How one county in North Carolina is combating vaccine hesitancy

In Onslow County, North Carolina, the public health department has already all but given up on herd immunity. This county has one of the highest rates of vaccine hesitancy in all of North Carolina, according to data from the US Centers for Disease Control and Prevention (CDC).

SAN ANTONIO, TX - MARCH 29: A nurse fills up a syringe with the Moderna Covid-19 vaccine at a vaccination site at a senior center on March 29, 2021 in San Antonio, Texas. Texas has opened up all vaccination eligibility to all adults starting today. Texas has had a slower roll out than some states and with the increase in eligibility leaders are hoping more and more citizens get vaccinated. (Photo by Sergio Flores/Getty Images)

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And it’s just one of hundreds of places across the country where the vaccine is not catching on, leading some experts to predict the US will never reach herd immunity, despite the advent of widely available and effective vaccines.

“About 70% of our population needs to be vaccinated for us to feel like we’ve got enough coverage, that we can kind of control this disease in our community and kind of learn to live along with it,” said Kristen Richmond-Hoover, public health director in Onslow. “We’re (at) about 20% that have had at least one vaccine in Onslow County. We have a long way yet to go.”

Making it personal

Onslow County, located on the edge of the Atlantic, hosts some of America’s largest domestic Marine Corps facilities, housing an always-ready force of thousands poised to deploy whenever the call comes.

Inland, the agriculture sector dominates the economy as it does all across eastern North Carolina – hogs, tobacco and other crops that heavily rely on migrant workers.

Marines and migrant workers – a recipe for a transitory population that makes any consistent public health effort a struggle, not to mention one based around convincing people to take newly-developed vaccines.

Sign for the city of Jacksonville, located within Onslow County.

Migrant farm workers can be wary of interacting with the government-run vaccine programs, advocates say, especially after four years of Trump administration rhetoric about undocumented immigrants.

So some local authorities are adopting a “take the mountain to Mohammed” approach.

Every week, Brandy Quinn, a health department nurse supervisor in Onslow County, plugs a refrigerated cooler of Johnson & Johnson vaccines into the cigarette lighter in her old Chevy truck and drives it across the county to find people she can cajole into getting a shot.

Quinn, who is from the area, is a natural salesperson – it’s easy to see why someone might feel less hesitant about the vaccine after talking to her about it.

When she rides out to farms, she brings along Nancy Brizuela, another health department employee who is fluent in Spanish.

“We helped (workers) fill out their paperwork,” Quinn said, recalling a recent farm visit. “The farmer could not help them because he is not bilingual.”

Brandy Quinn

Simple hurdles, like a language barrier, are easier to tackle. But other populations Quinn works with, like inmates in the county jail, need more convincing, she said.

“They thought I was taking something in to kind of harm them,” she said. “Everyone that day at the jail, after I sat down and talked to them and they had seen me in there several times… they said yes.”

Appealing to a sense of duty

Quinn can’t work her magic on the county’s military facilities – those are a federal problem. The base keeps its own vaccination numbers, separately from the county, making it difficult for health department officials to get a complete picture of Onslow’s numbers.

But vaccine hesitancy within the Marine Corps’ ranks is well known, and the military has its own effort in place to try and combat it.

“Prior to the vaccine even being created we knew that there would possibly be hesitancy to it,” Riley Eversull, public information officer at the Naval Medical Center, a Navy-run facility on the Marine Corps’ Camp Lejeune in Onslow County, told CNN.

Eversull’s job is usually about communicating with outsiders about the world on base. But during the vaccine push, she’s helped lead efforts to convince Marines to sign up for doses.

“People are concerned about getting sick from the vaccine and possibly having to be out of work,” she said. “We just communicate that it’s not the same for everybody.”

According to a spokesperson for the Marine Corps, in late-April, the vaccine declination rate for II Marine Expeditionary Force and Marine Corps Installation East at Camp Lejeune was about 66%, even as the declination rate throughout the Marine Corps was 36%.

It can be hard to fathom why a group so focused on being prepared for action at all times – the sign outside Camp Lejeune proudly declares “Home of Expeditionary Forces In Readiness” – might eschew a vaccine that could mean a serious disease could knock them out of an upcoming fight. But hesitancy runs deep on base, even after the Navy officers in charge of vaccinations try to appeal to that Marine Corps “oorah” spirit.

“The more people we have vaccinated as far as active duty members, the higher our operational readiness is which means that our active duty, if they are fully vaccinated and ready to go, they’re ready to answer the nation’s call at a moment’s notice whether we go afar or whether we stay in the United States,” Cmdr. Heather Kirk, site lead at the Naval Medical Center vaccination site on Camp Lejeune, said.

