NASHVILLE – Public health departments have held vaccine clinics in churches. They have organized rides to clinics. Went door to door. Even offers a lap of a NASCAR track for anyone who wanted a chance.
Still, the country's vaccination campaign is sputtering, especially in the south, where there are far more doses than people will take them.
With reports of new Covid-19 cases and deaths plummeting and many Americans venturing mask-less on something that is becoming almost normal, the delay in vaccinations poses a new risk. As variants of the coronavirus spread and restrictions are relaxed, experts fear the virus could eventually increase again in states like Alabama, Louisiana and Mississippi, where less than half of adults have started the vaccination process.
"A lot of people feel, 'Oh, I dodged that bullet,'" said Dr. Jeanne Marrazzo, director of the Division of Infectious Diseases at the University of Alabama at Birmingham. She added: "I don't think people appreciate that if we give up vaccine efforts, we could be back where we started."
A series of theories have emerged as to why the South, which has been home to eight of the ten states with the lowest vaccination rates since Wednesday, is lagging behind the rest of the country: hesitation from conservative whites, concern among some black residents, prolonged challenges when it comes to access to health care and transport.
The answer, according to interviews across the region, was all of the above.
"It's a rather complex concoction and we tease the individual pieces," says Dr. W. Mark Horne, president of the Mississippi State Medical Association. He added: “There is no magic bullet. There is no perfect solution. There is no pixie dust we can sprinkle on it.”
Vaccines, once a scarce commodity, are now widely available in the United States and anyone 12 years and older is eligible for an injection. But daily vaccinations across the country have fallen to about 1.1 million doses from a peak of more than 3.3 million doses per day in mid-April.
Barring a sudden upswing, the country will fall just a little short President Biden's goal of giving 70 percent of American adults their first dose by July 4. Through Tuesday, the country was on track for 68 percent of adults to receive their first dose by the holidays.
Thirteen states, mostly in the Northeast and West Coast, have already given vaccines to at least 70 percent of adult residents, with several others remaining on track to do so in the coming weeks. Experts now believe that the United States may never achieve herd immunity, the point where the virus dies out, but Mr Biden has said getting 70 percent of adults on July 4 would be "a serious step toward a return to normal."
But in parts of the South, it's uncertain whether that milestone can be reached anytime soon or ever.
“I certainly don't expect to reach 70 percent on July 4. "I don't know if we're going to get 70 percent in Alabama," said Dr. Karen Landers, Alabama's assistant state health officer. "We just have a certain group of people, from all walks of life, who just don't get vaccinated."
Time is of the essence, both to prevent new infections and to use the doses already provided to states. With a shelf life of three months at refrigeration temperatures, millions of doses of the Johnson & Johnson vaccine will expire nationwide this month, urge some governors to plead urgently that healthcare providers will soon be using them.
On Monday, more than 57,000 doses of the vaccine would expire this month in Arkansas, officials said. And in Tennessee, thousands of doses lay unused with looming expiration dates.
From rural Appalachian towns to urban centers like Memphis and Birmingham, Ala., the delay has forced officials to fine-tune their pitches for skeptical residents. Among the latest offerings: Mobile Clinics, Facebook Live Forums and free football tickets for those who are vaccinated.
In the small town of Forest in central Mississippi, Rev. Odee Akines begged the members of his church to get vaccinated by sharing the story of his own near-fatal brush with Covidincluding 80 days in the hospital and about a month in a coma. In Alabama, Nick Saban, the championship-winning soccer coach, urged fans to get vaccinated so they could safely go to games this fall.
So far there have been individual success stories, but no major change in trend. When Alabama civil servants set up a clinic at Talladega Superspeedway and let vaccine recipients drive around the famous track, about 100 people took up the offer. dr. Landers said organizers had hoped for more people.
No reason explains why the vaccination campaign in the South is faltering, meaning no one is likely to change the trend. Common barriers to vaccination are not unique to the South, but mainly occur there.
Some Republicans distrust the government's role in developing and promoting the vaccines, polls show. Some black people distrust the medical profession because of generations of discriminatory care and experimentation. And others are busy, or bide their time, or can't get to a vaccination site, or have unanswered questions.
Certainly, millions of Southerners have already been vaccinated, and the vaccination campaign around some major cities in the region, including Nashville and Charleston, S.C., has progressed much more rapidly than in many rural areas. Vaccination rates in Virginia, Maryland, Delaware and Washington, D.C., are higher than the national average.
But in much of the South, skepticism about vaccines is ubiquitous. In Jackson, Miss., Felix Bell Sr., a warehouse supervisor, expressed concern about how quickly the vaccines were being developed. He wasn't about to shoot.
“At first they said it would take several years,” said Mr. Bell, who said he had previously recovered from Covid-19. "And then all of a sudden it was 'Boom'." He added: "They need to get more information about what's happening down the road."
The three vaccines approved by the federal government for emergency use have been shown to be safe and highly effective in preventing Covid-19. But Americans eager to get vaccinated got their shots weeks ago. Now health officials are trying new methods to convince the disinterested and the skeptical, and to keep the number of cases low in the coming months.
"My concern is the trap," said Susanne Straif-Bourgeois, an epidemiologist at Louisiana State University Health in New Orleans. "Because then everyone goes back to school, to university, to universities."
The national outlook has improved dramatically in recent weeks. The country averages about 14,000 new cases a day, the least since testing became widely available, and deaths and hospitalizations have fallen sharply. Mississippi Governor Tate Reeves, a Republican, recently called Mr. Biden's July 4 target arbitrary, saying he was encouraged by the relatively low hospitalization rates and case count in his state, which has the lowest vaccination rate in the country.
But doctors have warned that low vaccination rates could leave the South vulnerable to another wave of infections, a point some raise when offering the vaccines to skeptical residents. federal officials are particularly concerned about the highly transmissible Delta variant, first discovered in India and increasingly common in the United States. The Pfizer-BioNTech vaccine was found to protect against the Delta variant, officials said:.
"If we don't raise our numbers, we could be where we were last year, in our place of shelter," said William Parker, Birmingham City Council chairman, who has proposed spending millions of dollars on vaccine incentives and that answered questions about vaccines on Monday as part of an online forum for residents.
In the sparsely populated rural communities of Tennessee's northeast corner, officials say they've had less trouble convincing people to get vaccinated than getting the injections in people who don't have the time, transportation, or knowledge about the process. In one community, two vans have been converted into mobile mobile vaccination sites, sent to churches and workplaces to intercept people as they go about their days.
There are modest signs of progress. The first weekend the vans were in use, about 40 doses were given. But at a recent event, about 135 people were shot.
"We've always been a little behind the rest of the country when it comes to infrastructure," said Mark Stevans, the director of special projects for the First Tennessee Development District, the agency overseeing the effort. "And I would argue that the vaccine is a critical piece of infrastructure."
Across the region, doctors and public health officials repeatedly cited two factors that make a difference to the hardest-to-reach people: easy access and a personalized pitch.
dr. Kelly Rodney Arnold, the founder of Clínica Médicos, which treats underprivileged and uninsured people in Chattanooga, Tennessee, said she knew the trust she had built over the years with her patients, many of whom were Latino, would be critical. in overcoming skepticism.
The staggered rollout of the vaccines, she said, had allowed disinformation to spread and complicated the campaign.
"They're not going to knock on the E.K.'s door to get a vaccination," said Dr. Arnold. "They're not going to approach something that's new and full of a lot of scary information around it."
Luke Ramseth contributed reporting from Jackson, Miss. Lazaro Gamio, Amy Schoenfeld Walker and Noah Weiland reporting contributed.