Just a pinch: Phyllis Kochel gets her fist dose of the COVID-19 vaccine Jan. 28 from senior IU Kokomo nursing student Kelly Alford at the Kokomo Event Center. Staff ohoto by Tim Bath
Just a pinch: Phyllis Kochel gets her fist dose of the COVID-19 vaccine Jan. 28 from senior IU Kokomo nursing student Kelly Alford at the Kokomo Event Center. Staff ohoto by Tim Bath
More than 2.4 million Hoosiers have been vaccinated against the coronavirus, but that's only about 35% of the state's population.

The figure lags behind neighboring states and is in the bottom half nationally, according to John Hopkins Coronavirus Resource Center. It’s nowhere near what is needed for herd immunity.

The consensus among public health officials across the state is those who want the vaccine have already gotten it.

This includes many in the 55-and-older age range, which has the highest rate of vaccination, likely due to vaccine priority and being the most at-risk population.

But now, demand is waning.

There’s no one-size-fits-all reason as to why. Misinformation, politics, lack of trust in public institutions and government, along with lack of access all play a part, state officials reported.

Health officials are trying to discern why their communities have hit a wall with vaccinations and how to encourage more shots in arms.

“At the end of the day, we’re not doing great,” said Jon Macy, a professor at the Indiana University School of Public Health. “There’s a lot of room for improvement.”

'They’re just not interested'

Joyce Yoder isn’t sure why Carroll County is toward the bottom of the state when it comes to vaccinations.

Only about 28% of the population is vaccinated. A county of 20,000, Carroll County is a farming community with a presence of Amish and German Baptists.

Amish communities tend to have low vaccination numbers. LaGrange County has an even lower rate at 21.2%, according to the Indiana State Health Department. Over a third of its population is Amish.

Yoder, the Carroll County nurse, has watched vaccine clinic turnout dwindle. The twice-a-week clinics were busy to start, averaging about 300 people per day, but have since dwindled to about 100. Come June, clinics will be only once a week.

The nurse said the halt in the Johnson & Johnson vaccine made hesitancy even worse. The one-dose shot was paused briefly after eight out of 6.8 million recipients developed a severe type of blood clot.

“They just don’t want to, they’re just not interested,” Yoder said.

Side-effect concerns are present in other communities, too.

Kristina Sommers, of the Howard County Health Department, said she’s heard people concerned about alleged fertility issues that come with getting vaccinated.

Doctors say there is no risk of infertility. Women who have received the vaccine have gotten pregnant, and there is no evidence of reduced fertility, according to Henry Ford Health System.

Sommers said they’re trying to push information out on social media to counter these type of myths.

About 37% of the Howard County population is vaccinated but demand has fallen. The health department announced earlier this month it was moving vaccine clinics from the Kokomo Event Center to the Jeff Stout Government Center starting in June due to a decrease in demand.

Howard County Health Department has someone available to address questions and concerns. They are available through the nursing office from 8 a.m. to noon and 1 to 4 p.m. Monday through Friday by calling 765-456-2408, option 1.

Distrust in authority

A lack of trust in public institutions is a factor in vaccine hesitancy, especially in communities of color.

For Black communities, decades of discrimination and unethical experiments at the hands of the health care industry has given way to skepticism and distrust.

“We still struggle with racism and other ills in society,” said the Rev. William Smith, pastor of Second Missionary Baptist Church in Kokomo.

The church recently conducted a vaccine clinic, which saw strong turnout. Smith and the church are voices for the local Black community.

Black communities place trust in their churches, Smith explained. Hosting a vaccine clinic is one way to make people more comfortable.

As Smith put it, “If the church is putting it on, it must be safe.”

Macy said public institutions have been underfunded and undermined for decades. When public institutions don’t have the resources or infrastructure, it makes it harder for them to push back against misinformation and reach people who have concerns about the vaccine.

Skepticism and misinformation have plagued the pandemic from the beginning. Conspiracy theories have been adapted as the virus and pandemic have become more understood.

“I think it’s all related to people not having confidence,” Macy said. “It’s easier for people to buy into the conspiracy stuff.”

Ask questions, educate

Many counties sporting a 40% vaccination rate or higher are in and around more densely populated metro areas. Rural counties tend to lag behind.

However, there are exceptions, such as Ohio County in southeast Indiana.

The county of 6,000 people that borders the Ohio River has just one incorporated community, but more than 60% of its population is vaccinated.

Switzerland County to the south has a 25% vaccination rate. Dearborn County to the north has about 40% of its population vaccinated.

So what gives?

