COVID-19 vaccination divides rural America

Many rural Americans are reluctant or unwilling to be vaccinated against COVID-19, raising concerns about rural America's ability to achieve "herd immunity." But health care experts have some recommendations of how to persuade rural residents to get vaccinated.

A syringe needle is filled with the Moderna COVID-19 vaccine on Wednesday, March 24, 2021, during a vaccination clinic at Winona Park & Rec East Recreation Center in Winona, Minn. (Traci Westcott / Forum News Service)
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Chris Haugen and Mark Strand reflect the new great divide in rural America: whether or not to be vaccinated against COVID-19 .

Haugen believes in freedom of choice and the importance of thinking for himself. And the 44-year-old Butte, N.D., farmer and entrepreneur has decided not to be vaccinated.

"I'm just not going to do it," he said, citing his distrust of the federal government and the Centers for Disease Control and Prevention, as well as his belief that the dangers of COVID-19 have been exaggerated.

Strand is a Portland, N.D., farm kid who retains close ties with, and strong affection for, rural America. He's also a professor in the Pharmacy Practice and Public Health departments at North Dakota State University, as well as an epidemiologist, or a specialist in epidemics.


Mark Strand is a professor in the Pharmacy Practice and Public Health departments at North Dakota State University, as well as an epidemiologist, or a specialist in epidemics. (NDSU photo)

He's worried that many rural Americans say they're not going to be vaccinated against COVID-19 , despite what his professional expertise tells him is overwhelming evidence in favor of it .

"This has been a prolonged, devastating pandemic. The only way through is high vaccine rates," he said.

While many Americans have been vaccinated, or soon will be, Haugen is far from alone. All across rural America a solid core of residents are hesitating — or flat-out refusing — to be vaccinated. Just one measure of that: A recent survey by the Kaiser Family Foundation found that 30% of rural residents say they will either “definitely not” get vaccinated or will only do so if required. That's nearly double the 16% of urban residents who gave that answer.

Kaiser - rural vaccination.png
Kaiser Family Foundation

So there's concern, even alarm, among vaccination supporters who warn that rural America is in danger of failing to achieve so-called "herd immunity." That's the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infection.

Though the percentage won't be known until the pandemic is over, experts estimate that 70% to 80% of the population needs to be immune to the virus to achieve herd immunity. As things stand now, reaching 70% will be difficult and hitting 80% will be extremely challenging, experts say.

To be sure, there are encouraging signs, in particular the rising number of rural Americans who have been vaccinated recently as larger vaccine supplies become available in their states and communities .


When this Agweek article was being prepared, about a third of all American adults were fully vaccinated and a little more than half had received at least one dose At the same time, more than 570,000 Americans had died from COVID-19.

Nonetheless, "We're seeing gradual decline in the number of individuals who are left unvaccinated (and) that are willing to be vaccinated. It happens to predominantly be in rural areas," said Shawnda Schroeder, associate director of the University of North Dakota Center for Rural Health.

McVille, N.D., population 375, in Nelson County, North Dakota is home to Nelson-Griggs Public Health District. (Katie Pinke / Agweek)

That's true nationally, too, said Alan Morgan, CEO of the National Rural Health Association in Washington, D.C.

"COVID cases, hospitalization and fatalities in rural towns across the country have consistently been higher than in urban areas. You've got these small towns that are most in need of vaccines that in most cases aren't having the uptick in vaccination rates that they need," he said.

Poor messaging

Alan Morgan is the CEO of the National Rural Health Association in Washington, D.C. (National Rural Health Association)

Morgan said pro-vaccination "messaging to date hasn't been rural appropriate" — focusing too much on the argument that rural residents should get vaccinated because the federal government tells them to.

He's originally from a rural town himself, "and usually when the government tells me what I can or can't do, oftentimes, I do the opposite."


"This (current messaging) has to change. It needs leadership at the local community-level," he said. "Rather than a story of the federal government telling us what to do, this needs to change into a discussion of what we do to keep our family, friends and loved ones safe."

Local leaders advocating for vaccination need to include farmers and ranchers. "You can't be a successful farmer or rancher today without understanding science and how vaccines work," Morgan said.

