The Daily - Rural Tennessee’s Vaccine Hesitators

Episode Date: May 10, 2021

Vaccine hesitancy is a major reason that many experts now fear the United States will struggle to attain herd immunity against the coronavirus.And while many initially hesitant demographics have become more open to vaccinations, one group is shifting much less: white Republican evangelical Christians, who tend to live in rural communities.Here’s what that looks like in Greeneville, Tenn.Guest: Jan Hoffman, a reporter covering behavioral health and health law for The New York Times.  Sign up here to get The Daily in your inbox each morning. And for an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. Background reading: Reluctance to get vaccinated is widespread in white, Republican communities like this one in Appalachia. But it’s far more complicated than just a partisan divide. Read Jan’s reporting here. For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday.

From The New York Times, I'm Michael Barbaro. This is The Daily. On Friday, I spoke with my colleague, Apoorva Mondavili, about the growing consensus that herd immunity is no longer achievable in the United States. A major reason why is vaccine hesitancy. Today, what that hesitancy looks like inside a single community. Astead Herndon spoke with our colleague Jan Hoffman about her reporting in rural Tennessee.

It's Monday, May 10th. Jen, tell me about your reporting on vaccines over the course of this pandemic. I focused mostly on vaccine hesitancy. In the early months of vaccine development and then the eventual rollout, the concern really had to do with people in Black and Latino communities because of their historic maltreatment on the part of medical researchers and, frankly, the healthcare system. But as the months have continued, because of the efforts of leaders in the Black community, the Latino community,

among medical professionals in those communities, and also religious figures in those communities, hesitation has decreased in those communities, although it's still present. And surveys showed that the hesitation remained firmest in people who describe themselves variously as Republican, white, and or evangelical Christian, and who tend to live in rural communities. So in your focus on vaccination efforts across demographic groups, you've zeroed in on these white conservative communities, partly because they're the firmest or steadiest holdouts that we've seen so far.

Absolutely. And I really wanted to understand what was underlying it. So what did you do? I went a few weeks ago to Greenville, Tennessee, a little town of 15,000 in a very rural community in northeastern Tennessee. It had been hit very hard by COVID, particularly this winter. More trucks were opened in the parking lots of the medical center, and they were considering opening a special second COVID unit in that hospital. And today, Greene County, of which Greenville is the county seat, has a vaccine rate of about 31% for adults who've gotten at least one shot, compared to the national rate of 56%.

Wow. So in a community like Greenville, if there isn't sufficient vaccination, COVID will keep coming round and round and round. What kind of conversations are people in Greenville having about vaccines? What did you find in your reporting? You know, I found that a lot of people had gotten tired of talking about it. I met innumerable people

who'd had squabbles and fights in their families. A father was not going to get it. A daughter was. I met an older woman whose husband has multiple myeloma who had to say to her adult children, if you don't get the vaccine, you cannot visit your father even though he's dying of cancer. And yet they have refused to get the vaccine. Wow. So it's become basically a painful and silent point of contention because people feel that

there is nothing they can do to change each other's minds. And studies show that the most effective way to change someone's mind is by having that person talk with an authority figure whom they know and trust. So what's particularly difficult is the position, the very complicated position of the pastors in the community. They have a broad range of views about the vaccine, but for the most part, they have chosen not to use their pulpits as a place to speak about their positions because they feel for both religious reasons and for reasons that have to do with the ethos of the community, which is very much you get to make your own decision that they are not going to speak out about this particular issue. This is not where

they're going to plant their flag. And yet they are among the most trusted people in the community. As you say, the pastor is a trusted figure who could talk and sway maybe hesitant people. Are there other figures who are working to do that in places like Greenville? Certainly. The family physician, the primary care provider, is the quintessential trusted figure on all things health and medical. And I met a number of physicians who are trying very hard. So you're the head of the family medicine clinic?

