When it comes to getting the coronavirus vaccine, Mississippi residents have an abundance of options. On Thursday, there were more than 73,000 slots to be had on the state’s scheduling website, up from 68,000 on Tuesday.
In some ways, the growing glut of appointments in Mississippi is something to celebrate: It reflects the mounting supplies that have prompted states across the country to open up eligibility to anyone over 16.
But public health experts say the pileup of unclaimed appointments in Mississippi exposes something more worrisome: the large number of people who are reluctant to get vaccinated.
“It’s time to do the heavy lifting needed to overcome the hesitancy we’re encountering,” said Dr. Obie McNair, an internal medicine practitioner in Jackson, the state capital, whose office has a plentiful supply of vaccines but not enough takers.
Though access remains a problem in rural Mississippi, experts say that the state — one of the first to open eligibility to all adults three weeks ago — may be a harbinger of what much of the country will confront in the coming weeks, as increasing supplies enable most Americans who want the vaccine to easily make appointments.
The hesitancy has national implications. Experts say between 70 percent to 90 percent of all Americans must be vaccinated for the country to reach herd immunity, the point at which the virus can no longer spread through the population.
When it comes to rates of vaccination, Mississippi still has a way to go, with just a quarter of all residents having received at least one dose compared to the nationwide average of 33 percent, according to state data. Other southern states, among them Tennessee, Arkansas, Alabama and Georgia, have similarly low rates of vaccination.
A closer look at Mississippi’s demographics explains why hesitancy may be especially pronounced.The state reliably votes Republican, a group that remains highly skeptical of the coronavirus vaccine. Nearly half of all Republican men and 40 percent of Republicans over all have said they do not plan to get vaccinated, according to several recent surveys. Those figures have barely budged in the months since vaccines first became available. By contrast, just 4 percent of Democrats have said they will not get the vaccine.
Another factor in the state’s low vaccination rate may be Mississippi’s large Black community, which comprises 38 percent of the state’s population but accounts for 31 percent of the doses administered, according to state data. Vaccine hesitancy remains somewhat high among African-Americans, though the doubts and distrust — tied to longstanding neglect by the health care system and past government malfeasance like the notorious Tuskegee syphilis experiments — have markedly declined in recent months.
According to a survey by the Kaiser Family Foundation released last week, about 55 percent of Black adults said they had been vaccinated or planned to be soon, up 14 percentage points from February, a rate that approaches those of Hispanic-Americans, at 61 percent, and white Americans, at 64 percent.
A number of other heavily Republican states are also finding themselves with surfeits of doses. On Thursday, officials in Oklahoma, which has delivered at least one dose to 34 percent of its residents, announced they would open up eligibility to out-of-state residents, and in recent weeks, Republican governors in Ohio and Georgia voiced concern about the lackluster vaccine demand among their residents.
Tim Callaghan, an assistant professor at the Texas A&M University School of Public Health and an expert on vaccine skepticism, said that more research was needed to divine the reasons behind Mississippi’s slackening vaccine demand but that states with large rural populations, Republican voters and African-Americans were likely to be the first to confront the problem. “If you’re looking to see vaccine hesitancy to emerge, it’s going to be in red states like Mississippi,” he said.
Mississippi officials are well aware of the challenge. On Tuesday, Gov. Tate Reeves held a news conference with a panel of medical experts who sought to dispel some of the misinformation surrounding the vaccines. They tried to explain the vaccine development process, rebutted claims that the vaccine can cause miscarriages and recounted their own personal experiences after getting the shot.
“I had about 18 hours of turbulence,” Governor Reeves said, describing the mild, flulike symptoms he had felt after his second injection. “But I was able to continue and move on and work, and I feel much better waking up every day knowing that I have been vaccinated.”
Access is still a challenge in swaths of rural Mississippi, especially among African-Americans who live far from the drive-through vaccination sites in urban areas that account for roughly half the doses administered by the state. The scheduling system has also proved frustrating for the poor and for older people, who often lack internet access to book appointments or the transportation to get them to distant vaccination sites.
“We’ve got to take the vaccines to the people, to pop-up locations that don’t require internet or registration in advance,” said Pam Chatman, the founder of Boss Lady Workforce Transportation, a system of minivans that has been ferrying residents in the Mississippi Delta to mass vaccination locations.
Demand among African-Americans was still robust, she said, noting long lines that formed this week outside a tent in Indianola, a small city in the Delta, where the single-dose Johnson & Johnson vaccine was being offered. (The tents offering the Pfizer and Moderna vaccines, which require two doses, were nearly empty.)
But hesitancy is rife. Dr. Vernon Rayford, an internal medicine doctor in Tupelo, said he had been frustrated by patients who offered up a variety of reasons for rejecting the vaccine. They claim it will give them Covid-19 or render them infertile, and they worry about unknown repercussions that might emerge decades down the road. “I’ve heard some really wacky theories,” he said.
Dr. Rayford, who sees patients of all races, said he had discerned subtle differences in the skepticism: African-Americans voice mistrust of the health care system, while white people express a more amorphous distrust of government. “It’s like that line from ‘Anna Karenina,’” he said. “‘All happy families are alike; each unhappy family is unhappy in its own way.’”
Dr. Brian Castrucci, president of the de Beaumont Foundation, which focuses on public health, has been working on ways to allay such fears. Dr. Castrucci, an epidemiologist, is especially worried about young conservatives, ages 18 to 34; he cited a recent survey that found that 55 percent of college-educated Republican women under age 49 would not get vaccinated.
“Its polls like these that keep me awake at night,” he said.
The biggest obstacles to greater vaccine acceptance, he said, are the misinformation that flourishes on social media and the mixed messaging from Republican governors that leave people confused.
“By relaxing Covid restrictions, elected leaders in states like Florida, Mississippi, Texas and Georgia are pushing narratives about coronavirus that are working against a narrative that promotes the urgency of vaccinations,” he said. “And unfortunately, our vaccine campaigns are being undone late at night by Facebook and Twitter and Instagram.”
Until now, Mississippi health officials have been focusing much of their vaccine hesitancy efforts on African-American and Hispanic residents through partnerships with churches and health clinics. Governor Reeves, a Republican, has so far declined to single out skepticism among white conservatives in the state, but health officials said they were planning to address the problem through Facebook and Zoom meetings with local organizations.
Public health experts say what’s needed are well-crafted messages delivered by doctors, religious leaders and other figures who are trusted in a particular community. Dr. Thomas Frieden, a former director of the Centers for Disease Control and Prevention who took part in a focus group with vaccine-hesitant Trump voters that was organized last month by the de Beaumont Foundation, said participants wanted their fears acknowledged, and they craved factual information without being lectured or belittled. “There isn’t one right way to communicate about vaccines, but you need multiple messages with multiple messengers,” said Dr. Frieden, who leads the health advocacy group Resolve to Save Lives. “And people don’t want to hear from politicians.”