Some Rural Counties Battle Vaccine Hesitancy

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Nearly a month ago, Joseph P. Fiumara Jr. started noticing a worrisome trend at COVID-19 vaccine clinics run by his health department in eastern Oregon: more and more appointments for first doses went unclaimed.

Even as additional Umatilla County residents became eligible, doses sat unused. In stark contrast to the Portland area, where appointments can be gone in a flash, even walk-in clinics hadn’t filled up.

The county kept accruing a surplus of doses. Enough to start raising questions.

“Why do we only have 100 people planning to come?” Fiumara wondered last week in advance of a two-day clinic where 800 first doses would be made available.

It’s not an easy question to answer.

As Oregon prepares to open the vaccine floodgates to everyone 16 and older April 19, state health officers and rural leaders in some counties face a potential issue: What to do with the not-insignificant portions of the population who apparently aren’t clamoring for a shot.

It’s a question that’s hummed at a low level in the background for months until finally reaching a crescendo last week, when Oregon Health Authority Director Patrick Allen said seven counties had vaccinated less than half their seniors. The problem, health officials warned, would likely grow as younger and healthier Oregonians become eligible and any possible late-adopters get crowded out.

Allen told lawmakers during a legislative hearing Wednesday that Oregon will change how it distributes vaccines to a more “demand-based model” instead of directing largely on per-capita eligibility. That would seemingly spell bad news for Umatilla County and other locales where demand has been tepid. Allen said the change is “so that we don’t over-allocate to places where we can’t administer those doses efficiently.”

The policy change could create a self-fulfilling prophecy, where early hesitancy prompts fewer doses in the community and helps keep some counties under vaccinated. Fewer people vaccinated makes it easier for the virus to continue spreading and, potentially, mutate.

The scale of the challenge in parts of rural Oregon remains difficult to enumerate. Some of the counties hardest hit by COVID-19 appear to be among the least vaccinated. But rural leaders question if there are unknowns behind those numbers, like how many residents were vaccinated by tribes, the federal government or in neighboring states.

Umatilla County previously ranked near or at the top in state data for most infections per capita and at the bottom in vaccines administered per capita – a problem that health officials, business leaders and politicians acknowledge likely reflects reality.

As of Friday, Umatilla still had the lowest vaccination rate in the state, with about 21% of people at least partially inoculated, and Malheur was second worst at 22%, according to the state’s recently updated database. The Centers for Disease Control and Prevention, which calculates rates based on full vaccinations, ranks both better.

Umatilla county officials think the figures are slightly better than what shows up in Oregon’s database, particularly among people 65 and older.

“We think perhaps 60% of our seniors have probably gotten a vaccine,” said George Murdock, chair of Umatilla County’s Board of Commissioners. “But when you realize that 75% of the deaths are among that age group, it’s mind-boggling why that number wouldn’t be considerably higher.”

In fact, as of Friday, only about 55% of the county’s seniors had received at least one dose of vaccine. That’s significantly below the statewide average for seniors of more than 70%.

“I can’t fathom why somebody wouldn’t,” Murdock, 78, said of getting the vaccine. “I got mine on the first day” of eligibility.

The hesitancy is frustrating, Murdock said, because he’s adamant the county should have received more doses in the first place. County officials were particularly steamed when doses from many rural parts of the state were funneled toward the metro area in late January to help inoculate health care workers and teachers there. That anger lingered.

The commission sent a blistering letter to Gov. Kate Brown’s office March 3 calling the vaccine distribution “unconscionable” and decrying the “embarrassing contradiction” in the state’s vaccine plans by not funneling more shots to Morrow, Malheur and Umatilla counties.

“We have several things in common with both of those counties in that we have collectively suffered from the highest rates of infection and we are three of the five counties with the highest Latino population,” Murdock and the other commissioners wrote.

The supply lag due to smaller portions of health care workers and teachers left the county playing catchup.

“We needed more time to get the attention of farm workers,” he said.

Murdock said he is now concerned the county, which typically has a low percentage of people who get flu shots, will miss out on its coveted summer events – fairs, rodeos, the iconic Pendleton Roundup and more – because the state will not authorize large gatherings due to low vaccination rates or perceived COVID-19 risks.

Fiumara doesn’t think the county’s problems are as extensive as they appear in the data -- due to people getting shots at the Jonathan M. Wainwright Memorial Veterans Affairs Medical Center in Walla Walla, Washington or the Yellowhawk Tribal Health Center in Pendleton, where about 1,050 non-tribal members have been vaccinated.

But he can’t deny the reality he’s seen with his own eyes.

On the first day of the clinic he operated last week, they used just 82 first doses. On day two, officials administered 139 first doses. They had enough supply for 400 first doses each day. Second doses tallied 407 and 346 on each of the two days respectively, showing that there had been more demand from residents several weeks earlier who returned for boosters.

Fiumara blames an ideological divide for a piece of the problem now.

“I really don’t understand how a vaccine produced under a Republican administration and continued to be dispersed under a Democratic administration falls under party lines,” he said.

