WAYNESVILLE, N.C. — After Nathan Murray and his fellow emergency services workers in Haywood County first stood up a mass vaccination site on a idle fairgrounds here three months ago, they were undaunted by the crushingly busy days, brushing off the exhaustion as they vaccinated their neighbors.
But on Wednesday, at the 17th mass vaccination clinic of the year in Haywood County, something worrying happened: a slow day.
“This is bizarre, very bizarre,” Murray, a captain in the local emergency medical services who was staffing a check-in tent, said as the lulls between patients stretched ever longer. The site near the Carolina side of the Great Smoky Mountains had 1,400 first doses of the Moderna vaccine to give out, but only 903 arms that wanted them.
”We’re running out of people,” Murray said grimly. “That’s really what’s driving this.”
Until now, the country’s primary challenge in the race to inoculate the public against COVID-19 has been logistical, as factories scrambled to produce hundreds of millions of doses while state, local, and federal officials improvised ways to get them to the people clamoring to have them — and they have much to be proud of.
But in some states — especially in the South — vaccine appointments are going begging, as broad swaths of the public remain hesitant. Skepticism runs highest among white evangelicals and conservatives, according to polls, populations that are well-represented in this upland stretch of Western North Carolina where Donald Trump won 62 percent of the vote last year and residents, who are 95 percent white, harbor a generational distrust of government.
About 37 percent of the county’s 62,000 residents have had at least their first dose, which is just above the statewide rate of 36 percent, according to the state’s health department. Massachusetts, by contrast, has vaccinated 43.6 percent of its population with at least one dose. North Carolina is in the bottom 15 states for vaccination rates, according to an analysis by The New York Times.
While vaccines here are now more widely available among local pharmacies and other sites, officials worry that demand for shots will peak soon, leaving the county well short of the 70 to 90 percent vaccination rate necessary to achieve herd immunity.
“I’ve talked to some of the surrounding counties and they’re saying, ‘You know, we’re hitting this wall,’” said Garron Bradish, vaccine coordinator for Haywood County. “It’s a little bit concerning that we’re hitting the wall this early.”
It’s an impasse the Biden administration has been dreading, one that threatens the nation’s ability to finally defeat the pandemic. Public health experts worry that vaccination rates are mirroring the US political map, with red states lagging behind blue states, and they say the hard work of convincing the hesitant must ramp up.
The White House announced it is trying to reach Republican men through advertising on the “Deadliest Catch” show and partnerships with NASCAR and Country Music Television. (They’re also continuing outreach to communities of color, which on average have been hit harder by the pandemic than largely white counties like Haywood.) But a closer look at Haywood County reveals the daunting challenge to convince deeply skeptical Americans to get vaccinated — and suggests that it is the quiet work of locals fighting a tide of misinformation and skepticism among their neighbors and friends that appears to have the best chance at succeeding.
Murray, for example, is a 39-year-old Baptist pastor as well as a paramedic, who spent last week filling in on Sunday for a preacher he knows, then staffing two mass vaccination clinics, on Wednesday and Thursday. A born-again Christian and Republican who voted twice for Trump, he might not seem at first glance like an obvious vaccine proponent. But he has spent months reaching out to churches for volunteers for the vaccination clinics, informally discussing COVID-19 with other pastors, and answering questions from locals in religious or conservative groups when they come up, well aware of their doubts about everything from the vaccines’ safety to the apocalyptic conspiracy theories about them that thrive online.
“I don’t know your degree of theology or anything like that, but [to] the God I profess to believe, my salvation is not in jeopardy because I take a vaccine,” Murray told a meeting of the county GOP here on a cold night in February after a woman expressed distrust about the shots. “It’s my personal belief that once I’m saved, I’m always saved.”
Experts say this is the best form of public health outreach there is — a trusted messenger from within the community vouching for the vaccine to friends and neighbors. But it’s slow work, and it can be hard to tell if it’s effective.
Even Murray’s parents and brother have “pushed back” on vaccines, he said, and they’re not alone. Officials here believe about 60 percent of the population is willing to get a vaccine without too much nudging. But given the trickle of people who came to get vaccinated on Wednesday, even that figure is beginning to look like a high bar.
“Having relationships with those people — it takes time. It’s very messy. It doesn’t always work,” Murray said in an interview this week, sitting by a lake in town where a tall cross stands sentinel. “I’ve never outright said, ‘Well you should do this or that.’ I just tell them what I do.”
On Dec. 18, with a surge of COVID infections threatening to push the county’s medical resources to the brink, Murray posted a photograph of his freshly filled-out vaccination card to his Facebook wall.
“So others may live…” he wrote. “With all of the turmoil, politicizing, controversy, and even spiritualizing that surrounds this issue, I’ve decided to place what is best for others ahead of myself, which is the epitome of Christian virtue.”
It was a way of setting an example, and also of highlighting real scripture over viral disinformation that suggests COVID vaccines are the “mark of the beast” from the Book of Revelation or a sign of the end times — rumors that left Murray frustrated and have likely fomented evangelical opposition to the vaccines.
“If you can ever break through this dogmatic crap that people have been force fed, that’s tough,” Murray said.
At the time, it was becoming clear vaccine hesitancy was going to affect his community on a broader scale, too. The low number of the county’s emergency workers who initially wanted to receive the vaccine when it first became available surprised him, he said, although those numbers ticked up as COVID again swept through the county — a development that galvanized him to put everything he could into the vaccine effort.
“It was like, scary insane,” Murray said. “So there was an urgency on my part to say, we’ve got to do it. Let’s mobilize. Let’s get this done.”
With little guidance from the state or the federal government, Murray and other county workers teamed up with a local hospital, drew a heart-shaped route through the fairgrounds, and devised an elaborate system of Post-it notes to guide patients through the vaccine site. Murray recruited volunteers from Methodist, Baptist, Mormon, and other churches.
