Georgia’s rural Trump-supporting turf drags down state’s COVID vaccination rank

When Grantville Councilman Jim Sells started feeling sick this summer, he tried to tough it out.

He described himself as a hardcore conservative and a skeptic of masks, vaccines and other COVID-19 precautions. He tried some home remedies he read about online, but nothing helped, so he checked himself into the hospital, not knowing just how close he was to death.

“I’m trying to say as they’re taking off my clothes, ‘What are we doing here?’ And they said, ‘You’re admitted. You’re not leaving.’ And then the doctor comes over and says, ‘You’re in really bad shape. I don’t know if we can help you. Do you want us to resuscitate you?’ And now I’m in shock. I went in there because I’m just not feeling well, and she’s telling me I’m in real bad shape,” he said.

During the first 18 hours of what would become a 16-day hospital stay, Sells and his doctors did not know whether he would live or die. Luckily, he responded well to his treatment. He’s back home and feeling better every day, he said, and now he’s on a mission to persuade other conservatives that COVID-19 is real, dangerous and preventable.

“I wouldn’t be here if it weren’t for my friends pounding heaven and the doctors and nurses at Fayette Piedmont,” he said. “Every day is an extra day for me. I want people to know we can save some lives here and save some hospital stays, if we can educate them on how COVID kills you, and how you can tell your lungs are going bad for $10 to $30 with an oximeter.

“But even more importantly, if you get the vaccine, now you can save passing this on, and like my wife, you can be here to help those unvaccinated that wind up in bad shape.”

Sells said he blames much of the problem on social media, which he said creates an echo chamber by showing people content that will not challenge their beliefs, and for conservatives, the algorithms often select anti-vaccine content. Sells’ own Facebook page, which was once host to mainly religious, pro-police and military and personal posts, is now dominated by calls to the hardcore anti-vaccine crowd to avoid his fate and get the shot.

But convincing skeptical Georgians to get a jab will not be an easy task.

Rural-urban divide

Only 44% of Georgians are fully vaccinated, compared with more than 53% for the nation. Though the state has moved up in state rankings, it is still near the end of the pack, ahead of only West Virginia, Idaho, Mississippi, Alabama and Wyoming in fully vaccinated residents, according to Centers for Disease Control and Prevention data compiled by the New York Times. And vaccine hesitancy is not spread equally throughout the state.

Each of the counties with the 10 lowest vaccination rates is a rural county, according to the Georgia Office of Rural Health, while only one of the top 10 vaccinated counties — Terrell County — is.

Among those bottom counties, only 26.8% of residents have gotten at least one shot, while that number for the top vaccinated counties is 57%. Overall, 52% of Georgians have gotten at least one dose.

That’s not necessarily surprising, said Georgia State University public health professor Dr. Harry J. Heiman.

“We know that our health care infrastructure in the state, particularly in rural areas, is poor, with rural hospitals continuing to close despite populations that, in general, are older, with more comorbidities and at a higher rate of people living with disabilities,” he said. “So there may also be more significant access barriers in terms of people being able to easily get the vaccine in rural counties, compared to urban areas.”

The average infection rate in the 10 counties with the lowest vaccination rates over the last two weeks is more than 35% higher than in the 10 with the highest vaccine rates, though with their much smaller population levels, a relatively small spike in the number of cases can be magnified in rural areas, Heiman cautions.

Still, the difference is stark.

“Think about how Georgia might do if the other 149 counties had vaccination rates that would still be in general lower than the national average, but the average of the top 10, we’d be seeing significantly fewer cases, hospitalizations and deaths.”

Political divide

Politics could also provide a partial explanation for the difference, Heiman said.

“You also see pretty significant political differences between urban and rural counties in our state, and we know from polling data that political affiliation and ideological affiliation has, unfortunately, influenced behavior around people getting vaccinated and also wearing masks,” he said.

In general, that bears out in the data, with most of the lowest-ranking counties voting for former President Donald Trump in the 2020 election and the highest-ranking counties choosing President Joe Biden.

The vaccines were developed under the Trump administration, a fact that Georgia Gov. Brian Kemp likes to point out while encouraging skeptical Georgians to talk to their health care provider or pastor about getting vaccinated.

