  

A third of Black residents in Bladen are fully vaccinated, according to DHHS, compared to 30% of white residents.  

More than half of the COVID-19 cases in Bladen are among white residents, according to DHHS. The information does not show how many cases were among Black residents. Information on race in 29% of the Bladen cases is suppressed. The race for 16% of cases is labeled “other.” 

In its June 28 press release, DHHS said that 60% of new Bladen County COVID-19 cases in the first weeks of June were associated with a cluster in Bladenboro, and that 81 cases and one death had been linked to the area. People 49 years old and younger accounted for more than 60% of the cases; 63% of cases were among white people and 15% were among Black people.  

The Bladen County Health Department offers drive-up COVID-19 testing at its Elizabethtown office. Traffic was slow Wednesday afternoon. For long stretches, no one arrived.  

Two men outside the Bladen health department said in separate interviews that living in a remote area protects them. That’s not true. DHHS reported last fall that some of the fastest viral spread was in rural counties.  

Kris Rush, 24, said two of his co-workers had tested positive for COVID-19, so he decided to get a test while he waited for his girlfriend to finish her health appointment.   

Rush, who lives in the tiny community of White Oak, said he has not been vaccinated and doesn’t think he needs it. “I’m not big into stuff like that,” said Rush, who is Black. “I stay out in the middle of nowhere. I’ve been pretty safe.” 

A 30-year-old white man who would not give his name said while sitting in the health department parking lot that he would not get a COVID-19 vaccination. “They say the shot causes cancer,” he said, repeating a common and false myth. “I do believe that. I’m scared to get any shots. I try to stay away from everybody.”