Editor’s note: This story uses data from the Centers for Disease Control and Prevention (CDC). The CDC data had initially listed Martin County, North Carolina, as the rural Southern county with the highest vaccination rate (75.1%), but Martin County health officials said that is a computing error and the true figure is 39%. The CDC data for Dare County matches closely with local vaccination figures, which have been verified with health officials for this story. This data represents patients who are fully vaccinated.
DARE COUNTY, N.C. – Isolation is one of the biggest draws of Dare County, a nearly 110-mile strip of islands off the North Carolina coast. But the beachy, Outer Banks community has also separated itself from the mainland when it comes to COVID-19 vaccination rates.
Dare County has the highest vaccination rate (59%) of any rural Southern county, according to CDC data released August 1. The high percentage is notable at a time when Southern states have seven of the nation’s 15 lowest vaccination rates amid a surge in cases and hospitalizations due to the delta variant. The South’s rural counties, which last year had some of the nation’s highest rates of COVID-19 per capita, currently have an average of 28.5% of their populations vaccinated, according to CDC data.
Sheila Davies, the Dare County director of public health, said she wishes the county’s vaccination rate was closer to 85%. Still, she has been heartened by the majority of her community accepting the COVID-19 vaccine. Dare County is one of only three rural counties in the South with more than 50% of its residents vaccinated, along with Hyde County, North Carolina (52%), and Meigs County, Tennessee (50.3%).
“It does give me a sense of pride, especially in recognition for how hard our team has worked,” Davies said. “But we have to keep pushing.”
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‘We were ready… we just didn’t have enough vaccine’
Davies said the success of their vaccination rollout came down to two things: outreach infrastructure and pushing for a greater vaccine supply.
Dare County is used to hurricane season, during which the local government and healthcare systems have to coordinate emergency protocols. Davies said those existing communication channels and relationships made it easier to assemble and publicize mass vaccination sites with online registration.
“What we found was that we were ready,” Davies said. “We just didn’t have enough vaccine.”
Dare County’s community messaging was working. Shortly after vaccines became available, the county had more than 2,000 people on a waiting list, Davies said.
So Davies and her team decided to be proactive. They called, emailed and even drove to other counties that had surpluses of the vaccine. They also requested extra doses from the state, doses which Davies said came with a caveat.
“There was one week that they ended up giving us 1,100 doses and they’re like, ‘You have to use these within the week or you won’t be able to get any more,’” Davies said. “And we did. We had to prove to them that just because we’re a rural area didn’t mean that we didn’t have the capability to pull it off, and then we did start seeing more vaccines.”
The speedy mobilization of mass vaccination clinics led to a strong word-of-mouth campaign for the vaccine, said Kelly Nettnin, communications director for the Dare County Department of Health and Human Services. Dare County is also a tourist destination, and Nettnin said many of those in the service industry were eager to get vaccinated.
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By April, Dare County led North Carolina with a 47% vaccination rate and received a congratulatory visit from Gov. Roy Cooper.
“It drew some attention to us like, ‘Wow, look at little Dare County. They are able to do this,’” Davies said.
From the start of the pandemic, the South’s rural counties faced a tough road to mitigating COVID-19 cases and deaths. High rates of pre-existing conditions meant residents were more vulnerable to the disease. The closures of rural hospitals — some of which were even shuttered during the pandemic — stymied access to care. Geographically distant communities or lack of internet access presented communication and vaccine access challenges.
Now, as states such as Louisiana and Alabama endure hospitalization numbers not seen since the height of the pandemic, the National Rural Hospital Association (NRHA) is looking at places like Dare County for clues on how to connect with unvaccinated residents in rural areas.
As a non-profit advocacy group representing 90% of the nation’s rural hospitals, the NRHA has worked to study and develop effective vaccine messaging strategies to disseminate to communities, particularly through local healthcare providers.
Alan Morgan, the chief executive officer for theNRHA, said the rural counties are “where the greatest problem is.”
“We’re focusing right now to see what the difference was between that county, and counties in states such as Mississippi, Louisiana and Alabama where we’re seeing the rates anywhere from the high teens to the low 30s,” Morgan said.
Morgan said anti-vaccination stances have “hardened” since the early days of the vaccine rollout, making it difficult to drum up support for the vaccine amongst those who haven’t received it. Now, rural communities hoping to replicate Dare County’s word-of-mouth success have better luck emphasizing how vaccinations can help local businesses stay open than with more bureaucratic messaging, he said.
“Today, the successful model is having a local clinician speaking directly to patients, which is a tough slog,” Morgan said. “It’s really about harnessing community pride and saying: ‘Forget what the government may tell you, let’s talk about what we need to do.’”
Davies said she hopes back-to-school clinics will help Dare County and other communities continue to increase vaccination numbers.
For Morgan, he knows his work won’t be ending anytime soon.
“Back in March, I was honestly thinking we were too late, that we were going to be done with this by fall,” Morgan said. “It’s been painfully clear that is not going to be the case.”
Follow reporter Andrew Yawn on Twitter: @yawn_meister