Fiumara said they are trying to bring mobile vaccination clinics to work sites, but adoption rates vary. A recent event at a county employer drew 29 signups ahead of time and 48 people ultimately showed up to get a shot.

That was viewed as success. “They want the one dose shot,” Fiumara said of the Johnson & Johnson vaccine.

“We’re trying to find every barrier we can identify and find a way to reduce it.”

Over in Umatilla County’s city of Hermiston, Kristina Olivas, the new executive director of the local chamber of commerce, said she’s not surprised by the low adoption rate and high infection rate.

Olivas, who was born and raised in Hermiston, said her 87-year-old grandmother is one of those locals who is doing well, as is, and is uninterested in a vaccine.

“I don’t leave the house anyway,” she said of her grandmother’s thinking, “I’m not getting it.”

When asked if Olivas tried to convince her to take the shot, Olivas demurred: “She’s a real strong woman, she’s going to do what she wants.”

Early Intervention

Where Umatilla has struggled even in recent weeks, Morrow County got a shout out from the governor and health officials for its successes last week. Melissa Lindsay, a county commissioner, said the county raised its hand two months ago to partner with Federal Emergency Management Agency to reach agricultural workers in the rural area.

The mobile clinics brought shots directly to people at their workplaces.

It was a pain to get the program off the ground, she said, but ultimately the county administered 1,000 doses in the span of four days.

Despite that success, Lindsay is concerned there’s still reluctance from some quarters in the county, where about 25% of the population has received at least one vaccine dose. Some calls to big employers are met with reluctance, with people saying they would wait and see what restrictions, if any, will meet those who don’t opt for a vaccine.

Some express concern about the long-term effects of the new vaccines, Lindsay has heard, a concern scientists say isn’t an issue. She’s worried that while the mobile clinics were a success, other agricultural workers are already in the fields and may not be reachable.

“The spring has sprung, and everyone is going full speed ahead,” she said.

In Hood River County, early invention with agricultural workers paid dividends. Ed Weathers, president of Duckwall Fruit in rural Odell, said his pear packing and shipping company started educating employees two months ago about vaccines.

But by that point, the company had already had a sizable outbreak half a year earlier, starting in May 2020. Ultimately, the state documented 69 confirmed COVID-19 cases connected to the facility.

Despite that pandemic history, the company still saw vaccine hesitancy. Weathers said an early survey of the 200-plus-person crew indicated just 40% would opt for a vaccine. But they kept plugging away and educating workers about the vaccines’ efficacy and safety. By the middle of March, a new poll yielded 70% likely to take the vaccine.

In its first clinic on site March 23, roughly that same percent of the workforce received a Johnson & Johnson vaccine.

A second clinic this week saw several hundred more vaccines administered to a combination of Duckwall workers and agricultural crews from elsewhere. Weathers said workers have the option to be vaccinated, and most are opting in.

“I think it’s just education and the time that people had to prepare and educate themselves,” he said.

Listening To Concerns

Sarah Poe, public health director for Malheur County, said the local numbers don’t tell the full story.

“The situation is not as bad as you think it is,” Poe said of hesitancy in the massive county, which is nearly the physical size of Massachusetts but has a population of about 31,000.

In Malheur, convenience is a huge part of the puzzle.

Poe noted that Idaho’s Payette, Washington, Canyon and Owyhee counties, all of which border Malheur, also have low vaccination rates according to Idaho’s official tallies.

“It’s likely because we have vaccinated so many of them in Oregon,” she said, citing high numbers of Idahoans who work in Oregon. According to the state’s vaccination website, 44,526 people vaccinated in Oregon so far had an address outside the state.

Malheur is also heavily dependent on Johnson & Johnson’s single-dose vaccine because some people live far away and only want a one-and-done option. But that vaccine only recently became available and manufacturing challenges and production mistakes have led to limited supply.

County officials have gone to major employers like Heinz North America, which has roughly 700 employees in the county, and tried to hit workers on multiple shifts.

In some ways, Poe said, rural counties have it tougher than the metro area. “There’s some ease in administering vaccines when you are able to just put shots in arms in the big, long lines that are just waiting,” she said of the mass clinics in the Portland area.

Poe said hesitancy is misunderstood, and she doesn’t think it is a product of politics or people “hating science.”

“People just need to feel that their fears are heard,” she said. “And that their personal concerns are listened to.”

Poe said Malheur, where more than one-third of the population is Hispanic, is doing its best to share information about the vaccine’s safety. With time, more people will see that it’s safe, she predicted.

While national polls have indicated Republican men are the most likely to say no to a vaccine, Poe said that doesn’t capture the whole story in her county. Poe said a lot of it comes down to trust of government, and she said people of color and immigrants trust the government less than white Republican men.

The Oregonian/OregonLive’s Mark Friesen contributed to this report

-- Andrew Theen; [email protected]; 503-294-4026; @andrewtheen

This story was originally published by The Oregonian/OregonLive and is posted here through an coronavirus-sharing agreement among a dozen media outlets in Oregon.

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