How to close rural vaccine gap? Facts, teamwork, respect and patience, with no politics or confrontation, experts say

Rural Virginia couple Everett and Kristin Jiles got Covid-19 in July, but only she was vaccinated. After he had a much harder time recovering, the conservative Christian couple became crusaders for vaccination. Here, they talk about their story. (Assn. of American Medical Colleges video)

"Many people in rural and conservative areas remain frustratingly resistant to vaccination, challenging public health officials to come up with more convincing — and sensitive — approaches to promoting greater vaccine uptake," Beth Howard reports for the Association of American Medical Colleges. "It’s not enough to refute misinformation, experts say. To reach the vaccine-hesitant, public-health officials urge a combination of approaches, from connecting with local physicians to having respectful conversations."

The problem is persistent. A recent University of Pittsburgh study shows that, although overall vaccine confidence rates have increased nationwide since Covid-19 vaccines became available early this year, the same percentage of people who strongly opposed vaccination in January felt the same way in May. Even after adjusting for factors like age, sex, race, employment status and education, people in very rural counties were 23 percent more likely to be vaccine-hesitant than urbanites.

Partisanship is also strongly correlated with attitudes toward coronavirus vaccination. "People in counties with the highest support for former President Donald Trump in the 2020 presidential election were 44% more likely to be vaccine-hesitant," Howard reports. "Those living in a state with a Republican governor were 34% more likely to be hesitant than people living in a state with a Democratic governor."

Rural emergency medicine doctor Edwin Leap, who grew up in West Virginia, told Howard that the pandemic has exposed cultural rifts that go back generations. Because of that, mandates won't work, he said: "People in rural America are a culture. They tend to be fiercely independent. . . . The very last way you’ll get them to comply is by telling them they better do what’s right. They’re not going to have you tell them what to do."

Health and communications experts suggest the following approaches to increase coronavirus vaccination rates in rural areas:

• Just provide the facts. Rural Americans resist mandates because they want to make their own decisions. So providing unbiased, basic information that will help them make an informed decision is the way to go.
• Leave politics at the door. The coronavirus has been deeply politicized, so it's important to avoid saying anything even remotely political in discussion vaccination. One expert told Howard that, if the subject of politics comes up, the best way to respond is something along the lines of "This virus does not care who you are or what you believe." That removes the discussion from politics and enables you to address the other person's concerns.
• Team up with community influencers. Rural Americans trust local health-care professionals much more than outsiders, so they're more likely to listen to fact-based vaccine recommendations from a community doctor, nurse, pharmacist or community health worker.
• Don't refute false claims about the vaccines. By bringing up misinformation, even if you do so to disprove it, you end up reinforcing the belief in the person's mind. So don't repeat falsehoods when providing vaccine information. "For instance, if someone says that vaccines give you Covid-19, you don’t have to say they don’t give you Covid-19," Howard reports. "Instead, provide an answer that addresses the vaccine’s overall safety — why and how they’re safe."
• Treat people with care and respect. Regardless of what someone believes, take their concerns seriously and treat them with respect. Don't talk down to people or make them feel judged or shamed.
• Be prepared to play the long game. It will likely take more than one conversation to change someone's mind about vaccination. When you're wrapping up a discussion about vaccination, "give them a call to action, such as offering additional resources to learn about the efficacy of the vaccine and inviting them to come back and talk about it more so that you can answer any other questions," Howard reports.