By Catharin Shepard • Staff writer • “It is too new,” “I don’t need the shot, I am not high risk to die from COVID-19,” “I don’t believe in immunizations,” “COVID-19 is not real, so why do I need a vaccine?”

Those are just some of the reasons people have given Hoke County Health Department Director Helene Edwards for why they chose not to get vaccinated against COVID-19.

“There are many people who believe COVID-19 is a hoax in Hoke County, even after half a million dead in the U.S.,” she wrote in an email Monday.

The numbers show that Hoke is lagging behind in getting its population vaccinated against the coronavirus, according to North Carolina Department of Health and Human Services (NCDHHS) data. The county is tied with Onslow for worst North Carolina’s 100 counties, with only about 15 percent of people having gotten at least one vaccine dose and just about 13 percent fully vaccinated.

North Carolina itself is also fairly low compared to other states, ranking 38^th out of 50 for the overall percentage of adults who’ve gotten at least one shot, according to the Centers for Disease Control and Prevention (CDC).

Hoke County’s neighbors have seen more people vaccinated, with 18 percent of people in Cumberland County, 20 percent of people in Robeson County, 29 percent of people in Scotland County and 35 percent of people in Moore County fully vaccinated, according to the NCDHHS.

Many young adults 18 and older are not getting vaccinated, according to what Edwards is seeing. And issues such as misinformation in the public, or conflicting information from some doctors could also be playing a part in the low vaccination numbers.

“Hoke County younger adults are not interested in receiving the vaccine right now. Also, some people who have had COVID-19 have been told by their doctor that they don’t need the vaccine,” Edwards said in an email. People who have had the virus should still get the vaccine, she clarified.

Local physician Karen Smith also said she’s seen people reluctant to get vaccinated because they’re afraid.

“I think in our county and several other communities that there’s a lot of misinformation that’s hit the public. People definitely fear the virus but they also fear the solution, the vaccine,” Smith said.

Smith has served the Hoke population for nearly 30 years, and additionally serves as medical director for the Health Department.

Over 4,600 people in the county, or about eight percent of Hoke’s population, have tested positive for the virus at least once since the start of the pandemic. The majority of those people have recovered, but 55 Hoke residents died after testing positive for COVID-19.

Another part of the problem could be that many of Hoke’s residents are too young to get the vaccine. About 27 to 30 percent of the county’s population is under the age of 18. While 16- and 17-year-olds can get the Pfizer vaccine, it hasn’t been widely available in Hoke County. The Pfizer vaccine has to be stored at an ultra-cold temperature, which requires special freezers that smaller offices just don’t have.

It’s mostly larger hospital systems with access to that equipment that can offer that particular vaccine, Smith said. Locally, FirstHealth of the Carolinas and Cape Fear Valley Health may be able to accommodate people who specifically need the Pfizer vaccine.

The Food and Drug Administration (FDA) hasn’t authorized any of the vaccines for emergency use in younger teens and children, though recent reports suggest the agency could soon make a decision to allow use of the Pfizer vaccine in 12- to 15-year-olds following promising results from clinical trials in youth.

Smith said she’s concerned that although one or two people in a household might have gotten vaccinated, it will be better to get everyone – adults and youth – inoculated against COVID-19. If even one person in the family gets the virus, the whole family can suffer for it, the physician said.

“It behooves us to make sure the whole household is vaccinated…to protect one (parent) and not the other, that’s not the best strategy we should be depending on,” she said.

Micro-targeting and the “trust bank”

Access to the vaccine has also been a big consideration. To make it easier for working adults to get the shot, the Hoke County Health Department has had Saturday clinics and evening clinics. Since April 5, anyone 18 years old or older can walk in to the Department and get the vaccine anytime between 9 a.m.-4 p.m. Monday-Friday.

Local public health officials continue trying to expand access for people to get vaccinated, and to spread the word about the availability. Smith said a strategy called “micro-targeting” has been helpful in providing vaccine access.

“We went into areas where perhaps the hospital system did not go,” she said.

