At first glance, there may not be a lot in common between the tiny downstate town of Arthur and Chicago’s Englewood neighborhood.
Arthur is surrounded by flat farmland in the heart of Illinois’ Amish country, a largely white, solidly Republican area. Englewood helps anchor Chicago’s dense South Side, largely Black and reliably Democratic. But the unprecedented pandemic has spurred one similarity: low COVID-19 vaccination rates.
Such communities represent the new battlefield for Illinois to reach herd immunity — or, more likely, something closer to it — in the march toward normalcy.
Those who study and work in vaccinations say an already exhausted public health ecosystem must build and flex a different set of bureaucratic muscles. The goal? To lure the ambivalent or leery into their favorite doctors’ offices or clinics where they can easily get a shot, or at least talk through concerns.
A Tribune analysis of federal and state data shows that there is plenty of work to do, with millions of adults remaining unvaccinated, and some regions now vaccinating so slowly that — if the pace doesn’t change — it could take them a year or more to get close to herd immunity.
Those wide swaths of unvaccinated are covered by different levels of public health systems that, while broadly acknowledging the problem, offer varying details of how they’ll try to boost rates to the point that communities can shed restrictions and make what’s left of 2021 look more like 2019.
Making that harder, according to health officials and researchers, are largely two buckets of people.
One is a group adamant against getting a shot, a group that Arthur’s mayor, Rod Randall, said is likely a key reason a Tribune analysis found his town’s ZIP code had one of the lowest vaccination rates, at roughly just a tenth of residents having gotten a shot by mid-April.
“No amount of encouraging, or debate, or incentivizing will make a significant difference to many of the deliberately unvaccinated,” he told the Tribune in an email.
But there are others who may be on the fence, either not sure it’s worth the hassle or nervous about safety. Researchers and advocates say primary care doctors say may be able sway many in this group, if only public health agencies can get them more vaccine with less red tape.
“The easiest part of this whole process is giving the vaccine,” said Dr. Vishnu Chundi, chairman of the Chicago Medical Society’s COVID-19 task force. “The hardest part of this is all the paperwork and bureaucracy that goes with it.”
Federal, state and local officials say they’ve begun to change their approach, including plans to get more doses to primary doctors, reach out to homebound residents and partner more with community-based groups. And they’ve begun touting incentives such as free hair cuts and concerts, in Chicago, and sport-shooting targets at a downstate Department of Natural Resources complex.
“There’s a lot of free stuff I’ll be announcing for people who get vaccinated,” Gov. J.B. Pritzker said Tuesday.
The changing approach follows a clear slowdown in shots administered in Illinois and across the country, threatening state and federal officials’ goal to wipe out the virus.
Where are we at?
After a slower start, Illinois has caught up and been among the faster states to vaccinate its population. By Tuesday, federal data showed Illinois ranked fourth out of the 10 largest states in the percent of population receiving at least one dose, at 47.4%. (Because of a lag in data collection, Illinois Department of Public Health figures may be slightly higher.)
Still, Illinois is seeing the same slowdown that’s occurring nationally.
In the first four weeks of April, Centers for Disease Control and Prevention data shows Illinois’ rate of getting unvaccinated residents at least one shot dropped from 4.4% of all residents during the month’s first seven-day period to 2.9% by its fourth. That’s not as bad a dip as seen in most other big states, but still sizable.
Within Illinois, the drop has been far more profound downstate, with clear signs of vaccine hesitancy emerging more than a month ago in some parts, even as limits were removed to allow anyone 16 and older to get a shot.
The Pritzker administration has split the state into 11 health regions, and state data shows the pace of vaccinations peaked in early March in west-central and east-central Illinois, then by mid-March in three more downstate regions. Those regions closest to Chicago were the last to peak, around mid-April.
IDPH has estimated that between 75% to 85% of residents would need to be vaccinated for the state to reach so-called herd immunity, when COVID-19 would die out because it couldn’t easily find people to infect. It’s a rough estimate — scientists still say they don’t know the precise number — and they’re increasingly doubtful the nation will get there anytime soon.
Adding even more confusion, in Illinois, is that IDPH doesn’t publish data online that breaks down, in each region, how many people have gotten at least one dose.
The Tribune calculated estimates from a mix of data obtained from IDPH and the CDC. The Tribune estimate shows that the closest region to reaching that 75% threshold is the one encompassing DuPage and Kane counties, where more than 48% of all residents have gotten at least one shot by Tuesday. Close behind are suburban Cook County and Chicago, at about 47% and 45%, respectively.
