SHEFFIELD, Ala. — George Grabryan and Mike Melton have been helping people here on the bank of the Tennessee River survive devastating tornadoes, floods and other disasters for decades. Ask any local official in rural Lauderdale County, and they have the two emergency managers’ numbers saved in their phones — just in case.
But Covid-19 has broken those bonds. Despite Grabryan and Melton’s best efforts, only 34 percent of county residents are vaccinated, even as the highly transmissible Delta variant has driven up new infections by 300 percent in the last two weeks. Three people have died, and health officials predict that many more will follow before the summer mist lifts off the cornfields.
Many people here and elsewhere in the Southeast are turning down Covid-19 vaccines because they are angry that President Donald Trump lost the election and sick of Democrats in Washington thinking they know what’s best. State and local public health officials have struggled to combat that deep-rooted obstinance. But they don’t want more on-the-ground help from the White House, fearful it would prolong the current surge — even as the Biden administration has begun approaching southern states with offers to send federal “surge teams” on door-knocking campaigns.
The pushback from both state officials and people who refuse vaccination underscores the extent to which the federal government may never be able to convince rural, conservative populations in parts of the South to get the shot. And it raises questions about how the Biden administration will shape its response to Covid-19 over the next several months as more schools and businesses reopen and Delta spreads.
“To say that politics doesn’t play a part would be wrong,” Melton said. “I think the national figures get people talking about the vaccine and that can sometimes take the wrong fork in the road and go the wrong way.”
Local public health officials and physicians in this part of the country are convinced that they are doing everything they can to save lives — pulling 15-hour days to set up pop-up mobile vaccine units, monitor patients on respirators, and administer rounds of therapeutics. But they can only do so much. They will not go to people’s homes to try and twist their arms, they say, and they do not want federal officials to do so either.
“I don’t know going door to door would help us,” said Karen Landers, an Alabama state health officer based in Sheffield. “People in more rural areas … you’re going on to their property. It might not be the best idea to have them do that because people are protective of their privacy.”
One day last week in Sheffield, Melton and Grabryan were sitting in a large van in front of a local church. Its parking lot displayed a small white sign advertising Covid-19 vaccine to anyone who wanted it.
Only 18 people showed up. It’s been like that for weeks. At one point, Grabryan laid his head back on the van’s cushy seat, shaking it side to side. “I've been out to the funeral home for more visitations this year than I have before,” he said. “There’s no one in this area that doesn’t know someone who was affected by it.”
Grabryan can’t understand what’s holding people back. But then again, maybe he can.
The amount of misinformation and disinformation propagated on Facebook is enormous, he said, and it’s convincing people everywhere in the county that the vaccine is a government plot or unsafe for use.
“Until it starts hitting here really bad again, these people aren’t going to get the shot,” Melton added.
Covid-19 is ever present in northern Alabama these days, as the Delta variant wraps its arms around the population, weaving in and out of homes, schools and churches. But locals rarely discuss the vaccine in public. And health officials believe in a hands-off approach — if they push too hard, they risk alienating their friends. Officials in both Alabama and Louisiana say their governments have in the past shied away from door knocking, trusting that if they put up enough flyers and promote the safety of the vaccine through the media, people would sign up. But that strategy is not working. Vaccination rates have declined in recent weeks.
“I did have a lady come down here and ask why we were pushing something that wasn’t an approved drug. I tried to tell her that this is a volunteer thing and we aren’t pushing it on anybody,” Melton said. “We’re just making it available for the ones that want it. If they want to take it here is the opportunity to take it. If they don’t want to get it, nobody is gonna chase them down and force it on them.”
That approach — believing that people will eventually get the shot to protect themselves and their community — has largely failed in parts of Louisiana, too, despite massive resources being spent to set up vaccine clinics across the state, including in stadiums, grocery stores, school gyms and churches. The vaccine is a non-starter in communities where people say they do not trust the federal government.
An hour east of Baton Rouge in Hammond, La., regional medical director Gina Lagarde sat among piles and piles of personal protective equipment, boxes of vaccine doses, and cardboard signs saying “VACCINES HERE.” Lagarde has brought on volunteers from the Louisiana National Guard to help roll out the vaccine in rural communities nearby. In recent days, vaccine administration numbers have begun to tick up slightly. Still, she said, “We worry we are in the surge now and schools are about to open.”
In a series of interviews, Louisiana regional medical directors and physicians described a horrific last two weeks marked by overcrowded ICUs, people showing up to emergency rooms after suddenly developing shortness of breath, and Covid-19 patients clinging to their last hours before abruptly letting go and dying. Almost all of these people died because they chose not to get the vaccine. And that’s what’s triggered doctors and nurses who are experiencing more anxiety and exhaustion now than they did during the first, second and third surges.
“At least then we didn’t have a vaccine and there was nothing we could do,” said Tonya Jagneaux, a critical care physician at Our Lady of the Lake Regional Medical Center in Baton Rouge. “Sometimes you just feel like screaming.”
The doctors here and across the street at Baton Rouge General Hospital are treating unprecedented numbers of Covid-19 patients. It’s not just the sheer number of cases that they are seeing, doctors say. It is that they are seeing them come in all at once. Jagneaux is sitting in a room at the hospital with her colleagues, discussing the last few days of caring for Covid-19 patients.
“What is different in my opinion this time is that it escalated so quickly. I would expect us to be here in about two weeks, based on the numbers in the community and when we first started seeing the hospitalizations go up,” said Catherine O’Neal, chief medical officer of Our Lady of the Lake. “Now it's like the doubling time is so much faster. And that's just the Delta variant.”