Sells said he has found namechecking Trump can be a tool to get skeptical conservatives to start listening, but ultimately, he feels that the more effective path is to take politics out of it.

“It is not a political issue, and that’s part of the problem with some conservatives,” he said. “Fauci is a foul word to a conservative. Everything he says, you’ve got to do the opposite because he said it. What we need to listen to is, if nothing else, the doctors and nurses, the ones at the hospital that can’t do anything, all the people they pulled off of other floors that used to do other things that can’t because they’ve got to have them in ICU helping these COVID patients that can’t breathe. Our hospitals are crippled.”

More than a third of the 17,000 Georgians hospitalized as of Wednesday are COVID-19 patients, a higher number than at the previous winter high point, and nearly 97% of Georgia’s intensive care unit beds are in use.

But the connection between a conservative worldview and vaccine skepticism is not absolute.

Georgia’s top-performing county, Fayette, voted for Trump by a small margin, and other highly vaccinated areas like Oconee, Greene and Forsyth counties chose the Republican candidate more decisively.

Sells said some of his conservative friends are not receptive to his message, but many of those who are, like him, personally affected by COVID-19.

“I get a lot of kickback,” he said. “They just haven’t had a close friend go through it. They haven’t been to a funeral. Let me tell you who’s getting vaccinated, it’s the people going to funerals and praying for their friends that are in the hospital near death hoping they come out. Those people are getting vaccinated. They’re finding out what’s really going on firsthand.”

Heiman said he’s still hopeful people will decide to protect themselves before they or a loved one become seriously ill.

“Many people have been humbled by the ferocity of this delta surge, and I think that the outliers, the counties with very high numbers of voters for Trump with high vaccination rates and low percentages of Trump voters with low vaccination rates, speaks to the fact that we need to do everything we can in every county that has a low rate, and we have the opportunity to convince more people to get vaccinated,” he said. “Polling data also suggests that the number of people who reported in polls that they will never get a vaccine continues to drop down, so hopefully, we have opportunities to do more.”

Vaccine incentives

A good way to do that is to partner with trusted members of local communities like pastors, local doctors or pharmacists to provide unbiased information, Heiman said.

The Georgia Department of Public Health’s 18 public health districts are each taking different approaches based on the areas they serve, said Georgia Department of Health spokeswoman Nancy Nydam.

“In some cases it’s working with the faith-based community, in other districts there are established community groups, and some districts have local government officials that are working to spread vaccine messages — Savannah’s mayor comes to mind, but there are many others throughout the districts,” she said.

Some local governments have been experimenting with incentives for those who go under the needle. A DeKalb County drive in which residents received a $100 gift card for getting a shot brought out more than 1,100 people last month.

Athens-Clarke County has followed suit, offering $100 gift cards to anyone who lives, works or studies in the county who gets their first vaccine. They can earn another $100 for their follow-up shot as well.

Since the program began Sept. 3, the number of people getting vaccinated has increased tenfold, said Athens-Clarke County Mayor Kelly Girtz.

The unified city-county government went a step further Tuesday, implementing a mandate for government employees which may be the first of its kind in the state.

Employees who are vaccinated by Nov. 10 will receive an extra $200 and eight extra vacation hours.

Those who do not comply could face disciplinary action.

“There are some masking requirements if you remain unvaccinated, and then I do believe that what’s likely as we move forward is that we’ll probably revisit both the carrot and the stick components of the program,” Girtz said.

An employee survey found the workers were split about 50-50, Girtz said, but commissioners felt the move will keep the workforce healthy and help protect the residents they interact with.

“One of the things that we believe is that when you work in the public sector, you work for the public, and everything that you do ought to be for the health and welfare of the broader populace,” he said. “So this is an opportunity whether somebody is at the front desk of a parks facility, or visiting somebody for utility service or is a frontline public safety person, that we’re ensuring that we’re most likely to keep the public healthy.”

Girtz said he is hoping other local governments will adopt similar measures.

“In the sense that DeKalb County’s program sort of inspired us, we’re hoping that we can inspire others to follow suit, whether that’s on the city or the county or even the school district level.”