But the numbers drop often the farther you get from Chicago. It’s about 40% of residents in the north-central region of Illinois, or 20 counties that stretch from Oswego to Bloomington, then west to the Iowa border. It drops close to 30% in the southern region, or the 20 counties spread from roughly Mount Vernon to Illinois’ southern tip and east to the Indiana line.
The data still isn’t precise. It doesn’t count Illinoisans who got shots across state borders, nor does it take into account the latest census figures suggesting there are more Illinoisans to vaccinate than previously estimated.
Still, the available data offers a sobering assessment of how long it could take to reach herd immunity.
In the southern region, the pace of vaccinations is so slow now that, in the past week, less than a percent of the population was added to the list of those who’d gotten any shot.
At that pace, the region would not approach 75% vaccination immunity for roughly a year, if not longer.
Compare that to the region for DuPage and Kane counties, where the weekly pace is so fast that, if it continues, the region could reach 75% vaccination by early July.
Paces could pick up, particularly with 12- to 15-year-olds likely to be approved for shots. But researchers remain concerned about some regions lagging others.
For strongly vaccinated regions, researchers have said, the novel coronavirus will become far less of a community threat, while less vaccinated regions face the potential of major outbreaks that could still strain their health care systems.
“It’s not really the statewide number,” the state health director, Dr. Ngozi Ezike, told lawmakers during a virtual hearing last week. “It really matters what’s happening in your very local community.”
Unclear efforts to target places
To figure out which communities are most at risk, researchers say health officials should be making more precise measurements of who’s not vaccinated yet.
“You have to start mapping out where are the neighborhoods that have the lower vaccination rates, not at the county level, but at census tract, or neighborhood, or ZIP code,” said Julie Swann, an engineering professor at North Carolina State University who researches health care logistics.
The state collects detailed data on all shots that could pinpoint where vaccinations efforts are flailing. The Chicago Department of Public Health has used the data to publish vaccination rates by ZIP code online, as well as target certain ZIP codes and neighborhoods for “hyper local” vaccination pushes, said the agency’s medical director, Dr. Candice Robinson.
“This is absolutely something we’re very focused on still, making plans for continuing kind of that work, local within those communities,” she said Tuesday.
Cook County Health has used that data as well to pinpoint ZIP codes where it believes uptake is low so it can work with the Chicago Medical Society to find doctors in those areas to help push vaccinations.
The Illinois Department of Public Health, which oversees efforts outside Chicago, did not answer questions in the past week about what specific research it has done to pinpoint low-vaccination areas across the state. It previously has said it uses data to dispatch its mobile vaccination teams. The governor last week told reporters the state also has “people going door to door,” although his administration didn’t respond to a question seeking specifics.
The Tribune has attempted to identify the poorly vaccinated areas using data it could obtain. Health agencies can strip raw vaccination data of identifying information and release it, but IDPH would not do so for the Tribune, saying it would be illegal to provide.
The federal Centers for Disease Control and Prevention did that, however, for shots administered through mid-April. And an analysis of that data shows massive differences in the rate of those vaccinated in ZIP codes across Illinois.
Analyzing ZIP code data can be tricky because population estimates are imprecise. But the data suggests some ZIP codes were at or above 60% of residents getting at least one shot by mid-April, while others were far less. That includes Arthur, where the data suggests barely a tenth of residents had gotten a shot by then.
The town of about 2,300 residents sits about 30 miles southwest of Champaign. It’s surrounded by farmland that’s home to about 4,000 Amish residents, according to the town website.
In pre-pandemic times, the area pushed tourism, with festivals celebrating everything from bluegrass music to strawberry jam. Its website touts the town’s motto of friendliness: “You’re A Stranger Only Once.”
Mayor Randall said the pandemic, however, has revealed a divide on how residents approach vaccination.
“Some of us believe we should be vaccinated for the common good, not just to protect ourselves, much like the wearing of face masks,” he said in an email. “Others do not feel as strong of social obligation and have taken a stance of rugged individualism when it comes to COVID. There is very little that can be done to change that position.”
The town straddles two counties whose health departments would be responsible for the vaccination efforts, Douglas and Moultrie. The latter did not respond to an email, but Douglas County said it suspected a decent amount of hesitancy could be within the Amish community. (It said it had been seeking ZIP code data itself to study, and asked the Tribune to provide its data, which the newspaper did.)
Douglas County’s public health community liaison, Colleen Lehmann, said last week that she’d mailed out letters to two dozen bishops of Amish churches in the county to tout the benefits of vaccination, but had not yet gotten any responses.
