The National Guard was ready and waiting.

Airman First Class Dakeem Blackiston, the vaccinator, was armed with about a dozen doses of COVID-19 vaccine — a mix of Pfizer and one-shot Johnson & Johnson shots.

Also on hand was Kelsey Grant, tracer/field investigator with Delaware’s Division of Public Health, offering a $10 gift card to anyone who got immunized.

But 40 minutes into the walk-in clinic Thursday at Laurel Junction, there had been zero takers.

“There is definitely some community resistance, with various reasons,” said Maj. Lixin Wang of the Army National Guard. “We try. All we can do is try.”

The Laurel mini-clinic was one of two on the National Guard’s vaccination schedule Thursday. The other was a similar small-scale setup at Woodbridge Early Child Education Center in Greenwood.

These tiny vaccination events are a far cry from the mass drive-thrus that drew hundreds and, in some cases, thousands earlier this year.

“We’re just trying to take it to them, instead of them coming to us,” said Spc. Christopher Johnson. “That’s what our role is. When we were doing the mass vaccines, people were driving through there like a McDonald’s or a Burger King. (Now,) we’re going to the people that aren’t as fortunate.”

Currently in Delaware, masks and social distancing in public are no longer required, coronavirus hospitalizations are a fraction of what they were a year ago, and deaths attributed to COVID-19 are now the exception, not the norm.

With about a half-million people — approximately 50% — fully vaccinated in the First State, Gov. John Carney intends to lift Delaware’s 16-month state of emergency order Tuesday.

Yet all news is not positive.

Health officials have great concern about geographic pockets, identified by ZIP code, that weigh in far below the average state vaccination rate and are labeled by the Centers for Disease Control and Prevention as “vulnerable.”

“Those vaccination rates do remain stubbornly low in some pockets, especially in our rural western Sussex County, the rural and minority communities,” said Katherine “Kat” Rodgers, director of community health initiatives for TidalHealth. “And this has been consistent throughout the pandemic and the vaccination effort.”

In Kent County, the Rev. Rita Paige said there has been a “noticeable decrease” in participation at vaccination clinics hosted by the Kent County Coalition.

“You don’t know what you’re going to get because people will register and then not show up,” she said. “We’re seeing lower numbers, but we’re doing the best we can.”

According to data provided Wednesday by DPH, more than a half-dozen “pockets” in Sussex County have a vaccination rate below 40%.

Most are in the western part of the county, from top to bottom — including Greenwood (30.9%), Bridgeville (33.6%), Seaford (36.4%), Laurel (30.1%) and the Delmar area (27.1%).

In central Sussex, the Ellendale area was at 29.4% and Georgetown’s 19947 ZIP code had a 35.4% vaccination rate.

“We have worked closely with (DPH) to try to figure out how to address those ongoing disparities in COVID-vaccination access and coverage,” Ms. Rodgers said. “When the vaccination effort first began, TidalHealth Nanticoke provided vaccine to eligible populations as people became eligible and vaccines started to roll out. We were a major source for the community — up until the state opened their walk-in clinics and the pharmacies began to offer it. So the disparities became way more obvious and concerning once there was what everyone thought was significant access and availability of the vaccine. Education about the vaccine had been out for several months, and yet we are still seeing a low uptake on that vaccine.”

In Kent County, several areas are below 40% — Hartly (30.5%), Frederica (34.3%), Harrington (36.1%), Dover’s 19901 ZIP code (36.6%), Felton (37.7%) and Dover’s 19904 ZIP code (39.5%).

“There are pockets of low vaccination rates throughout the state, but yes, there are a number in Sussex County,” said Mary Fennimore, DPH spokeswoman. “DPH is focusing efforts on areas with low vaccination rates, and we are providing additional educational information to these areas, as well as taking our mobile vaccination units into these areas.”

Hesitancy from legacy

For members of the Black community, vaccine hesitancy often stems from a legacy of medical mistreatment, the Rev. Paige said.

Some people are turning down the opportunity to get vaccinated by citing the “Tuskegee Study of Untreated Syphilis in the Negro Male” — an investigation where Black men were exposed to syphilis and not provided treatment between 1932 and 1972, the Rev. Paige said.

“They’re afraid,” she said.

To combat low turnout, the coalition is starting to change its approach — from clinics to going out into the community and offering vaccines directly.

Another cause of hesitancy, the Rev. Paige said, is that women are afraid the vaccine can cause infertility.

“Therefore, they don’t even want to let their children even get the vaccine for the same reason,” she said. “They just say the vaccine is too new, not enough is known about it, so they just don’t trust it.”

According to the CDC website, pregnant women can safely receive a COVID-19 vaccine. The website also states there is no evidence to suggest that any vaccines, including the COVID-19 shots, can cause female or male infertility.

The Rev. Paige said some members of the Latino and Haitian communities are fearful of getting vaccinated due to their immigration status. She noted that you do not need to be a U.S. citizen to receive the immunization.

“There can be a variety of reasons for low vaccination uptake, including mistrust of the vaccine, not understanding the science behind the vaccine, as well as a wait-and-see perspective,” said Ms. Fennimore. “We do know, based on data, that vaccination rates are lower in the African American community statewide, and this holds true for areas in Sussex County.”

