(Bloomberg) — Larry Krauck awoke in a strange hospital, the date written on a dry-erase board in his room: Dec. 12, 2020.
That can’t be right, he thought. He remembered being treated for Covid-19 at a different hospital in Springfield, Missouri, on Nov. 1. Could the last six weeks really be blank? He told a nurse her board was wrong.
She slipped out of the room and returned with a summary of his procedures, scrawled on a sticky note, including thirty-three days on a blood oxygenation machine called an ECMO. One day, Krauck had flat-lined and was resuscitated.
Krauck, 50 at the time, caught the coronavirus and nearly died well before vaccines were available. Since his ordeal, he’s become an advocate for the shots — the type of local, trusted messenger that health officials hope can woo the skeptical.
“I tell people all the time: you don’t want to be me,” he said in an interview. But where he lives, deep in Trump country where doubts run strong about vaccines and the virus, his tale of a near-death experience is only occasionally enough to persuade acquaintances — even close family — to get their shots.
Krauck’s uphill climb illustrates the challenge for President Joe Biden in fighting the pandemic. When friends and neighbors brush aside the pleas of a man who nearly died, it’s clear that Biden faces huge hurdles reinvigorating a U.S. vaccination campaign that’s grinding to a halt.
Biden set a goal for 70% of American adults to get at least one Covid-19 shot by July 4, a symbolic nod to Independence Day. Despite ample vaccine supplies, he missed that target, largely because the government has struggled to give away shots in rural, deeply conservative regions that are bastions of support for his predecessor, Donald Trump.
Two Americas have emerged from the growing vaccination gap. In one, dominated by states that Biden won in the November election, most adults got their shots and daily life is rapidly returning to normal, with assurances from health officials that the worst is over. But in the other — overwhelmingly Trump country — fewer adults are vaccinated and health officials fear that the new, more transmissible delta variant, first observed in India, is driving a surge of cases, hospitalizations and deaths.
Unvaccinated America is made up of places like Springfield: rural and small-urban areas where residents harbor doubts about the vaccines and pandemic skepticism runs deep. The coronavirus was slow to arrive in Republican-dominated states in the South, Midwest and West, the same places that also tended to be the first to lift mask mandates and other public health measures.
A stark partisan divide over the virus has emerged: a Gallup poll last week found that 57% of Republicans say the pandemic is over, compared with 4% of Democrats. And while Trump has sought credit for the development of vaccines, he’s seldom promoted their use, even declining to get his own in front of cameras.
In interviews, Trump’s supporters say their own doubts have little to do with him. Instead, a raft of questions, myths and conspiracy theories have taken hold among many Missourians and other Americans hesitant to get vaccinated, an alternate belief system that the Biden administration has struggled to knock down.
Now the delta variant is spreading. While it’s been found across the U.S., hotspots are erupting in less-vaccinated areas, like southern Missouri. As of June 27, for the first time since the U.S. started administering shots, the rate of Covid-19 hospitalizations in less-vaccinated places exceeded the rate in places with the highest proportions of inoculated people.
Southern Missouri is nowhere near Biden’s goal of 70% of adults with at least one shot, and even if it was, it might not be enough to stop delta, said Steve Edwards, president and chief executive of CoxHealth, which operates six hospitals in the region.
“We’re here to tell you it’s going to roll across this country. It is now,” he said in an interview.
In Springfield, vaccine doubters include Krauck’s niece, Jennifer Davis. She hasn’t had a shot and isn’t inclined to get one. Four of her five children, all of whom are eligible, are also unvaccinated; she worries that a daughter who got the shots will suffer side effects.
She and her uncle are close and speak fondly of each other. But Davis, 41, believes the vaccines were developed too quickly and that a series of illnesses suffered by friends and their families are broadly linked to other vaccines. She wonders why people line up for shots, and trusts doctors less after a previous recommendation led to complications and a hysterectomy. Coronavirus doesn’t seem that dangerous to her — even given Krauck’s experience.
“There hasn’t been enough research done on it, and I’d rather take my chances with the virus than I would to get the vaccine. I trust my immune system,” Davis said in an interview. “If I get it, and it’s my time to die, then I get it and it’s my time to die.”
