Rural Americans Are Much Less Likely to Get a Vaccine

Vaccine hesitancy is now the chief focus for rural-health experts like Morgan. They have an obligation to change minds, and fast. But persuasion works only with trustworthy messengers, such as local leaders, physicians, and pharmacists—people who already have relationships and friendships with community members, who share similar values, and whose children go to school together. “Rather than have these mass-vaccination sites through government-funded health departments with the National Guard” overseeing operations, health officials need to send vaccines straight to places such as doctors’ offices, churches, and familiar local clinics, Michael Meit, the research director at East Tennessee State University’s Center for Rural Health Research, told me. “It’s those relational pieces that are so, so important in our rural communities.”

Actually, personal relationships are important in all public-health messaging, regardless of geography. Take the 2019 measles outbreak in parts of New York City. In early spring that year, nearly 600 people across several Hasidic Jewish neighborhoods got sick, most of them unvaccinated children. Immunization rates there were low, in part because the Hasidic community had been targeted by anti-vaccination groups making false claims about vaccine safety. In response, city public-health officials enlisted the help of local doctors and rabbis to encourage locals to inoculate their kids. They also created informational booklets with accurate vaccine information in Yiddish, and distributed them to 30,000 households. Their efforts were successful: In the Williamsburg neighborhood of Brooklyn, where case numbers were highest, the share of people who had gotten the measles vaccine increased from 79 percent at the outbreak’s start to 91 percent by the end, Jennifer Rosen, the director of epidemiology and surveillance for the New York City Bureau of Immunization, told me.

Read: Hasidic, devout, and mad as hell about COVID-19

Effective vaccine messaging has to be tailored to people’s specific fears: If someone is worried about government overreach, the messenger should use language that affirms their right to make their own medical decisions, Broniatowski says. “Of course it’s your choice,” he advises messengers to say. “Here’s why it’s the right choice.” Facts alone won’t do the trick, and neither will shaming. Many conservatives have found the discourse around COVID-19 and vaccines to be “very demeaning,” he added. “There’s a lot of communication from people on the periphery of science communication that say things that come across as ‘What’s wrong, you idiot? Don’t you trust science?’” But it’s natural for people to be reluctant about a brand-new vaccine, and people shouldn’t be scolded for having doubts. Roger Brock, the public-health administrator in rural Barry County, Missouri, told me that he tries to create a judgment-free zone. After listening to patients’ concerns, he explains to them that the vaccines were developed by the smartest scientists in the world, who have no political agenda. (He also reminds them that the vaccines don’t contain microchips, Brock said with a laugh.) “Sometimes you have success” persuading people, “and sometimes you don’t,” he added.