Such hesitancy is not a surprise to those who study or work in public health, nor limited to certain religions, races or ethnicities.
In Englewood, resident Pamela Abrams, 59, survived COVID-19 and struggled with lingering fatigue. So did her daughter. Even still, the vaccine wasn’t an automatic choice.
Abrams said she decided two months ago to get vaccinated but sensed so much skepticism over the vaccine’s safety that she didn’t tell her family.
“I was like, ‘You know what, I’m not going to tell my kids I’m going to do it,’” she recalled, later adding: “I just prayed about it. I was like, ‘Lord, cover me. Watch over me.’”
Soon, her daughter got the shot as well. But her son, she said, remains hesitant, in a ZIP code with one of the lowest vaccination rates in the city, less than a fourth of all residents.
The Abrams family follows a pattern of vaccine hesitancy that researchers have long anticipated.
There’s the fear of something new, complicated by a social media ecosystem that can spread false information about dangers. Not helping boost confidence: the recent pause in using the Johnson & Johnson vaccine because of extremely rare, but potentially dangerous, side effects.
Perhaps more entrenched is the political divide after a year of shutdowns and mask mandates that pitted arguments for safety and vigilance against complaints the danger was overblown and governments had overreacted.
The debate largely followed party lines, with a sizable number of Republicans now saying they’re unlikely to get vaccinated, despite the shots developed during former President Donald Trump’s administration, Trump getting vaccinated and calling the shots “great” and “safe.”
The CDC has published survey data from mid-March that was used to predict the percent of residents in each county who at the time felt they probably or definitely wouldn’t get a shot. That ranges from just 12% in DuPage County to 19% of residents in four east-central Illinois counties.
Make it easy
If the CDC estimates hold true, that leaves millions more Illinoisans willing to get a shot who haven’t yet.
To reach them, researchers and advocates say, you have to make getting a shot much easier.
Gone should be the days, they say, when people had to hunt around multiple, confusing websites to try to discern where to find shots, and then work around appointment windows.
“I think the challenge now is to bring the vaccine to where people are — in their neighborhood, in their communities, even in their workplaces and especially in their primary care providers,” said Rebecca Weintraub, the faculty director of the Global Health Delivery Project at Harvard University.
“We really want to make it as convenient as possible for people to be vaccinated,” said CDPH’s Robinson.
The Biden administration also on Tuesday announced a host of efforts, including sending more doses to rural clinics. But the push to primary care may be difficult to pull off quickly.
It first requires a major change in how public health agencies have approached COVID-19 vaccinations. After all, back when supply was tight, public health agencies could easily herd the eager to big sites, even if those lucky enough to score a slot had to take off work or even drive several hours.
But today’s unvaccinated are far less likely to be able, or willing, to shape-shift their lives to get a shot, researchers said.
Now the process favors medical “touchpoints” — any time someone happens to come into contact with the health care system. Think of basic checkups or physicals, where a doctor or nurse asks if someone’s been vaccinated and can talk through concerns. For patients who decide to get shots, they can be injected on the spot.
That raises another challenge: making it easy for doctors too.
Traditional vaccinations, for things like measles and tetanus, have never been widely popular among many doctors who see adult patients, Chundi said, because of the additional regulatory requirements. It can take weeks to get signed up to use government registries, which then can take 15 to 20 minutes to fill out for each patient.
The COVID-19 vaccine has more bureaucratic hurdles too. Practices must order them through government agencies. And the vaccines are harder to mix, store and handle.
Chundi said most doctors are eager to help end the pandemic, and have been willing to sacrifice to do it, but need public health agencies to help work through the roadblocks.
“We’re having to adjust our lives to what the policymakers want all the time. But at the end of the day, that’s hard to do as a primary care office, where you’re going to have to re-engineer your office for this. It should be the other way around,” he said.
Public health officials, to varying degrees, have said they’ve already begun or plan to begin creating a system that gets more doses to primary care offices, beyond the recently announced federal push.
But the public health agencies are also banking on everyday residents becoming pseudo-ambassadors of the vaccine to friends and family. One example: South Shore resident Desiree Taylor.
Taylor, 29, a home care provider, used to be hesitant, after reading what she now says were misleading Facebook posts. Amid her hesitancy, she was approached by a patient’s wife, who asked Taylor to rethink her fears.
So she did her own research, got the shot and now says she takes a similar tact in how she approaches hesitant friends and family.
“I try to let people know, ‘Yes, I was against it. I was the one that was saying no, I’m not going to do this,’” Taylor said. “Now I try to tell people it’s OK.”
Chicago Tribune’s Dan Petrella contributed.