Getting vaccinated is voluntary in the military. But Kirk said getting the shot is part of being a good sailor (or Marine or Airman or solider or Space Force Specialist for that matter).

“It’s completing our duty to the nation and completing our mission,” Kirk said.

Cmdr. Heather Kirk

This has been a tough sell on Lejeune. But the Navy isn’t giving up, Eversull, the public information officer, said. They are sending teams into individual Marine units to offer one-on-one question and answer sessions that put skeptical rank and file Marines with medical experts.

And there are signs things are improving. The military has seen a 55% jump in Covid-19 vaccinations among active-duty service members over the last month, a senior defense official told CNN Thursday. The increase comes after the Pentagon opened up vaccinations to the general population on April 19.

Playing to the politics

Camp Lejeune, the neighboring military facilities in Onslow County, and the farm workers Quinn works with are just part of the hesitancy picture here.

There’s also the politics.

This county is bright red. Former President Donald Trump won the county with about 66% of the vote in 2016 and about 64% in 2020.

A pro-Trump sign in Onslow County

Vaccine hesitancy, particularly among conservative and rural voters in the Southeast and Mountain West, is common. A Monmouth poll published last month showed that 43% of Republicans said they would likely never get the vaccine.

US President Joe Biden delivers remarks and participates in the virtual Leaders Summit on Climate Session 5: The Economic Opportunities of Climate Action from the White House in Washington, DC, on April 23, 2021. (Photo by JIM WATSON / AFP) (Photo by JIM WATSON/AFP via Getty Images)

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The entire County Commission in Onslow County is Republican. The group has had its own internal arguments about how seriously to take the pandemic.

One Republican commissioner, Robin Knapp, uses his own social media account to repost county pandemic data weekly, and answers questions from constituents about the vaccine.

He said because people know him and trust him, he might be able to convince them to believe the science.

“It’s very frustrating because you’re trying to convince somebody, because you’re looking out for their welfare, and some people can be obstinate,” Knapp said.

But Knapp said that convincing skeptical locals means keeping his own frustration in check.

“I’m not going to push somebody to take the vaccine or be mad at them for not taking the vaccine or be upset with them or anything like that,” Knapp said. “Because that’s their choice and that’s their freedom of choice that they can exercise.”

Robin Knapp

Redefining success

The vaccine push in Onslow County is now counted shot by shot. One, two or five doses among a targeted group are seen as a victory.

The county health department is pushing personal stories to get the vaccine out – people may not listen to the government, officials say, but they might listen when someone they know says they got the shot and lived to tell about it.

“My grandma’s like not getting the vaccine cause she’s scared,” Quiara Bannerman, a 17-year-old getting her second dose at the American Legion hall, told CNN. “So I’m kind of like a test subject for her.”

Quiara Bannerman

The American Legion site is run by StarMed, a clinical services company contracted by the county to assist in vaccinations.

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In a specialized fridge, a visitor will find dose after dose of all three FDA-authorized vaccines ready to be administered. Anyone in Onslow County can walk in and pick whichever vaccine they want – no appointments needed.

So the operators of the American Legion site bring the shop to the people: Pop-up sites at grocery stores, malls and churches where medical staff offer shots to people.

“We want to see what’s on your mind, what are you hesitant of? What have you heard, the common wives’ tales on the street or the misconceptions? What are your fears?” said Jennifer Darrell, a nurse and one of the site coordinators for StarMed.

“So we kind of address all of those. And we’ve got a lot of people that have come back and let us know how they felt after they received all series of their doses and kind of put a lot of people to ease, knowing that information.”

Empty chairs at the Naval Medical Center at Camp Lejeune

Hoping for the best, preparing for the worst

Onslow County, like a lot of America, is preparing to have to deal with Covid-19 into the foreseeable future.

Richmond-Hoover, the public health director in Onslow, is now predicting a future where the pandemic is more like the annual flu virus, requiring a yearly booster shot. She’s not predicting a future where Covid is gone, just one where it is dangerous to fewer people, while still being deadly.

It’s not a guaranteed outcome. But the story needs to change on vaccines in Onslow, she said.

“We need everybody to understand that we know that these vaccines work, they are all extremely effective at preventing severe disease,” Hoover said. “If you can get a vaccine and it will prevent you from being sick enough to be hospitalized, that’s a humongous win.”?

CNN’s Oren Lieberman contributed to this report.