The Slatest

What It’s Like to Do Vaccine Outreach in One of the Least Vaccinated States

A masked nurse injects a masked woman's arm with a vaccine.
geargodz/iStock/Getty Images Plus

Nearly 180 million Americans, including 66 percent of adults, have received at least one dose of the vaccine. For some of the most highly vaccinated states, such as Vermont and Massachusetts, COVID rates have plummeted. But other states lag behind, for reasons of misinformation, mistrust, logistics, access, politics, and simple indifference.

The very worst states—Mississippi, Louisiana, Wyoming, Idaho, and Alabama—have single-dose vaccine rates of under 40 percent. To get a sense of why vaccine hesitancy and access remain such major issues in some of these states, Slate spoke with Hailey Bloom, the public information officer for the Casper-Natrona County Health Department in Casper, Wyoming. Around the area, which is rural and more than 90 percent white, Bloom and the health department have held large- and small-scale vaccine clinics. This conversation has been condensed and edited for clarity.

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Molly Olmstead: Can you tell me about the work you’re doing? 

Hailey Bloom: Throughout COVID, we’ve had to get really creative. We live in a rural community, and we have a very little health department. We’ve all had to pitch in. I hold a management position at the department. So I’m running and organizing clinics. I’ve done everything from doing testing to paperwork at vaccine clinics to managing the vaccine clinic and making sure that goes smoothly.

How have you focused on getting more people to agree to get the vaccine?

We’re just really making sure that we’re answering questions. We’ve provided a COVID hotline since the start, but that’s kind of become our go-to resource for people in the community. And at this point, we offer anyone any vaccine that they would like. So they’re able to choose what they feel most comfortable with, or what they think is the best fit for them. With the Janssen vaccine being a one-shot series and a completely different technology than Moderna and Pfizer, some people feel more comfortable with that. We found that other people they know and trust are a big influence in what they get. So, you know, if they have a family member or friend who got Moderna and they’ve been on the fence, they may be more likely to want Moderna more than another vaccine.

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We really haven’t focused a ton on people who are hard noes—“I do not want to be vaccinated”—because we don’t feel at this point it’s worth our effort and our time to try to convince them otherwise. Instead, we’re really focusing on those who are maybe just on the fence and trying to target why they may be on the fence. We’ve offered incentives to concerts and local events. And we’ve been at local events, so that for convenience purposes, you’re going out to the town bar, or the rodeo, and we’ll vaccinate you while you’re there. Or you’re coming into our community for our state’s high school track meet, and we will target you there. We’ve offered food trucks, we’ve offered food incentives, all kinds of different things.

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Do you have a sense of which vaccines people prefer?

We’ve given far more Pfizer, but I believe that’s just because we’ve had more quantity. I would say that we had a lot of people who told us that they were waiting specifically for Janssen.

What kind of messaging have you found to be most effective?

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We’ve done several vaccine series on what the technology is and what it means. We know that mRNA is a complex thing for a person who doesn’t have a science background to understand. And we’ve collected data on why people in the community haven’t gotten vaccinated. Most people are just saying that they really want more time to pass. And there really isn’t, of course, much that we can do about that besides continue to offer this. The other thing that we found that was interesting was we had a lot of people saying, “I’m pregnant, and I don’t know if I should get vaccinated.” In terms of that, we’re pushing them to talk to their doctors to make a decision that’s best for them and their child.

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How much are you thinking about hurdles of access and logistics versus misinformation? 

It’s all of the above, all the time. It’s just that this is all so new, it came about so quickly, people are lacking a lot of trust, at this point. And that’s, I think, been the biggest hurdle in general. In terms of misinformation, we’ve just been making sure that we’re upfront and honest from the beginning. So we talked about side effects, we talked about technology, just really putting those things out there before people really had a chance to worry too much about them.

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Are there any common misconceptions or conspiracy theories that you’re hearing? 

I think the biggest for us is just the new technology. People don’t trust whenever they hear mRNA. People commonly think that those vaccines work by altering your own DNA. Obviously, that’s not true. So we’re just making sure that we try to explain that to people in the most simple way.

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Do you target different groups or categories of people in different ways? 

We’ve looked at populations where we know that those pockets of people maybe weren’t receiving the information or maybe had some additional distrust. We understand that we’re perceived as part of the government. There are pockets of the population that don’t trust us. Like our immigrant and migrant communities. We do have smaller immigrant populations composed of both Hispanic Latinos and Asian Americans. So we’re working with someone in the community who they do trust, and being able to channel information that way. Or with people with language barriers we’ve had, we’re making sure that we had someone who spoke the language and was able to get that information to them. We purchased a mobile response vaccination trailer with our federal dollars. It’s a mobile clinic on wheels, and we’ll be able to pull that to our lower income communities where transportation may be difficult. We have probably three to four smaller communities of 3,000 to 4,000 people that we do know are disproportionately affected, either by socioeconomic status or transportation issues.

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Is there a point when you’ll turn to the “hard no” people you mentioned? 

Maybe at some point down the road, but right now, we’re just still trying to focus on people who either haven’t had the opportunity—whether that’s been a travel-related issue, whether that’s been a timing issue, whatever that’s been—or people that are just sitting on the fence. I won’t say that we will never target those people that are hard noes. But they definitely aren’t on the top of our list.

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But are there that many people left who are just sort of undecided?

That population’s shrinking for sure. We’ve reached approximately 30 percent vaccination rate in our county, which actually is pretty good compared to our state. There are only two other counties that have exceeded that 30 percent, and the majority are far below that. So we’re definitely shrinking that group of people who are still on the fence. And we’ve reached the majority of those folks who definitely wanted to be vaccinated.

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What do you think people outside the area need to understand? 

A lot of it is the fact that the vaccine was developed in such a quick manner. The fact that this is such a new technology. So people are a little bit wary.

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Was there anything else you wanted people to know?

I oversee all the contact tracing in my community. Every single death gets marked, and I see that. We’ve lost well over 100 people in my own community. And I think that’s been astonishing. It’s been incredibly heartbreaking to hear some of those stories, and go in and review the case notes of that person and see that they were previously healthy, 30 years old, whatever. I don’t think that people can understand the volume and the death and the destruction for our community. So we’re just gonna continue to make ourselves and the vaccines available for anyone who wants them.

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