“We’ve been asking ourselves the same question,” said Dr. Chris Walcott, health officer for Ohio County.

There are likely multiple reasons; the population skews older, flu shot clinics have been well-attended in the past and could signal a more health-conscious community.

But Walcott himself and his approach to those who are hesitant play a part, too.

The doctor grew up in Ohio County, left for college and returned. The head of the health department, he’s a medical authority figure. But he’s also an insider, someone many in the community know, and more importantly, trust.

When the health department started receiving questions about the vaccine, Walcott made easy-to-digest Facebook videos, such as how the vaccine works. The videos were reviewed by other staff members to make sure they were easy to understand for the general public.

“I was trying to distill it down so they could understand,” Walcott said. “When you don’t understand, you’re going to push something away.”

Walcott wants those who are hesitant to ask questions. They shouldn’t feel intimidated or scared into getting the shot.

Walcott compared it to parenting: educate your child instead of just slapping their hand.

He encouraged anyone who is on the fence about the vaccine to take their questions to the person who knows their health best.

Walcott also encouraged doctors to explain to people what they know and don’t know about the virus and vaccine to show that they’re not hiding any information.

A lot of headway can be made with a no-judgment conversation.

“More often than not, they end up getting it,” he said.

Will time tell a different story?

A common concern about the coronavirus vaccine is that it is new, rushed or hasn’t been properly tested.

Many are choosing to wait, to see how things play out.

Macy said this is an understandable position to have, especially if you’re not immersed in coronavirus or vaccine production information.

“I don’t blame people for that,” he said.

From the outside looking in, a vaccine made available in about a year does seem quick.

However, Macy said people should understand two main things: coronaviruses are not new and the quick turnaround is the result of a global, around-the-clock effort.

“I don’t think people understand scientists have been studying coronaviruses for decades,” he said. “It’s not a rushed thing, it [vaccines] is a monumental achievement.”

Macy noted public opinion on seatbelts didn’t happen overnight. It took time for the concept to become normalized.

For those unsure or on the fence, the most convincing argument might be seeing their friends and neighbors who got the vaccine.

“I think the biggest thing that has helped is people who have gotten the vaccine,” pastor Smith said.

Smith said he’s spoken to people who were hesitant to receive the vaccine because they didn’t want to be a “guinea pig” but eventually came around after talking to the church and seeing others get vaccinated.

Time may result in an uptick in vaccinations, but the longer people wait and the longer herd immunity is delayed could give way to variant strains of the virus that are resistant to the vaccine.

Macy said health officials are looking at why people get vaccinated and using responses to produce positive messaging to motivate others to do the same.

“It’s the right thing to do to protect yourself, to protect your family and get us back to normal,” Macy said.

Framing messaging around who the most important people are in one’s life — “do it for your mom” — is one method of encouraging vaccinations.

“I think that can move the needle a little bit,” Macy said. “Fear-based, negative appeal only gets you so far.”

Take the vaccine to people

Hesitancy isn’t the only reason people aren’t getting the vaccine. There’s also the issue of accessibility.

This is another reason why Black Hoosiers aren’t getting vaccinated at the rate of white Hoosiers, even though they’re at a higher risk of contracting the virus.

Economic disparities in predominantly Black neighborhoods can mean a lack of public transportation, internet or phone services.

Smith said the vaccine clinic at the church saw people who walked and biked there. He said not everyone knows how to navigate signing up for a vaccine and some people are still leery about riding public transportation during a pandemic.

In Vigo County, the health department has taken vaccines to the local jail and high school.

“We’re trying to think outside the box in how to get the vaccine to people,” said Roni Elder, health educator and media coordinator for the health department.

About 37% of Vigo County has received the vaccine. Elder said there is still interest but not like at the onset.

“I think we’ll continue to get people vaccinated but the numbers might not jump,” she said.

Hendricks County is one of those heavily populated counties with a high vaccination rate — 57%.

Michael Aviah, public health education specialist for the county’s health department, attributed the high rate to a health-conscious community that wanted to get vaccinated.

But the health department has also partnered with the community to bring vaccines to people who can’t make it to their clinics. The county worked with EMS to bring vaccines to people, part of the Homebound Hoosier initiative, a statewide program that brings vaccines to people who cannot leave their homes.

Hendricks County also partnered with Family Promise, a homeless shelter.

“I think the collaboration is something that really helped,” Aviah said.

However, Hendricks County is in the same boat as many others — more people are getting their second shot than their first. Aviah said they plan on surveying people on why they haven’t received the vaccine.

What Hendricks County finds out will probably be what other places have found out — there’s no single answer.
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