Why they're resisting vaccination

Allen vaccine shot
Dustin Allen, environmental health and safety technician at POST, receives his second dose of the COVID-19 vaccine on April 15, 2021, in Northfield, Minn. (Noah Fish / Agweek)

There appear to be many reasons why some rural Americans aren't getting vaccinated. The list includes:

  • Distrust of the federal government.
  • Concern that possible side effects of the vaccination shots could hamper ag producers during planting and calving.
  • The assertion that expert recommendations have changed over time. (Health care experts respond that they wisely changed their recommendations as new and better information became available.)
  • Traditional rural self-reliance and self-sufficiency.
  • A belief that the pandemic is primarily an urban problem, not a rural one.
  • Lack of confidence in experts such as the Centers for Disease Control and Prevention. The organization, the U.S. agency charged with tracking and investigating public health trends, has played a leading role in nationwide use to combat the pandemic.
  • Concern that variant strains of COVID-19 will make current vaccines ineffective.

Shawnda Schroeder, associate director of the University of North Dakota Center for Rural Health. (UND photo)

Don't use the variants as a reason not be vaccinated, Schroeder urged.

"Yes, there's a variant," she said. "But it's sort of like saying 'I don't want to get the flu shot to prevent myself from getting the flu because I might get strep throat anyway or get something sick with something else.'"

Early, preliminary research indicates that individuals who receive an existing vaccine also fare better against the variants, she said.

Most of the concern about vaccination isn't due to scientific or rational reasons, Strand said. So, "Please give respect to those who have genuine training and expertise in epidemiology, virology and vaccinology (and) who are working to protect people."

Politics a factor

By all accounts, political beliefs are a powerful force among rural Americans who haven't been vaccinated.

Most of the states with the highest vaccination rates traditionally have voted Democratic in presidential elections, while many of the states with the lowest vaccination rates traditionally go Republican in presidential elections, according to published reports.

Morgan, who's been at the National Rural Health Association for 20 years, said rural health care traditionally has been bipartisan, enjoying both Republican and Democratic support. "But now we have COVID and right from the get-go it's been politicized," he said.

The Kaiser Family Foundation survey found that people reluctant to be vaccinated usually are "Republicans, white evangelicals, essential workers in fields other than health care and young adults 18-49."

Haugen, asked whether he thinks that connection exists, said it definitely does.

Strand also said there's a link.

"To me, it's unfortunate that a scientific issue, a health issue, a medical issue — people's opinions about it, or their behaviors in response to it, would fall so discretely along partisan lines. That's the part that's sad for me to see because it seems there have been partisan motives that in some ways have encouraged and pushed people to be more or less opposed to what's really a biological phenomena," he said.

COVID-19 vaccines were carefully and methodically tested and were found to be effective and to cause minimal side effects, Strand said

Why herd immunity matters

Pandemic specialists have stressed for more than a year the danger that COVID-19 poses to individual Americans and their families. Now, attention is growing, especially in rural areas, on the importance of achieving herd immunity, sometimes known as community immunity.

Without herd immunity, "The virus will continue to circulate among the non-immune people. Meaning every community will have pockets of sick people, like we have now, so we can never let our guard down. This would mean that COVID-19 remains with us indefinitely. This also increases the opportunity for new, and possibly more dangerous, variants to emerge," Strand said.

Here's how the CDC defines herd immunity:

"A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community."

The herd immunity concept has allowed vaccines to successfully control contagious diseases such as smallpox, polio, diphtheria, rubella and many others, and will work with COVID-19, too, experts say.

Bridging the divide?

Haugen, asked what he'd tell people on the fence about vaccination, said he's not interested in doing that, except to say: "Get online and look for information yourself."

Morgan, asked the same question, said "appreciation of freedom and the desire to keep our family safe" are the key drivers in the debate over vaccination. That said, "Family is paramount in a rural context, and I think it's important at this point in time to have those tough discussions about we can do keep our families safe."

Strand said he understands and values rural Americans who are reluctant to be vaccinated.

"I know these are people of good will," he said. "There's no intention to do harm, but I want to appeal to them to put aside certain partisan or even philosophical values that really result in harm to themselves and also to their neighbors."

Strand, who described himself as a person of faith, drew on a prominent Biblical injunction. "We need to take it (vaccination) on as an act of service, of sacrifice. To me, it's an issue of, 'Love your neighbor as yourself,'" he said.

Making the case for vaccination

Persuading vaccination-wary rural Americans to get their shots won't be easy. But rural health care experts tell Agweek they have a number of suggestions to help:

  • Enlist local communities' medical doctors, farmers and ranchers, and religious leaders, also known as faith leaders, to help make the case for vaccination.
  • Focus on people who have been vaccinated, not those who haven't been. Vaccinated rural residents can talk about why they choose to get the shots and hopefully persuade others to do so.
  • Stay positive and respectful in making the pro-vaccination case, while not backing off the belief that the specialists who recommend vaccination know what's best.
  • Concentrate on rural Americans' deep concern for family, friends and neighbors and how vaccination can help to protect them.
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