I'm the chief medical officer for Greenville and three other hospitals in the community. Specifically, Dr. Daniel Lewis, who's a family medicine physician. I grew up in northeast Tennessee in Carter County. Dr. Lewis is 43 years old, has five kids, he's a devout Baptist. I'm a sports medicine trainer, so yeah, all the athletic trainers. He's the sports doctor for Lord knows how many teams at the high school and is very much a figure in the community. But he gained an extraordinary amount of gravitas about a year ago this spring when he himself had his own very serious COVID experience.

And what was that like? He told me that one of our team members began to cough. And we kind of jokingly said, you know, so have you got COVID? No, it's allergies or whatever else. He had been exposed to the virus by a colleague who at the time did not know that he was positive. So he came back positive. And then I developed symptoms. Began to feel a little short of breath. Sat down and said, not a physician heal that self situation.

I need to defer to somebody else. I'm not objective enough, so I called my wife and said, I'm going to the hospital to get checked out. And while he was at the hospital, it became harder and harder for him to breathe. His oxygen saturation levels dropped, and his condition became truly dire. I recorded voice memos for my kids on my phone

in case I didn't come back. Did they think there was a chance that you would die? No, absolutely. Absolutely. He posted a loving and very painful message to his community on Facebook. I made a Facebook post at that time that said, I'm getting on the ventilator. I'm okay. Everything will be fine. God's in charge. And I'll see you all on the other side. Hours before the decision was made to put him on a ventilator.

In anticipation of his possible passing? Yes. Wow. Yes. When he was sick, as a measure of how much this community loves him, they would drop off meals on his front porch for the family, restaurant gift cards, they mulched his flower beds, they fixed his truck, anything to give back to him.

The community and the area wrapped its arms around me in a way that was just amazing. I can never repay them for that. He ended up staying in the hospital for over a month. When he finally was released and went home, Hey everybody. So this is clearly outside my comfort zone. He made an extended video that he posted on Facebook. The story actually starts in early March.

Narrating his experiences. I was one of the 15% that required oscillation. I became one of the 5% that required ventilation and a ventilator. He really wanted patients, his own patients and the community at large, to understand what a grueling and terrifying experience it could be for them. But please, as you go out and go about your daily activities, do all you can to protect yourself from this virus. Do all you can to protect others from this virus.

Thanks for taking the time to watch this video. I hope it's been helpful. Hit me up with any questions. And again, thanks and love you all. do all you can to protect others from this virus. Thanks for taking the time to watch this video. I hope it's been helpful. Hit me up with any questions. And again, thanks and love you all. The video went viral. This doctor in Greenville is finally back to work after spending six weeks in the hospital sick with COVID-19. Local news came to his doorstep.

National news figures picked up on it. Tonight, a blessing and a curse. That's how my next guest describes his experience as a doctor. The video and his experiences really helped cement his presence in the community as someone who had absolute authority to speak about this experience and why it should be avoided at all costs. You know, at that point, I began to think, okay, so how can this story be used? And, you know, what is the purpose of this? And, you know, again, a lot of questions from a faith perspective, why did I go through this? He and his wife prayed about why God had put him through such an ordeal. And then I realized that people were listening and that I had an influence.

And that was maybe the purpose of this whole thing. And he told me that he realized it was truly his mission to advise patients about how to take their own precautions and to counsel them about getting the vaccine. So if you want to protect your neighbors and community, we need everyone that will take a shot to get a shot. Because the sooner we get to that 70%... So here's a doctor, Dr. Lewis, in a unique position in this community. Not only as a trusted physician,

but as someone who can speak personally to what it's like to be sick, very sick, from the virus. And he has decided that it is now his mission to use that position to encourage others in this community to take both virus and vaccine seriously. Absolutely. When you talk to Dr. Lewis, what does he say comes up in these conversations he is having with residents of Greenville? This, I think, really gets to the heart of the issue. People have many different questions and reasons for not wanting the vaccine. So the biggest argument I get is it was just too