The state has recorded an average of 2,400 coronavirus cases in the last 14 days, an uptick of more than 230 percent from the two weeks prior. The patients seeking medical help are younger than ever before, between 30 and 60 years old. And they are dying. Two of the doctors at Our Lady of the Lake hospital say they both lost unvaccinated family members to Covid. In the past several weeks, two nurses in the hospital nearby died, too.
“My absolute favorite patient and clinic, I just want to wrap my hands around every time I see him. He is the worst smoker ever. He's killing himself. I can't make him stop. I love that man. I never busted him. We've had the talk. He's not going to quit,” O’Neal said. “I don't want people to think that we don't see people who make bad choices for themselves. It's just that their bad choice has affected their entire community and is grinding to a halt good medical care.”
Forty minutes away at sister hospital Our Lady of Lourdes Regional Medical Center in Lafayette, chief medical officer Henry Kaufman held his head in his hands as he described the latest surge. His surgical staff has had to cut down to one inpatient case a week to accommodate people with Covid-19 patients who need beds.
“How do we pivot and adapt to this changing healthcare environment where we’ve lost a lot of nurses and team members? There are a lot of nurses here who stuck it out during the pandemic, putting their lives at risk. They said, ‘I’ve done my duty, and I am going to take a break.’ And it’s left holes and gaps we’re still trying to fill,” Kaufman said. “We’re reaping what we sow. We failed as a community and a state to convince people this was necessary. And as a result we’re now seeing a wave that is hitting us and it is going to affect families and the local economy. And people are going to die.”
As burned out and frustrated as these physicians are about vaccine resistance in their communities, they know that condemning the sick and unvaccinated will only make matters worse. Alabama Gov. Kay Ivey, a Republican, told reporters Friday that “it's time to start blaming the unvaccinated folks.”
“It's the unvaccinated folks that are letting us down," she added.
Christopher Thomas, a critical care physician who works with O’Neal and Jagneaux in Baton Rouge, said there is a misconception — often perpetuated by officials in Washington, political leaders throughout the country and the media — that those who did not get the shot are uneducated. It’s that kind of rhetoric, he says, that is pushing people here to continue to resist the vaccine.
“You've seen people nationally want to blame the patient or the vaccine. What we really are frustrated about is the inability to get what is evidence-based practice and what is science across. That's the disconnect,” he said. “And we're dealing with these new echo chambers, whatever they are. And they prevent that.”
Thomas says federal officials are partially responsible for fumbling the messaging at the beginning of the pandemic — changing their rhetoric and recommendations frequently, even if it was because the science had changed. Conservative media outlets picked up on that flip-flopping, he says, underscoring it publicly as reason not to trust the government.
“The unintended consequences on a national scale is that we walk in to have a conversation with an individual patient about an individual medication. And I'm no longer having a conversation with a patient. I'm having a conversation with X person who was on Y,” Thomas said, referring to broadcast media anchors. “That's really where the challenges are.”
Almost every public health official, local vaccine volunteer and physician in Alabama and Louisiana who spoke to POLITICO pointed to social media and the media as the main reason people in their neighborhoods are still holding out on the vaccine. It’s caused one nurse in rural Louisiana responsible for administering shot to think that the federal government concocted the vaccine so they could “flip a switch and turn everyone into zombies,” she said, asking to remain anonymous because her comments could get her in trouble at work. “I eventually got the shot because of my work. But people and power can do anything to us. You never know.”
That type of misinformation is hard to combat, O’Neal said.
“I'm talking to our friends this weekend, both of them have advanced medical degrees, she's vaccinated her husband's not. She said, ‘Catie, every time he gives me an argument, he brings a graph.’ It's a graph from social media. It's some random thing that's been posted … that says that highly vaccinated companies or countries are having surges and unvaccinated countries aren't. It's there, it's and there's a pretty graph,” O’Neal said. “And so if you're angry, and you're looking to stay angry, it's there. If you want to find your argument, you can find it.”
Doctors and health officials in Alabama and Louisiana say their only hope for getting people vaccinated is if the media outlets that message to these areas, primarily Fox News, start advocating people get the shot, instead of pushing them away from the jab.
“I have people come up to me and say, ‘Why on CNN? Couldn’t you go on Fox?’ They are still very angry over the last couple of years. There’s an irritation. They are super frustrated. They need to hear it from the people that they trust. They need to hear it from where they get their news every day. And I don’t know why not Fox. Why not?,” O’Neal said. “But it has to change this week. Every single show. And it has to be about the community, not the ‘you’ because there’s been too much about the ‘you.’ ‘You’ they got indoctrinated. It is not about ‘you,’ it is about the community. You’re going to kill your community.”
Sean Hannity and other Fox News reporters earlier this week suddenly changed their tune, as did many Republicans on Capitol Hill, calling on their viewers and constituents to sign up for the vaccine. It marked a new tone for the media channel which has for months raised questions publicly about the safety and efficacy of the shot, pushing talking points on the government trying to force the vaccine on people who do not want it.
But it has come too late for people in Sheffield and Baton Rouge who are sick with Covid-19 and on the verge of death.
Back in Alabama, Grabryan and Melton said they were unsure how long their mobile vaccination clinic will last. They are both fearful that as the Delta variant surges, more people may want to sign up for the shot, but that resources will have already been diverted to areas with higher demand.
Landers, the state public health official in Sheffield, says stepping back and accepting the fact that few people will get the vaccine in the future is not an option.
“This isn’t my first rodeo. I’ve been doing this for forty years,” Landers said. “I just can't give up. I can't give it up.”
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