Her office has held two walk-in vaccine clinics at a local church. When they had leftover doses from the second clinic, she and her team visited the poultry plant and vaccinated workers there. Then, they crossed the street to a nearby convenience store and offered the vaccine to employees and customers.

“We received very little hesitancy. We were able to explain what was going on, we were able to go through the side effects and people received the vaccine. That’s what makes the difference,” Smith said.

Part of why local doctors are a vital component to the vaccine effort is because of the “trust bank,” Smith said. Over time, physicians build trust with their patients while developing relationships with them.

In areas where more people don’t have a primary care doctor, or haven’t had access to healthcare in years, that “trust bank” might not exist. But Smith’s office has worked in other ways through outreach efforts to make a difference in the community: they did a bicycle giveaway in one location a few years ago, and when she and her staff returned with vaccine doses, people there recognized and trusted them.

“Our name was already known, we were already known by the individuals who live there. People knew we were there to help them, not hurt them,” Smith said.

The Health Department has also gone beyond its own doors to expand vaccine access. The Department’s staff have vaccinated the inmates at the Hoke County Detention Center, vaccinated homebound patients and vaccinated group home residents. The Department has also done “tons of advertising,” Edwards said, putting out the information on billboards, local radio, social media, newspapers and inserts for church bulletins, among other efforts.

“Now, we haven’t gone to churches or businesses to vaccinate individuals and are considering the idea. I wish some of the local physicians would do PSA to encourage people to get the COVID-19 vaccine,” Edwards wrote. She noted that Dr. Smith “is doing a fabulous job” in reaching out to the community, and called on more local physicians to do the same.

“Hoke County folks listen to their doctors,” Edwards said.

Vaccine fears, virus disbelief

A temporary pause on the Johnson & Johnson vaccine also led to problems. Out of nearly seven million doses given, health officials received reports of a very rare but serious adverse reaction led to dangerous blood clots in six women under the age of 50. After a pause to investigate the reports, the Centers for Disease Control and Prevention recommended continuing to offer the vaccine, saying that the benefits outweighed the potential risk.

Some people who were planning to get the one-dose vaccine at the Health Department either canceled their appointment or left when they found out the provider only had the two-dose Moderna shot, Edwards said.

“They didn’t come back or go anywhere else for vaccinations,” Edwards said.

There were also some people whose distrust grew due to the temporary pause.

“Look at J&J side effects, no I will take my chances with COVID-19,” is something some patients have said to her, Edwards recalled.

Smith, whose office has administered hundreds of doses of the Johnson & Johnson vaccine, said she, too saw some continued fears after the CDC recommended its use – along with some warning signs of blood clots to watch out for.

“People just didn’t want to receive it,” she said. On the other hand, just as the Health Department experienced, some people only wanted to receive the Johnson & Johnson vaccine and refused to accept the Moderna one, Smith said.

Edwards explained what she tells people who have concerns about getting the vaccine.

“The vaccine is new; however, the technology has been researched for over 15 years. Anyone is at risk for developing severe COVID-19 symptoms that may require hospitalization. You may not be at risk for dying from COVID-19, but your loved one or family member may be at high risk,” she wrote.

“Immunizations are designed to help your body fight infections. Even if you have had COVID-19, it is recommended that you receive the COVID-19 vaccine for immunity. If you want to stop wearing masks, get vaccinated. If you want to travel, get vaccinated.

“(The) COVID-19 pandemic is real and over 500,000 people have lost their lives in the U.S. COVID-19 affects everyone differently, some have mild symptoms and recover from the virus, while some have severe symptoms and die.”

Among the hundreds of people who’ve been vaccinated at the Health Department, none have experienced a severe side effect, the director said. Smith said the same for the over 600 people vaccinated at her clinic.

Smith, the Health Department and other providers such as Walmart Pharmacy and the local hospital systems continue offering the vaccine at no cost. Smith hopes that community collaboration among local doctors, and an amount of flexibility on the providers’ part, will ultimately help get more people in Hoke County vaccinated against COVID-19.

“I’ve instructed my office, I don’t care if they’re not our patient, give them the vaccine,” she said.