quick. It was just too much, too fast. How did this happen? The primary concern most people have is they feel it was developed far too quickly, and that makes them uneasy. I mean, the very title Operation Warp Speed reinforces that point of view. They are expressing religious concerns. They have heard that the vaccine was developed from stem cells from aborted fetuses. This is fundamentally not true. But the Lent is more a libertarian anti-government. I feel like it's more their assault on their individual freedoms. They have also soaked up a great deal of misinformation

from far-right sources. I've said to more than one person, I don't need to put a chip in to track you. Bill Gates doesn't have to chip you if he wants to track you. So that you will hear people ask about the conspiracy theory that Bill Gates has put microchips in the vaccines to track anyone who's gotten them, which is patently false. But yeah, there is that fear. But there are plenty of people who are still concerned about that. So that seems like a mountain of concerns for Dr. Lewis to address.

How does he do that? He talks to them one-on-one. He has conversations easily three or four times a day, every time a patient walks into his office for a consultation. And he opens that door to them and says, what are your thoughts about the vaccine? And Dr. Lewis, as well as the patient and the patient's wife, allowed me to sit in during one such consultation where the couple really expressed their concerns about the vaccine and Dr. Lewis attempted to answer them. We'll be right back. So, Jan, you got the opportunity to sit in Dr. Lewis's office while he was talking to people who were not sure whether they wanted to get vaccinated or not. What happened in that room?

I went to the family medicine clinic on a Tuesday morning. I'm Jim and this is Rita. And I met Jim and Rita Fletcher. OK, and are you here from Greenville? Yeah, yeah, yeah. We were born and raised here. OK, do you mind telling me how old you are? I'll soon be 74. You are not.

Oh yes. Oh no. And Miss Rita, how old do you pretend to be? I'm 70. They are in their early 70s. They're both retired. I'm a retired telecommunications engineer. Oh wow. What did you do? What kind of trouble did you get into?

I just did accounting work and secretarial work. Uh-huh. Okay. And they've been married for more than 50 years. We were kids. Yeah, we were just kids. They're both very devout Baptists. We're free will Baptists.

I was raised Methodist, and I married a Baptist. And they certainly believe COVID is real. Look, we know it's a real disease. It is. We know it's really bad. And from Thanksgiving to just after Christmas, we lost 11 people that we knew within our circle. They know at least 11 people in their circle who have died of COVID.

Wow, 11. 11. Have you ever had any shots? We've had all the normal vaccines, you know, of kids and everything. Yeah, we've had all those. And our children, we had them vaccinated. Always vaccinated. They had fully vaccinated their sons with the traditional vaccines,

but this is one vaccine they absolutely don't want to get. But I think that we have been hornswoggled. I think a lot of it has to do with, they've made it political, and a lot has to do with control. They had so many reasons to be apprehensive. My concern is more of a religious position. Mine would be, I don't trust it at my age. I don't know what will come down the road, what it will do to me three to five years from now. They did not trust the speed of development and frankly didn't quite understand how a vaccine could have come together so quickly.

And they also were very concerned about being microchipped. Well, considering those concerns, how did their conversation with Dr. Lewis go? Dr. Lewis walks into the room. Did Jan tell you why you should take the vaccine? Did she tell you all that? Or is that my job? No, it's your job. He's a shirt-sleeve kind of doctor.

And he sits down, pulls up a stool, and then he begins. I'm going to go backwards and take the fetal tissue one first, okay? And the first thing he answers them is their concerns about fetal stem cells. The vaccines themselves don't have those cells in them. When stem cells are beginning to be used as a potential tool in medicine. They did take some tissue potentially from the aborted fetus that they had put into a lab and they've grown, and they've used that in medical research 30, 50 years.

