At a county health department near my hometown in rural Arkansas, almost everyone who comes in for a COVID-19 test is congested and short of breath, with a sore throat and muscle aches. They might have the flu, except for the added telltale symptom of this coronavirus: the loss of taste and smell. Many of the patients now are younger than those in previous months; a nurse who works there told me she saw two cases of young children in one day. (The Atlantic agreed not to name the nurse, because, as a state employee, she is not authorized to speak with the media.) Even worse, though, is that almost every potential case she saw was avoidable. Almost none of the eligible adults she tested had had one of the vaccines.
Arkansas has one of the lowest vaccination rates in the United States, and one of the worst case rates for COVID-19. Our neighboring states—especially Missouri—are seeing similar trends. Case counts have been increasing at the highest rates since February, and we have the most new cases per capita in the nation. On Monday, we saw the highest single-day increase in hospitalizations, 79 new patients, of the entire pandemic. Test-positivity rates are also high, suggesting that infections are undercounted. In my county, Van Buren County; in the more rural Searcy County to the north; and in the more densely populated Faulkner County to the south, the daily case totals are, respectively, 119 percent, 142 percent, and 191 percent higher than their averages over the previous two weeks. Because new cases show no sign of slowing down, we likely have more illness ahead. My local Facebook feed has again become a steady stream of families asking for prayers and making announcements for memorial services.
The nurse at the health department told me that she and her co-workers had expected that some people would resist vaccination, but that “seeing that resistance persist despite education, despite outreach” had left her and her colleagues depressed and downtrodden. “Why are they not understanding how this is putting people’s lives in danger?” she asked. Like her, I’ve been haunted by this question. Sixty-two percent of my neighbors remain unvaccinated for complicated, interrelated reasons that map onto existing, bitter divisions. Any solutions, equally complicated, will likely come only after we’ve seen more death.
I had expected some amount of vaccine hesitancy in my hometown, a small place of about 2,500 residents, called Clinton, on the southern edge of the Ozark Mountains, because of the way this pandemic has unfolded from the beginning. Although schools and many restaurants temporarily shut down here, my region is full of people who have been reluctant to wear masks, stay at home, and otherwise adapt to new recommendations from health authorities. Big stores such as Walmart enforced mask wearing, but many smaller establishments didn’t. Many schools went partly remote, but ball games continued. The community seemed split between people who were taking the pandemic seriously and people who thought the disease was a hoax, or no worse than the regular flu.
That split remains today, as unvaccinated people continue to go about their life as if this pandemic never happened, even as the Delta variant’s presence makes the virus as dangerous as ever. Those of us who rushed out to get vaccinated feel personally safe but remain cautious. Persisting in this contradiction can seem like living in the distorted reality of a fun-house mirror, as we watch those least protected from the virus take the most risks, likely ensuring the disease’s continued spread.
My small county has had 24 COVID-19 deaths throughout the pandemic, and statewide that number has passed 6,000 (for comparison, in recent years, flu deaths ranged between 620 and 720). News of these deaths trickled out among friends and family—I found out about a former teacher’s death because of a group email. We haven’t set aside a time to mourn the community’s loss together, and we haven’t had a COVID-19 memorial. Unlike my friends who live in Washington, D.C., and New York City, I never experienced nights filled with the sounds of sirens, and many of my neighbors never saw the death and devastation up close. The virus spread primarily through family networks because people continued to see their families, but rural life can be atomized and isolating. That kept us from feeling the full force of the pandemic’s effects, and also provided a small amount of protection from the disease itself.
Now the virus’s increased ability to spread, hitting just as we’ve reopened, has finally collapsed that rural space. Suddenly, we’re racing against time, trying to get more and more people vaccinated before hospitals become too full and start turning patients away. The strain on health-care facilities is especially worrisome in rural areas, which have few hospitals and ICU beds. Our most serious medical cases are typically sent to Little Rock, and on Saturday, the University of Arkansas for Medical Sciences announced that its hospital, a public facility ranked among the best in the state, was full.
During last year’s relative isolation, more people went online, especially to Facebook, for socialization and information; today, that is where the vaccines’ loudest opponents announce why they’re not getting the shots. People I know seemed concerned about the fact that the vaccine was approved only for emergency use. They also believe that people have died from the vaccines in large numbers, that the vaccines themselves have caused illness, that they’re responsible for the Delta variant, that they’re made with fetal tissue from aborted babies, that they alter your DNA, that they cause infertility, that the government’s eagerness to offer incentives for vaccination is suspicious, and that because the vaccines are new, their use amounts to a government experiment on the citizen population. There is some understandable distrust of the pharmaceutical industry because of the U.S. opioid epidemic, and of the government because of this country’s history with medical racism. Every vaccinated friend of mine who has tried to champion vaccines to the disbelievers said they end up sad, disappointed, and frustrated, caught in circular arguments that rely more on ideology than facts, and in which every piece of evidence is taken as more proof of conspiracy.
More often, the reasons people give for skipping vaccination are less extreme and more personal. Last Tuesday, I met up with Courtney Patrick, my partner’s co-worker at a medical-cannabis facility. She had just received her first dose of the Moderna vaccine. She is 31, and had avoided vaccination until last week because she doesn’t like needles, and because she wasn’t very concerned about contracting COVID-19. “I still have that false sense of ‘I’m young; I’ll be okay,’” she said. She knows that this isn’t exactly true, because the flu made her very sick three years ago. In her previous job, Patrick worked as a veterinary technician (she still rescues turtles in her spare time), preaching to patients that they should get their dogs and cats vaccinated every year. She knows that vaccines work and believes in them. The push she needed to overcome her fear came from her family. Patrick’s grandmother was diagnosed with breast cancer, and will need help with errands—plus, Patrick wants to be able to visit her grandmother without putting her at risk, which she couldn’t do without getting vaccinated. Before that, she said, “it was just low on my list.”
