In Rural Arkansas, a Shocking Loss Wards Off Vaccine Hesitancy
(Bloomberg) -- Bradley County, Arkansas has much in common with communities across the U.S. that have seen widespread resistance to vaccinating against Covid-19: It is extremely rural, heavily Republican and has significant Black and Latino populations.
Yet Bradley is an outlier in a state where uptake of vaccines is among the lowest in the nation. In July, Gov. Asa Hutchinson announced it was the first county in Arkansas to vaccinate at least half of the eligible population. At the time, that was more than twice the rate of several other counties in the state.
As the delta variant rips through the country, calls from public-health experts to increase vaccination rates have fresh urgency. The relative success in Bradley — a county of about 10,000 people — could provide a blueprint for areas struggling to boost vaccination rates.
Coordinated efforts by local health practitioners ranged from vaccine clinics at timber plants to online videos about how to slow the spread of the virus. Those initiatives gained traction after Bradley’s early introduction to the grim toll of Covid-19 when a beloved, retired schoolteacher died from the virus in April 2020, a time when much of the country had not yet felt the pandemic’s impact close to home.
“To see that happen with one of the first cases in our county, I think really woke people up,” said Jeff Wardlaw, the state representative whose district includes Bradley County. “That’s what gets people’s attention, is when somebody ends up on a ventilator.”
It was just the kind of somber wake-up call that other small towns might be getting for the first time now, as the highly-contagious delta variant ravages under-vaccinated pockets of America.
Close to Home
In early March 2020, Beverly Reep and her family set off on the vacation that she had always dreamed of: A whirlwind five days in the U.K. and France. The coronavirus was spreading rapidly in Italy and China, but in the U.S., it still seemed to many like a far-off threat.
The Reep family consulted local medical authorities on their travel plans, who advised them to be vigilant with handwashing while abroad. The family visited London and Paris, the beaches of Normandy and the gardens of Versailles. The next month, after weeks on a ventilator at a hospital in Little Rock, Arkansas, 63-year-old Reep died from Covid-19.
Her death made headlines across the state, and her family made the rounds in the press warning others to take the virus seriously. But it shook her hometown especially hard.
For 39 years, Reep had taught history in Bradley, a sleepy southeastern part of the state best known for its pine trees and pink tomatoes. Mention her in this area and you’re likely to be regaled with a story about the legendary eighth-grade trips to Washington, D.C., that she chaperoned, or how she managed to make a boring school subject fun. Reep was a local icon.
“After Beverly passed away, it really caught the attention of a lot of people. People would talk about it. People would come in shocked,” said Kerry Pennington, a local physician. “So when the vaccine became available, they were aware and smart enough to realize that they needed to get it.”
That scenario — of a neighbor’s battle with the illness scaring others into getting vaccinated — may now be playing out elsewhere. In Louisiana, Arkansas, and Missouri, case counts are hitting records and hospitals are newly overwhelmed. The number of people receiving their first vaccine dose each day in Louisiana has increased from an average of about 2,500 people at the end of June to nearly 12,000 people at the end of July, according to CDC data.
“Lots of people know someone who’s sick,” said Joseph Kanter, the top health officer in the state of Louisiana. “It is those personal anecdotes that are driving behavior.” He said he’s talked to many people over the past few weeks who have chosen to get vaccinated after putting it off for months.
“A lot of them wish that they had done it five weeks ago so that they would have more protection right now,” Kanter said.
In Arkansas, Col. Robert Ator, the leader of the state’s vaccine rollout efforts, said fear of delta has driven vaccination rates up by nearly 300% in the past month. Four weeks ago, he said, they gave out 27,000 doses in a week. Last week, it was close to 90,000. The vast majority of those were first shots.
“I am wildly encouraged by the increase in demand,” he said, “But what’s driving this is my fellow citizens are suffering. That’s a mixed bag.”
More Than Fear
Fear alone may not be enough to push those on the fence about a vaccine over to the other side. “People’s decisions to vaccinate are associated with so many sociological, economic and psychological factors,” said Matt Motta, a political scientist who studies vaccine hesitancy at Oklahoma State University at Stillwater. “People have been witnessing the destruction of this pandemic for a long time, and that wasn’t enough to move the needle up until this point.”