Then he says that the vaccine is absolutely not related to those initial stem cell developments. The two things I've heard most prominently is the newness of the vaccine and then also the speed at which it was developed. How the government helped develop that quickly. And then he explains to them that the model for the vaccine that has been currently developed was really begun to be established 15, 20 years ago, so that even though the vaccine appears to be pulled out of a hat like a rabbit, in fact, it's been cooking for quite some time. now use mRNA technology. So they use a piece of genetic material of the virus to then deliver part of the code for the protein of the virus into your body. Now you speak of the code. Does that alter our DNA? Not at all. So our bodies are made of proteins that are built off of genetic material.

Your body uses your DNA, it unzips the DNA, it makes a copy of that with the mRNA. As you were sitting there, what stood out to you about the conversation? I was struck by how respectful and caring his tone was.

It's essentially a recipe. We're adding an ingredient to your body, so your body can then read that like a recipe card and develop something that fights against it. He used clear metaphors, straightforward analogies. The reason why this virus is so deadly is because we haven't seen it before. I equate it to essentially, it's like your home being broken into for the first time. If you've never had your home broken into, never thought about that, never been concerned, you're going to be caught unaware

for the first time. It's kind of the same as a virus. When our body's never seen it before, it doesn't know how to respond. But the second time, your body maintains a memory of that and it knows it. So the second time it was to see it again,

most likely, it's not going to get infected at all. Or if you do, it's not going to be very sick. It was really accessible language so that he was describing fairly complicated scientific concepts, but they were easily understood. What about treatment? If you get COVID, we were hearing early on that hydroxychloroquine with zinc and vitamin D and other things would defeat the virus.

I wish. I tried. You tried that? I had this. It didn't do anything for me. He also spoke from his personal experience as a patient, which is something that he has, of course, this terrible authority that he can hold forth on. I had hydroxychloroquine. I took it as soon as I went to the hospital. It didn't prevent. this terrible authority that he can hold forth on. I had hydroxychloroquine. I took it as soon as I went to the hospital.

It didn't prevent. I tell people I did not die. So I don't know if I had a piece of that or not. I think I had more of a piece of that than anything else. I didn't die. I don't think it was hydroxychloroquine. But I certainly went on the vent. I stayed in the hospital for a month and a half. It didn't prevent those complications.

Do you think it would have had you taken it early or in the... I don't think my course would have changed if I had taken it three days earlier. But I think what was most important is that he met them where they were at, and they didn't feel looked down upon. They felt respected. How can we be sure there are no... That's the little devil. Think-fitting your dog. Chip chips? Yeah. How can we be sure there's no chip involved? Well, I would say this. When you get the injection, it comes with a needle that's got an opening up that wide. We make microchips all the time. We

don't make them that small. You know, I mean mean there has to be some degree I think just the other faith I guess in that regard but there's no way to introduce a chip through a needle at this point or else we do it to dogs and everything else when you have a dog that gets microchipped for example there's a surgery done right they don't inject it to it it's just kind of it's kind of like a grain of rice yeah but I can't inject a grain of rice through a needle. No, no. Not unless the needle is big enough.

I had this shop class that ain't that big a needle, I promise you. I don't have a needle that's big enough in my building to inject through the grain of rice.

As an engineer, I think of those things. I understand. Listen, and that's why that's part of this conversation is multiple things. So what other questions do you have about the vaccine, about COVID in general?

Will this be a yearly vaccine? We don't know that yet either. And he answered every question they had and kept asking if they had more questions. I just want you to have an informed decision. So I'm going to do the best I can to help you. Well, we have some time to spend in discussion. Absolutely. And you guys please do.

And that's more than fair. And we do have a formal decision. Okay, good. And they paused and said they had some things to talk about and think about, and they would continue to talk about it between themselves. That's all I actually do is consider it. Okay. After listening to this conversation, you really get a sense of the time and effort that has to

be put in to win over skeptical people about the vaccine. Is that the takeaway that you had? I had several takeaways. I was struck by how much time he gave them, which was so much longer than what I would consider to be a typical patient visit in a doctor's office. But more importantly, I thought, how many conversations is he going to have to have to persuade them to take the vaccine? Is he getting paid for this, which of course he's not. He has to charge for just a regular visit. not. He has to charge for just a regular visit. And then what's most frustrating of all is that, as he's told me, when he is successful with patients and is able to talk them into getting the vaccine, they'll say, okay, are you going to give it to me now? And he'll say, I'm sorry, I can't, I don't have it here. Wait, really? They don't have it?

