JOHNSON CITY, Tenn. (WJHL) – Dr. Karen Shelton had words of wisdom for a Congressional panel discussing the struggle to increase COVID “vaccine confidence” — show people respect and don’t overestimate vaccine hesitancy in rural areas.
“Many labeled as hesitant have simply not had access to vaccine or opportunity to have their questions answered,” the Mount Rogers Health District medical director told members of the House Energy and Commerce Oversight and Investigations Subcommittee during a virtual hearing.
“We feel it is important not to label our population in order to avoid creating resistance where it may not truly exist.”
Shelton is also acting director of the Lenowisco and Cumberland Plateau districts of Southwest Virginia. Her purview encompasses an area larger than the entire state of Connecticut.
She told members at the hearing titled “A Shot at Normalcy”: Building Covid-19 Vaccine Confidence” the reasons behind lagging vaccine uptake in rural areas like hers aren’t simple.
Virginia 9th District Congressman Morgan Griffith agreed. The Salem Republican represents the region and said there’s definitely a wrong way to try and convince people in his district to do something they may have some skepticism about.
“You want to turn folks off, come in and say ‘we’re from Richmond or we’re from Northern Virginia and we’re gonna tell you how to do it,'” he said. “That doesn’t work in our area.”
Southwest Virginia is filled with isolated communities, spotty broadband and cell service and plenty of other vaccine impediments having nothing to do with people’s political views or other commonly held conceptions about why fewer people in rural areas are getting vaccinated.
“We realized early on that the vaccination rollout heavily favored the tech savvy,” Shelton said. “Those with internet, cell service, smart phones and computers.”
Shelton noted Southwest Virginia’s early vaccination success – nearly 11 percent of people in the region were fully vaccinated in late February compared to less than 7 percent statewide. The state caught up in April and now the region is almost 12 points behind the state total of 43 percent. She said the typical rural challenges have played roles.
Another panelist — Shelton was the only one of five who was a local public health official — said just 12 percent of Americans say they won’t get the vaccine. Nearly 20 percent are “fence sitters.”
Shelton said getting those folks vaccinated over the coming months will require success in strategies like the one her districts are pursuing — but also adequate resources, support and messaging at the national level.
“We know our communities well, including the assets and barriers to care in our communities, distinct local culture, the industries and living situations that may pose challenges, as well as the community-level partners and organizations that must be included to be successful,” she said.
She said some people just need more time before they’re ready, and even then, getting to them in a way that’s convenient can be difficult. Only 48 percent of households in the area have broadband subscriptions, making online appointments a barrier, and vaccine access points aren’t just around every corner like they are in most more urbanized places.
“We are scheduling outreach and mobile clinics at farmers markets, festivals large and small, high traffic areas such as convenience stores, and places people are already gathering,” Shelton said.
Those include restaurants, breweries, wineries, churches, hiking trails, sporting events, food banks, parks and music events.
“We are partnering to give tickets as an incentive for vaccines, and we are creating messaging with trusted local voices.”
Even as that effort continues ramping up, though, Southwest Virginia has seen a gap between its per capita vaccination rates and those of the state swell to a reported 15 percent for first-doses administered.
Committee chairwoman Diana Degette, a Colorado Democrat, asked Shelton where that leaves her team. She said it will take time – and more resources that pair vaccinators with educators – currently in short supply — as mobile teams visit isolated communities.
“We do have some community health workers beginning to come on line but again training them and getting them up and going to be able to actually answer those questions on the spot, paired with people who are there to give vaccines would be very helpful in our ongoing strategy,” Shelton said.
She also said the likelihood that some residents may have gotten vaccinated in any of the five states within easy driving distance “makes it challenging to discern our true vaccine numbers.”
The region is also home to a high proportion of military veterans, many of whom have probably gotten vaccinated at VA facilities in Johnson City, Tenn. or Salem, Va. and whose numbers also aren’t being included in their home counties’ data.
“Virginia is working to access this data,” she said.
Even if all those vaccinations found their way into the counties’ systems, though, the region would likely be well behind state and national averages.
Shelton stressed several times that a respectful approach using trusted community members is just as important as the additional resources she said the federal government needs to provide.
“We do respect all the viewpoints here and we try to work with people in their own communities and to address their concerns specifically by not labeling them but giving them time,” she said.
“People without internet access may not have had all their questions answered yet.”
With vaccine fence sitters numbering about a fifth of the population, Griffith said closing first dose gaps between rural areas and more urban ones trumps politics.
“As the chairwoman pointed out this is not a Democrat or Republican issue this is about all of us working together,” he said.