And nothing around her signaled that that should change. The state has been treating the pandemic as though it’s essentially over. Restaurants were allowed to resume operations at full capacity in February, our mask mandate was lifted in March, and the pandemic unemployment-assistance programs ended on June 26. Although the governor, Asa Hutchinson, still gives regular COVID-19 briefings and encourages people to get vaccinated, we lost a sense of urgency just when we needed it most.
In this context, getting vaccinated has meant acting on our own volition. Although every county has a walk-in center for free vaccines, many are open only during business hours on weekdays, and they’re located in population centers. Two of the three biggest clinics in our county are located here in Clinton—it’s the county seat. From the rural outreaches of the county, the trip can be almost an hour each way. In elderly and low-income rural populations, many people are unable to drive or do not have regular access to a working car, and our county hasn’t made a widespread effort to take mobile vaccination sites out to community centers, churches, or firehouses. Deborah Shoenberger Brennan, a retired veterinarian who volunteered with the county’s wellness committee—which was disbanded last year to avoid meeting during the pandemic—thinks we need them. “We veterinarians, we go out into the whole county to, like, 12, 15 different stations … to vaccinate for rabies. I’d like to see our public-health professionals or our doctors or physician assistants do that,” she told me.
Making vaccinations easier might pull in some people who are simply hesitant because of inertia, like Patrick. The Delta variant’s threat is also pulling a few more people in. On Thursday, a pharmacist in Clinton, Marinda Bryan, who has been vaccinating patients since the shots became available, said on a local radio show that she’s now seeing 10 to 15 people coming in every day for their first dose. (On Friday, the state health department reported its largest daily dose total since May 21.) Bryan said many people falsely believe that the vaccines cost money, but more people arrive with medical misinformation. She and her staff have been able to allay their concerns in most cases. At her pharmacy, all customers are reassured that they are free to make their own choices, but are also asked whether they’ve had a COVID-19 vaccine. If they have not, they get a reminder: It’s always available.
Still, how many people will keep resisting, no matter what? If people also resist mask wearing or other public-health mandates, the idea that getting the vaccine is a matter of personal choice takes on a different valence. “Your choice is your choice, but you don’t have the freedom to force your choice on other people,” Shoenberger Brennan said.
For the 33 percent of people in our county who have already been fully vaccinated, living with that tension has been frustrating: Many of us feel that our neighbors are continuing to put others in danger. Breakthrough cases among vaccinated patients are rare—nationally and in the state, more than 99 percent of current deaths are among the unvaccinated—but they’re more common in populations with high numbers of unvaccinated people. Those of us who were vaccinated early have reluctantly begun wearing masks in stores again. “If something doesn’t change, I will never be able to leave the house!” a friend, Lisa Ray, who is a professor at the University of Central Arkansas, told me.
Courtney Patrick thinks more people won’t be moved to get the vaccine until a health problem affects them personally, like her grandmother’s cancer did her. One Arkansas mother named Angela Morris was interviewed by the Little Rock CBS affiliate, THV 11, from Arkansas Children’s Hospital, where her 13-year-old daughter had been on a ventilator because of COVID-19 for 12 days. That day, the children’s hospital had six other pediatric COVID-19 patients, two of them on ventilators. (By Tuesday, the children’s hospital said it had 12 COVID-19 patients.) “I just want people to get their kids their shots. Everybody just needs to get the shot. It’s a much better route than the one we’re in,” Morris told the station.
But I’ve seen other cases in which personal tragedies haven’t changed anyone’s mind. A friend forwarded me a message from a new COVID-19 widow preparing to bury her middle-aged husband. “I truly believe God has had our time planned for a long time before that day comes,” she wrote. “If you are meant to go, you will despite anything you try to prevent it.”
Many white evangelicals had already begun to shun vaccines altogether, and part of their rationale is this sense of predestination. The message of these anti-vaxxers builds on a basic idea: God built your body, and the immunity that nature gave you is better than any medicine. Sometimes, doctors repeat these messages. Bryan, the local pharmacist, told me that two doctors in our hometown are not discouraging their patients from getting the vaccines, but they are also not advocating for them. Some are more blatant in their opposition—Amy Beard, who practices telemedicine and is licensed in the state, has been outspoken about treating COVID-19 patients instead with medication typically used to prevent heartworms in dogs, cows, and goats. On her Facebook page, she called the shots “mutant factories,” in response to comments about the vaccines creating variants. Someone who had recovered from COVID-19 in January asked her about “natural” immunity; Beard responded, “Before Covid, natural immunity was the BEST immunity. And it still is.”
For the nurse at the county health department and other health-care professionals, this strain of resistance began with President Donald Trump and has been the hardest to fight. “I think that this would be a totally different story had it been addressed appropriately in 2020, at the very beginning,” the nurse told me. When Trump and other leaders questioned health professionals and epidemiologists, those uncertainties led more people to feel empowered to question them as well. Individual reasons for avoiding vaccination keep shifting—whatever it takes to stay on that side of the political divide. Meanwhile, the rest of us have to reckon with what it means that so many of our neighbors have been reluctant to act in the public good, and what that augurs for our sense of community, now and whenever this is over.