Most physicians at this point still do not have their own supply of vaccines to be distributed to their own patients. And so that means that patients have to go find a location. They have to go to a pharmacy if it's available, a vaccination site. And what the travel can mean is that they will have to take off time from work or secure transportation, all of which are obstacles to many, many people to getting vaccinated. And unfortunately, it also means that the moment of inspiration where they decide they're going to take it can get lost. So Jim and Rita took time and thought about it more with all that information that Dr. Lewis gave them. Did they end up getting vaccinated? I jumped on the phone with them about a week ago, and Jim told me that they had decided

at that point not to get the vaccine. Jan, after hearing about this long process that Dr. Lewis has gone through, and then to know that some people still choose not to get the vaccine, I think for many people, it's fairly natural to be confused or even angry at that decision because it has larger public health ramifications. I think there's an instinct to see it as a selfish or potentially harmful choice. What do you think, having spent time with these people, having spent time in that room, should be the takeaway from these decisions? Well, I certainly know that anger and dismissiveness do not work.

I met a patient in Greenville who was on the fence about getting the vaccine. patient in Greenville who was on the fence about getting the vaccine, but she told me that she felt that her doctor patronized her and looked down her nose at the patient for not getting the vaccine. And she felt so insulted that she turned and walked out. So collectively, I don't think that's a good way to treat people who are hesitant about vaccines. In fact, the research shows that people who are hesitant have the opportunity to see people who are getting the vaccine, enjoying their regained life and doing just fine, are more inclined to think, well, maybe I can get it. And maybe I'll do fine, too. well, maybe I can get it, and maybe I'll do fine too. That's one prompt, and the other, of course, is a trusted source, such as a Dr. Lewis.

But that means you'd have to multiply Dr. Lewis endless numbers of times across the United States. And so, to say that you respectfully disagree, I think is where you leave it for now and hope for the best. Thank you so much. I appreciate your time. Thank you, Ested. Looking back on your conversation with Jim and Rita, they told me, of course, that they are at this point not going to take the vaccine. So do you hear that as a hard stop or just an incentive or a go to go at them again when the time's right?

No, I'll definitely engage them again and try to ask follow up questions and help move them and others like them as they go forth. Even last week, I thought somebody would give the vaccine here. I aided them in their deliberation to determine that they wanted to take the vaccine, let me say that. I would say that there's been more successes than there have been failures. So I do feel optimistic that it's made a difference. To encourage reluctant Americans to get vaccinated, the Biden administration says it will now shift its focus away from mass vaccination sites toward smaller local vaccination sites, including doctors' offices and pharmacies, and said that it would try to enlist the help of trusted voices in every community, such as family physicians. We'll be right back.

Here's what else you need to know today. A major cyber attack has resulted in the shutdown of one of the nation's largest pipelines, which carries refined gasoline and jet fuel from Texas to the East Coast. The attack demonstrated once again how vulnerable America's critical energy infrastructure remains to online attacks. The 5,500-mile pipeline carries about half the East Coast's fuel supply. But the impact on consumers is expected to be minimal for now because the East Coast has large supplies of fuel in storage. Over the weekend,

the owner of the pipeline, Colonial Pipeline, said that its computer system was the subject of a ransomware attack in which criminal groups hold data hostage until the victim pays a ransom. But the company has yet to say whether it has paid the ransom. Today's episode was produced by Aastha Chaturvedi and Austin Mitchell.

It was edited by Dave Shaw and engineered by Chris Wood. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.