Case in point: In New York City — which was once the U.S. epicenter of the pandemic and where the death toll is more than 30,000 people — a quarter of eligible adults are still unvaccinated. In some neighborhoods, those percentages are far lower. A recent Bloomberg analysis found that 17 New York City ZIP codes have vaccination rates of 40% or less, primarily in Black or Orthodox Jewish communities that were both hit hard by the pandemic.
In Bradley County, it was more than fear that moved residents to roll up their sleeves for a jab. Beverly Reep’s husband, Gregg Reep, is a prominent local figure in his own right, having served as mayor of Bradley’s largest town, Warren, for nearly two decades and, briefly, as a member of the state legislature. He and his son, Robert, made a point to speak out about the grief of losing a loved one to Covid-19, even as they faced online attacks from people who speculated his family was responsible for bringing the coronavirus to Arkansas from Europe.
Crucially, the local medical community in Bradley County organized to present a cohesive message about the importance of protective measures such as social distancing and mask-wearing. The county has just a handful of doctors and public-health officials, and they met regularly and texted each other often to make sure everyone had the most up-to-date information and were on the same page.
Michelle Weaver, a doctor at the Bradley County Medical Center and the local county health officer, put out Facebook videos early in the pandemic discussing how the county was faring and explaining new recommendations about how to stop the spread of the virus. In one video, she talks about the difficulty of getting teens to practice social distancing, mentioning that she had allowed her own teen son to go fishing outdoors with friends as long as he kept appropriate distance from them. It was the sort of practical advice that many parents were looking for.
When the vaccine arrived, Bradley’s medical providers went to work making sure it was easily accessible. Mainline Health Systems, a town clinic where Pennington has practiced for decades, has gone to the local high school to offer vaccines to its athletes. Every time a patient shows up at the clinic, Pennington said he asks them about their vaccination status, and if they aren’t vaccinated, he pushes them to get one on the spot, often successfully.
Tyler Staten, the pharmacy manager at Gannaway Drug in town, set up vaccine clinics at local timber manufacturing plants. The roads of Bradley County are lined with pine trees, and timber is a major local industry. He reasoned that many of those workers might want to be vaccinated, but might not be able to do so during the hours his small-town pharmacy offered a vaccine clinic. He has also made house calls to give jabs to less mobile patients.
Gregg Reep, too, has kept up his awareness campaign.
“Once the vaccinations started being made available, of course, we were urging everybody to get vaccinated,” said Gregg Reep. “It just doesn't make any sense not to care about yourself and your family.”
A More Receptive Audience
The advocacy of the Reep family and the efforts of local health care practitioners appear to have driven enthusiasm for vaccination long before the delta variant hit the state.
“There are a thousand different reasons why people get the vaccine or avoid the vaccine,” said Col. Ator. “One lesson we have learned is you have to empower the local community and let them lead the discussion.”
Now, local figures may find a more receptive audience to their overtures because of the surge in cases associated with the delta variant.
“It’s even scarier than it’s been before, and for some people, also closer to home,” said Motta, the Oklahoma State University political scientist.
Vaccine campaigns may also get a boost thanks to a recent change in messaging from prominent conservatives, Motta said. In Missouri, for example, Gov. Mike Parson tweeted this week, “The best way to combat the virus is through widespread vaccination.” Fox News host Sean Hannity told his viewers in July, “I believe in the science of vaccination.”
In Bradley County, the vaccination rate is still higher than much of rest of the state but likely not high enough to effectively stop the spread of the virus. Wardlaw, the state legislator, said that in recent weeks, as delta has spread, he’s had an uptick in calls from constituents asking him how to get vaccinated — many who had previously expressed strong doubts about the vaccine.
“You’re seeing the attention higher than we’ve ever seen it,” he said. “People are seeing the danger of the delta variant, and they’re seeing the danger of Covid-19 in itself.”
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