DPH is trying to provide education “to dispel myths and have individual conversations with people in areas with low vaccination rates to ensure people are armed with reliable information for (making) informed decisions,” Ms. Fennimore said.

One resource DPH just launched via its website is an “About the Science” page, “highlighting common questions we hear about the vaccine and quick-hit facts and videos from Delaware medical providers, answering some of these questions,” she said.

Ms. Rodgers also mentioned skepticism among the unvaccinated.

“So we know that the issues at first were because of the unknown. It was new and limited access,” she said. “But now the consensus is that there are historical and current experiences of racism that have contributed to mistrust of medical systems, especially among racial and ethnic minority groups. So there is an increase of skepticism.”

Lower rate means higher risk

Ms. Rodgers said the populations targeted in those low-rate ZIP codes are at greater risk for severe COVID-19 symptoms and morbidity.

“We’ve got older people, low-income, low-education, high-poverty, high rates of uninsured, underinsured, language barriers,” she said. “If you are low-literacy and English is your second language, it is going to be a bigger challenge to get information in your language that is understandable, (so) that you can then act on and make an informed decision.”

Ms. Fennimore agreed.

“We are seeing that low vaccination rates are overlapping with many communities listed on the CDC Social Vulnerability Index as vulnerable communities,” she said. “We are concentrating vaccination activities in these areas and are also working with communities and Healthy Communities Delaware to address social determinants of health that we hope will lead to overall better health outcomes.”

Efforts, initiatives

Vaccination efforts to reach minorities have entailed clinics in collaboration with the poultry industry, whose workforce includes high numbers of Spanish and Haitian employees, as well as through church and community connections, Ms. Rodgers said.

“Health care providers, health systems and public health are all trying to work together to make sure that information is given to low-literacy populations and (to) people whose first language is not English,” she said. “We at TidalHealth looked outside the hospital walls, out into the community. The partnerships in the community are key at this point to address those areas, those neighborhoods where there is still low vaccination rate, because you’ve got to have trusted members within the community who are speaking Creole and speaking Spanish, who are doctors, pastors and priests and other sort of community-based organizational leaders, sharing information and sharing stories, dispelling the myth.”

Ms. Grant, the DPH tracer, added, “We have a couple co-workers who are Haitian Creole. We’re really trying to push it in their churches.”

In the coalition’s efforts to reach Kent County’s Haitian community, the Rev. Paige said having a Haitian person on-site to administer the vaccine has helped reduce people’s fear.

Though she said she understands the anxiety behind people’s hesitancy, the reverend encouraged everyone who is able to get their shots.

“I think this is the only way that we’re going to wipe out this pandemic,” she said. “You want to protect yourself. You want to protect your family. In my case, I’m a pastor, so I want my congregation to be safe, and I want them to get vaccinated, so they don’t pass it on to anyone else. It’s the only thing we can do to keep ourselves safe and destroy the pandemic.”

She added that, though the vaccine’s side effects can be unpleasant, it reduces your chances of being hospitalized due to the virus.

“We can’t just think about ourselves. We have to think about others with this vaccine,” the Rev. Paige said. “I would rather go through some of the side effects than to be in the hospital, possibly on a ventilator.”

Partnership

Through Wednesday, TidalHealth had administered more than 44,500 doses at its various facilities. TidalHealth Nanticoke, based in Seaford, surpassed the 12,000-dose mark this past week.

“We are no longer doing it through our hospital-based clinic. We just work with individual groups and partner with the state, kind of on an as-needed basis,” Ms. Rodgers said. “(DPH) really has the lead, and they are the primary ones hosting those community clinics. Our role in it is much smaller now than it was before, but I see our role as shifting more, so where we might be doing a very small amount of the actual vaccinations, … we are still a big piece in getting that message out … to all of the people that we come in contact with in our work as a health system.”

One gap TidalHealth Nanticoke is helping to fill is vaccinations for the homebound.

“That is another pocket of people who can’t get out, and they have different needs as far as going through the vaccination process,” Ms. Rodgers said. “We get referrals from partners, at the state, other providers. … We go out into that service area and go into the individual homes. It’s literally one arm, one person at a time.”

Not yet in the clear
Ms. Rodgers said it is imperative for people to understand that COVID-19 has not gone away.

“The most important thing is to try to get as many people as we can get vaccinated as soon as possible, if they are eligible,” she said. “If, for some reason, people cannot or are not ready to be vaccinated, or they are unwilling, then continuing to wear their mask and staying 6 feet away from others is the key to protecting themselves from contracting and spreading COVID. Because it is still here. There continue to be different variants, mutating variants of the COVID virus, and those other variants are on the rise throughout the country, including in Delaware. So the urgency and the importance of protection remains strong.”

Maj. Wang concurred, saying, “You cannot really force anyone, to like mandate anybody, to get the vaccination. So we are all adults. We make informed decisions. And we’re trying our best to educate the community. Hopefully, we can give more information, so that they can make better decisions.

“But there is only so much we can do.”