As a physician focused on public health in West Virginia, I am accustomed to our state scoring low in all national measures of health. We have high rates of obesity, chronic diseases, and fatal opioid overdoses. Now, however, we are leading in the country’s most important health initiative: We are one of the states with the highest per capita distribution of COVID-19 vaccines, just behind Alaska.
With a state population comparable to that of Phoenix, Arizona, the logistics of vaccine administration and the flexibility to adapt to a rapidly changing situation are much easier for West Virginia than they are for larger states. We can be nimble because we are small. But that is not the only or main factor here. In West Virginia, community connections and a shared collective identity are strong. Every public-health leader here, including those of us at West Virginia University’s School of Public Health, knows this, and it guides many of our strategies, whether we are planning for walking paths around community clinics or asking former coal miners to help with black-lung outreach. Our COVID-19 response team harnessed that sense of community—and the high level of trust that goes along with it—to deliver early success in our vaccination program.
Unlike many other states, we modified the national vaccine-administration plans to reflect regional realities. In October, the federal government announced an agreement with CVS and Walgreens pharmacies to provide and administer COVID-19 vaccines to residents of long-term-care facilities. Such an approach was not feasible here. West Virginia has fewer than 150 CVS and Walgreens pharmacies, and these are clustered in larger towns. We do, however, have more than 250 independent, community-based pharmacy sites, which serve many of our more rural populations. Rather than follow the federal plan, the state chose to partner with these independent pharmacies. Most of the pharmacists at these stores, which often carry the names of owners who were born and raised in that community, are people whom residents know, and who know the residents.
By the end of January, residents and staff members at the state’s 214 long-term-care facilities who had chosen to be vaccinated had been given both doses. In that month, the number of active COVID-19 outbreaks in those facilities fell by 50 percent.
We’re making rapid progress where other states are not because we’ve made long-standing personal connections central to the distribution effort. Studies consistently show that the most trusted source of information on vaccines is a person’s health-care provider. The most effective way to communicate information on vaccines is one-on-one, through messages tailored to an individual.
Peter Sandman, a leading figure in risk communication, notes that people consistently overestimate their personal risk from rare events such as plane crashes, terrorist attacks, and shark encounters—and I would add here adverse reactions from vaccinations—yet underestimate the risk from more common activities, including riding in a car, smoking, and maintaining a poor diet.
In focus-group research, my colleagues at West Virginia University’s Reed College of Media found this line of thinking prevalent in our state’s population. Some feel that a COVID-19 vaccine may be forced upon them and they won’t have an option to say no. Others fear vaccines in general because they are artificial and unfamiliar. Some are suspicious of the new technology used to develop the vaccines and the speed with which scientists were able to make them.
These concerns show that simply providing data on the vaccines won’t sway people, and dismissing vaccine-hesitant people as simply uninformed or uneducated is misguided. Effective communication about vaccines requires an understanding of why a person is hesitant. The emotional context of risk perception must be addressed first, and that can be achieved only through a relationship of trust.
At one long-term-care facility here in West Virginia, a candidate was reluctant to be vaccinated. The pharmacist, who is also an experienced diabetes educator, recognized the need for a conversation in a private room. The pharmacist listened as the woman described a concern based on a traumatic experience in childhood. They talked it over, but they also discussed the fact that the vaccine would protect her loved ones from possibly contracting COVID-19 from her. She ended up opting for the shot.
My wife, who is a nurse practitioner, has been volunteering to administer vaccines to older state residents, and she has described a high level of intimacy between those administering and receiving the shots. She saw tears of joy and felt palpable excitement on some days. One man likened his recent lockdown experience to being kept indoors during polio epidemics in childhood. A consistent theme was that vaccination was seen as a pathway to reconnect with loved ones.
This sense of community didn’t play a role only in small-town clinics and pharmacies and at the individual level. In Morgantown, one of the state’s largest towns, local leaders were able to build broad collaborations among disparate agencies. Recently, a community COVID-19 vaccination clinic opened in a shopping mall, an alliance among six different agencies, including the county health department and two competing health-care systems.
The state’s vaccine response is still in its early days, and the biggest obstacle we face is dose availability. It is therefore likely that we are not yet seeing the full effect of vaccine hesitancy. For every candidate who hesitates now, many others are still anxious to receive that scarce dose. Surveys in West Virginia show similar levels of COVID-19 vaccine hesitancy as in the rest of the country. Our experience however, indicates that the more the state collaborates with those at the local, community level, the greater the vaccine uptake. Trust is key.