Great Health Divide | Rural vaccine disparities increasingly evident as cases rise in Appalachia

Health departments are trying to combat vaccine hesitancy.
Health departments are trying to combat vaccine hesitancy.
Published: Aug. 26, 2021 at 3:12 PM EDT
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MANCHESTER, Ky. (WKYT) - Lingering vaccine disparities between Kentucky’s rural and urban areas threaten to prolong the coronavirus pandemic as the delta variant continues to ravage many communities.

A WKYT Investigates analysis of state COVID-19 vaccine data shows a wide gulf between vaccination rates, with higher percentages in northern Kentucky and the Lexington metro, and significantly lower percentages in the state’s Appalachian and western counties.

[EXPLORE: Interactive COVID vaccine dashboard]

In eastern Kentucky, where statistics have shown health disadvantages for decades due to a lack of access to medical care, health departments on the front lines of the latest outbreaks are doing their best to persuade the vaccine hesitant in an attempt to bridge perhaps the most pressing aspect of the great health divide.

“I would say that this is probably the most challenging public health communications effort that I’ve encountered in my 20+ year history in public health in Kentucky,” said Christie Green, public health director for the Cumberland Valley District Health Department, which covers Clay, Jackson and Rockcastle counties.

Fewer than 1/3 of the population of each of those counties has been vaccinated so far.

[FULL DOCUMENTARY: Bridging the Great Health Divide showcases efforts to fight disparities in rural America]

Just over half of the U.S. population is fully vaccinated. As the delta variant spreads, shots have begun to increase again after a several-week lull. But certain areas lag behind, even with widespread availability and clinics in communities all over.

About 56 percent of Kentucky’s population is vaccinated, state data showed as of Wednesday evening, or about 67 percent of the population above 18 years old.

The Pfizer vaccine has been authorized for ages 12 and older, and is now fully approved for ages 16 and older. Yet cases and hospitalizations are climbing across Kentucky as many remain hesitant to or outright oppose the vaccine.

“Every vaccine we can put in an arm at this point is a win,” Green said.

Overall, less than 40 percent of people who live in the state’s Appalachian counties have been vaccinated. Only two of those counties - Perry and Clark - have more than 50 percent of their respective populations vaccinated.

[MORE: WKYT coverage of Bridging the Great Health Divide]

And the incidence rates reflect that.

Transmission in 31 of 54 Appalachian counties is higher than the overall rate statewide (79.65 average daily cases per 100,000 residents). Transmission rates in 19 counties are above 100.

Six Appalachian Kentucky counties have incidence rates more than double the statewide rate, through Wednesday. In each of them, significantly fewer than half of their residents are vaccinated.

  • Clay:
    • 245.5 average daily cases per 100,000 people
    • 32.21% vaccinated
  • Bell:
    • 191.5 average daily cases per 100,000 people
    • 36.07% vaccinated
  • Whitley:
    • 188.7 average daily cases per 100,000 people
    • 35.53% vaccinated
  • Owsley:
    • 174.7 average daily cases per 100,000 people
    • 33.21% vaccinated
  • Jackson:
    • 167.2 average daily cases per 100,000 people
    • 28.74% vaccinated
  • Magoffin:
    • 160.9 average daily cases per 100,000 people
    • 40.08% vaccinated.

Refusal to get a COVID vaccine can come at a high cost. A CDC study found that unvaccinated people were five times more likely to be infected and 29 times more likely to be hospitalized than unvaccinated people.

The 20 Appalachian Kentucky counties with the lowest vaccination rates - all roughly at or below one-third - are all officially designated as Medically Underserved Areas. And underlying health conditions more prevalent here, such as heart disease, COPD, diabetes and obesity, can make COVID even worse for patients.

It all comes in many communities with longer drives to doctors or hospitals - right now, with no guarantee there is room in one.

[ONE-ON-ONE: Gov. Beshear concerned about ‘alarming’ rise of Ky. hospital capacity levels]

So what’s fueling hesitancy? Misinformation and mistrust are the biggest barriers, Green said.

The health department is trying to combat it by working one-on-one to answer questions and concerns, knowing some out there can still be persuaded.

“Typically misinformation can be countered over time with consistent messaging,” Green said. “The challenge is now we’re in a pandemic, and we do not have the time it typically takes for people to adopt or embrace new scientific information”

Unvaccinated people with whom WKYT’s Garrett Wymer spoke last week cited vaccine side effects and breakthrough cases in vaccinated people as reasons they chose not to get the shot.

“It’s made a lot of people sick that I know,” one woman said. “But unless I have to get it, I’m going to try not to.”

[QUESTIONS? Submit a question to the WKYT COVID-19 Vaccine Team]

Experts say breakthrough cases in vaccinated people are still less common, but even if the highly contagious delta variant changes the math, the vaccine is still largely keeping vaccinated people out of hospitals and off ventilators.

Meanwhile, public health leaders have transitioned from general appeals for vaccination, to attempts to reach pockets of unvaccinated people by holding clinics at individual workplaces and schools.

During the first three days of a four-day clinic last week at EKU Manchester, the health department gave out about 100 shots to people who had not been vaccinated. Many were school-aged children brought in by their parents, Green said.

Cases and quarantines have been widespread in schools all across Kentucky since in-person classes began again. Several school districts in the Appalachian region - including Greenup, Knott and Lee counties - have closed or are currently closed because of COVID cases in staff and students.

[MORE: WKYT Investigates]

The state’s COVID reports in recent days have included some of the highest numbers since the pandemic began. Hospitalizations have increased every day for the past 42 days, Gov. Andy Beshear, D-Ky., said Thursday.

It may not get better until vaccination rates boost.

A CDC report from May similarly found a rural-urban divide in vaccinations that it says “can hinder progress toward ending the pandemic.”

Vaccinations across the U.S. dropped in July to an average of about a half-million shots per day, the Associated Press reported earlier this week. That was down from a peak of 3.4 million a day in mid-April. But as concerns about the delta variant grow, shots are on the rise again; a million a day were given Thursday, Friday and Saturday of last week.

Vaccine requirements are also becoming more widespread from some employers and event organizers.


Learn some key things to know about COVID-19 vaccines here.

The COVID-19 Hotline (800) 722-5725 can answer general COVID-19 vaccine questions.

Visit the state’s vaccine portal, with links to the CDC’s vaccine toolkit for you and your family, which includes resources to explain:

Find a COVID-19 vaccine near you using this tool.

Need help with transportation to a COVID-19 vaccine appointment? Learn more here.

A mural in downtown Manchester, Ky. with the message "Hope Endures."
A mural in downtown Manchester, Ky. with the message "Hope Endures."(WKYT)

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