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Woodford County is the second-most-vaccinated county in Kentucky, with a rate 14 points higher than the state as a whole. It also happens to be firmly in so-called “Trump country”; the county just west of Lexington went for the former president by double digits in 2020.
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A stark political divide generally exists between highly vaccinated areas and those with lower rates. As of early last month, the rate of fully vaccinated people in counties that went for Biden was nearly 12 points higher (46.7 percent) than those that went for Trump (35 percent), according to the Kaiser Family Foundation.
But certain red counties, some of them in rural and sparsely populated areas, have managed to vaccinate a high percentage of residents during a pandemic that’s been politicized since its first victim. And what they’ve done to break through vaccine skepticism and misinformation could help show the way forward as the Delta variant overwhelms the nation’s hospitals, especially in areas where distrust in the government runs deep.
In Woodford County, home to fewer than 30,000 people, health department officials “got rid of every dose we had” during the early days of the vaccine’s availability, according to Cassie Prather, the county’s public health director. Since then, they’ve used a variety of methods, including working with local doctors. For someone skeptical of getting the vaccine, a physician they know and trust is much more likely to have an impact than a national figure like President Joe Biden or Dr. Anthony Fauci, or even a local government official.
“We say that if you don’t trust the health department or you don’t trust the government, then contact your local physician or someone that you know that had COVID or got the vaccine,” Prather told VICE News.
And at times, she said, health officials have even used the increasingly politicized conversation around the vaccine as a way to convince people to get the shot. “We remind people that Operation Warp Speed was created under Trump’s presidency,” Prather said, referring to the program created to facilitate the creation and distribution of a COVID vaccine.
Liberal strongholds pepper the list of the most highly vaccinated counties in the U.S.; of the dozen counties that have fully vaccinated 70 percent of all residents, according to the New York Times, Biden won all but one, 10 of them by more than 35 percentage points.
Generally speaking, the Republican-leaning counties that have succeeded so far tend to be wealthier than those that have similar political ideology but lower vaccination rates. Woodford County’s poverty rate is half that of Kentucky’s as a whole, for example, though Prather stresses that there’s a stark wealth disparity between residents of Versailles, Woodford’s largest city, and the rest of the county. (Nearly a quarter of Versailles residents live in poverty, according to census data.)
“We find that more-affluent counties have better health outcomes,” Prather said.
The demographics of Ohio County, Indiana, which went 75 percent for Trump in 2020, also make it a bit easier to get people vaccinated: The area skews older, with more than one in five residents over the age of 65. Right now, it’s the highest-vaccinated county in the state, with 70 percent of all eligible residents vaccinated. That reflects the national stats showing more than 90 percent of people over 65 have gotten at least one shot, according to Dr. Christopher Walcott, who grew up in the town of Rising Sun and now serves as the county’s public health director. He’s also a local primary care physician.
According to Walcott, Ohio County—which is the smallest in the state with fewer than 7,000 residents—was prepared when the pandemic began because it had already been running drive-thru influenza vaccine clinics staffed by community members for years. He also said their outreach has been apolitical in nature.
“The people who are working in the clinic are [patients’] neighbors, grandparents, sisters, teachers of people within the community,” Walcott said. “We took the politics out of it completely and made it a purely scientific endeavor.”
Sheila Davies, the public health director for Dare County, North Carolina, similarly credited the area’s majority-Republican board of commissioners with supporting the health department’s vaccination efforts.
“They’ve been nothing but supportive in all of our efforts,” she said. “And I think that that sends a very strong message to our community that it’s not about politics, it’s about protecting lives and the health of our community.”
Dare County is one of the most inoculated areas in the state, with 60 percent of all residents fully vaccinated—10 points more than the national average. It also went for Trump by more than 16 points in 2020.
“I’m not asking you to do something I’m not doing myself.”
Davies said that when vaccinations first started, her department, like most around the country, was overwhelmed with demand and that she would personally drive around the state to pick up vaccines from whoever was willing to give them. But once the supply got going, Davies said, the county was prepared.