On Wednesday, the Rev. Steve Frazier of Riverside Baptist Church maneuvered his white Ford F150 over fresh gravel and through the fairgrounds to get his first dose of the vaccine.
“There are some people in our church who would rather not get it,” Frazier said later, adding that he does not see it at his job to convince them otherwise. “My job is to preach the gospel of Jesus Christ and not to promote the vaccine, but it’s a good thing to do as God’s people.”
County officials, however, say faith leaders can help get reliable information about vaccines out to their congregations.
Nationally, nearly 30 percent of white evangelicals say they “definitely” won’t get the vaccine, according to polling by the Kaiser Family Foundation, making them the most hesitant group polled, along with Republicans.
“I think here in the South, and here in Haywood County, more than maybe other places in the United States, just because of who we are and the heritage we have, faith is going to be the next logical step for getting past that 60 percent number,” said Cody Grasty, the incident planning team section chief for the county.
The night Murray spoke to local Republicans, Kay Miller was listening — but she wasn’t buying it.
The chair of the county Republicans, Miller, 60, runs three local restaurants with her husband (they lost a fourth during the pandemic). In an interview this week, she dismissed the dangers of COVID-19 — which has a US death toll larger than that of World War II — as trifling.
“This virus is highly curable with readily available medicines,” said Miller, citing discredited claims pushed by Trump that hydroxychloroquine and other drugs could cure the disease.
Miller rarely wears a mask, and the way she sees it, it’s her right to not get a vaccine. “I am fiercely for liberty, maybe you can even argue to a fault,” she said. “The survival rate is so high.”
Experts say that, overall, somewhere between a quarter and 40 percent of the public is either unsure or firmly decided against getting COVID vaccines — a figure that, if borne out at the high end, would likely allow COVID variants to continue to spread.
Figuring out how to persuade those reluctant people to get the vaccine is “the most important work that needs to be done” to end the epidemic, said Timothy Callaghan, an assistant professor at Texas A&M University who studies vaccine hesitancy.
Officials in Haywood County say that work is beginning, and they are thinking about how best to appeal to a population with a deep distrust of certain authorities.
“We’re notoriously stubborn — Scots-Irish, clannish, you know, very strong-willed and minded and antigovernment, in the mountains,” said Ray Shepard, an associate pastor at Canton First Baptist Church.
County officials believe the reluctance to get a vaccine may be powered by a drop in infections here from their spike a few months ago, which has made the virus seem less urgent to locals.
Residents such as Dorothy Burnette, 55, say they are still worried about the potential side effects of the vaccine. That distrust was heightened last week when the FDA paused use of the Johnson & Johnson vaccine after doctors observed dangerous blood clots in six of the 7 million patients who have gotten it.
“It’s not been out long enough to see what happens,” said Burnette, a cook in a gas station cafe and a self-described “Trumper” who said she would make a decision about getting the vaccine based on what happens to her sister, who got it last week. “I’m going to track her,” Burnette said.
The county sent a mobile unit to bring the vaccine to the small number of Latino and Black people who live here, and they are considering doing the same in insular white mountain towns.
“We have a lot of residents that don’t like to travel out in town. They live in the holler and they don’t like to come out of the holler,” said Zack Koonce, the emergency management officer with the county. “We’ve got to figure out how to reach those.”
But officials know there are some residents they will probably never convince.
“We may not get to herd immunity,” Dr. Mark Jaben, the county’s medical director, admitted, “and sort of have rolling waves of this among people who are not vaccinated.”
Cody Grasty, the county’s planning official, understands vaccine hesitancy — he felt it himself. A devout Catholic, he wasn’t sure what to do when he was offered a dose of the Johnson & Johnson vaccine before the FDA paused its use. He knew the US Conference of Catholic Bishops urged people not to take it if they had other options, because stem cells were used to develop it.
“My faith told me not to take the J&J,” he said. But he Googled the issue on the spot and found an endorsement from a higher authority.
“I found out the pope himself said get the dang vaccine, it doesn’t matter where it comes from,” Grasty recalled as he took a break from crunching numbers at Wednesday’s clinic. He got the shot and he is hoping to persuade his grandmother, who survived COVID after catching it at a religious revival, to do the same.
If the county is indeed hitting a plateau, it’s these individual interactions —-friends convincing friends, relatives convincing relatives — that could make the difference between defeating the pandemic and living through more COVID winters with more COVID funerals.
That was evident on Wednesday in the line of cars outside of the vaccine clinic, where Carolyn Rathbone, 62, brought her son Steven, 30, to get his first shot, handily steamrolling his concerns about “rumors” by telling him he didn’t have a choice.
“Everyone has to be protected,” she said.
Nancy Rice, 74, got the vaccine because she had been hospitalized for a month with COVID, and is urging people to get it so they won’t go through what she did. Claudia Conard, 37, a stay-at-home mom, said she got the vaccine so she would be able to visit her mother in the hospital, and was about to go home to call her sister to make sure she does the same.
And Roz Fisher, 55, who was driving a black SUV with a “Jesus take the wheel” bumper sticker and a dachshund named Bella on her lap, said she has urged everyone she knows to get the vaccine. Her daughter, Lacie, died in 2019 from a sudden case of the flu.
Some of her Christian friends have expressed reservations, but Fisher has an answer for that: “If it wasn’t for God,” she said, “the doctors and people who came up with the shot, they wouldn’t have the knowledge to do that.”
Ultimately, it’s those relationships and conversations that will continue to fuel the vaccine drive Murray and others have worked so hard on.
“You try to make your case,” he said, “even if it’s one person at a time.”