“I attribute a lot of that readiness in resources to our constant state of readiness with hurricanes,” she said. “We were ready to set up, within days, mass vaccination clinics where we could vaccinate anywhere from 500 to 1,500 people. We just didn’t have the vaccine.”
Vaccination rates show a geographic split as well. Urban and suburban areas tend to be more vaccinated than their rural counterparts. As of August 10, the rural vaccination rate was just under 37 percent, compared with 48 percent in metropolitan areas, according to the rural-focused website The Daily Yonder.
“I think one of the things we need to really highlight is that rural America is not monolithic,” Mike Meit, director of programs at East Tennessee State University’s Center for Rural Health Research, told VICE News.
But Meit pointed out that in general, rural areas never really recovered from the Great Recession; the latest census data shows growth over the last decade took place almost exclusively in urban areas. And the feeling of being left behind has helped to foster a sense of distrust with the government, which has complicated a government-led pandemic response.
“When that’s your experience, and one party has taken you for granted and the other party has neglected you, you might be a little bit mad, a little bit distrustful, and you may even want to poke your finger in the eye of the system,” Meit said.
Misinformation about the safety and effectiveness of COVID vaccines—like the debunked conspiracy that they alter your DNA—has been an issue all over the country. In Ohio County, Indiana, Walcott has taken a delicate approach to dealing with it in the small community he serves. He doesn’t pressure his patients in either direction and chooses instead to give them all the information they need to decide for themselves.
“You always validate them and say, ‘That’s a reasonable concern, that’s a good question.’ And then let’s address that question,” he said.
Even wealthier areas that tend to have higher rates of vaccination, like Woodford County, still struggle with misinformation. “A lot of people are holding out because they want to hear from their personal longtime doctor,” Prather said.
In addition to vaccine clinics, Woodford County is working with local doctors to provide a voucher to their patients and expanding access by doing community events with local organizations and businesses, Prather said.
They’ve also focused on outreach to the county’s Latino community. While more than 86 percent of Woodford County residents as of 2019 were white and non-Hispanic, according to census data, Prather said that Woodford has a high Hispanic population relative to other parts of the state; 16 percent of Woodford County school students are Hispanic or Latino, according to the Kentucky Department of Education.
Prather credits the health department’s workers, several of whom are bilingual, in helping to lay the groundwork for the vaccination campaign.
“We already had a trusted relationship with our Hispanic community,” she said. “And so when the vaccine became available, they were ready and willing to receive it.”
Public health experts and local officials almost uniformly agree that direct outreach is the best way to persuade the unvaccinated, particularly in rural areas. But it has to to be from local community members rather than national politicians or federal health officials.
“The last thing my neighbors want to see or experience is having a person from the CDC knock on their door and ask them if they have the vaccine,” Alana Knudson, a principal research scientist at the Walsh Center for Rural Health Analysis at the University of Chicago who grew up in rural North Dakota, told VICE News. “I think it’s really important to remember that public health is local.”
“I think it’s more likely to be a faith leader, a business leader, a person in that community who has built influence and respect,” Meit said. “And I suspect that in those communities, you will find that there is somebody who is a vocal advocate who has a lot of community trust.”
But the GOP has often balked at the suggestion.
When President Joe Biden said last month that the vaccination effort would include “literally knocking on doors,” conservative media and Republican politicians immediately portrayed the effort as one where CDC employees would bang on your door and demand you get vaccinated. (Biden was referring to the COVID-19 Community Corps, a Department of Health and Human Services initiative launched in April.)
In Ohio County, Indiana, Walcott is quick to credit the county health department’s workers, but it appears he’s stepped into a hyperlocal version of the role played by governors and public health experts throughout the pandemic.
Earlier in the pandemic, Walcott frequently posted Facebook videos updating residents on the situation, and the department still updates residents on the county’s caseload and when it has vaccine doses available, along with other public health issues such as school vaccinations and mosquitos.
“The local newspaper would often quote my Facebook videos, and the older people who aren’t really on the internet who do get the paper, which we have a fair population of, would [get] that information,” Walcott said. “And when I got my first shot, [the paper] took a picture of that, and that was publicized.”
“I’m not asking you to do something I’m not doing myself.”