Davis supports Trump, but says not even the former president could change her mind. “It’s silly that people think just because one man says ‘go get it,’ that we’re going to line up and do it. Because it’s not going to happen.”
Across the region, health officials lament the politicization of vaccines. So does Davis. She believes incentives for shots, like lotteries and other giveaways, fuel doubts about their safety, and she questions why other crucial medicines, like insulin, aren’t also distributed for free.
“There’s other life-saving drugs that people need that they can’t get because they can’t afford — and yet they’re begging people to take this vaccine? It doesn’t make sense,” she said.
Davis’s resistance to vaccination isn’t rooted in her politics, but some health officials in the region wonder whether Biden inadvertently hamstrung himself by setting his July 4 target.
“There’s a part of me, in thinking through this — are there folks who are still going back to the election results and saying, ‘you know what, the current administration set a goal so we’re going to do our part to make sure they don’t hit their goal?’” said Craig McCoy, a former paramedic who’s president of Mercy Springfield Communities, where Krauck was first hospitalized and spent his time on ECMO.
Vaccination Campaign Slows
Nationally, the U.S. isn’t far off Biden’s target. About 67% of all adults have gotten at least one shot and 58% are fully vaccinated. It’s one of the best rates of vaccine coverage in the world, among countries large and small, according to the Bloomberg Vaccine Tracker.
But that masks much lower vaccination rates in places like Springfield, a hub of deeply Republican southern Missouri in the heart of the Ozarks. Just 47.4% of adults in the county that includes Springfield had at least one shot as of last week, with 42% fully vaccinated. The rates are even lower in more rural counties nearby, which send their most severe cases to Springfield’s hospitals. Nonetheless, virtually all mitigation measures such as mask mandates have long been lifted. Virus cases are now soaring in the region.
“Right now, as I speak to you, millions of Americans are unvaccinated and unprotected, and because of that, their communities are at risk, their friends are at risk, the people they care about are at risk,” Biden said Tuesday at the White House, after celebrating what he called U.S. “independence” from the pandemic over the weekend. “This is an even bigger concern because of the delta variant.”
The U.S. vaccination campaign peaked in April, at about 3.4 million shots per day. That’s about when the FDA paused use of Johnson & Johnson’s vaccine after a few cases of serious blood clots, potentially fueling safety concerns. The rate of shots has since declined and is now roughly a million per day. And the vaccine gap — the difference between U.S. counties with the highest vaccination coverage and those with the lowest — is more than 30 percentage points and rising.
One sign of the disparity: even as restaurants and shops run as usual, Springfield’s hospitals still require masks and are starting to fill up again. On Tuesday, Mercy Hospital Springfield had 120 Covid-19 patients admitted, three times as many as its average in June and the most for a single day in the entire pandemic. Only three are fully vaccinated.
Springfield’s other major hospital, run by CoxHealth, has 94 Covid-19 patients and is expecting a spike this month. A special Covid unit, built last year and closed in February as caseloads fell, has been reopened.
The latest patients in the city include a three-month old, two teenagers and several people in their 20s and 30s. Nearly all are unvaccinated, officials say, and all the most severe cases are. And, of all the variant cases found in June in the county, 96% were delta.
“If you’ve ever desired a vacation on a ventilator in the ICU, then not getting vaccinated is probably for you,” McCoy said. “People think they’re invincible. Right now, we have young people on ventilators in the ICU and it’s heartbreaking.”
Polling by the state hospital association points to evangelical Christians, political conservatives, young Republicans and African Americans as most hesitant. Biden has pushed for racial equity in vaccinations but the White House has openly acknowledged that the president is not the best person to persuade conservatives to get their shots.
The administration has tried anyway. Biden visited North Carolina last month to promote vaccination, and first lady Jill Biden has gone to Mississippi, Florida and Tennessee — all states the president lost to Trump.
Jill Biden was direct in a speech at Jackson State University, a historically Black college in the Mississippi capital. The state’s vaccination rate is “just not enough,” she said, urging her audience not to believe “misinformation” about the shots.
Later that day in Nashville, the first lady was joined by country music star Brad Paisley, who performed a short set inside a distillery that hosted a pop-up vaccination clinic. Members of the audience booed when she pointed out that Tennessee’s vaccination rate is low compared to the rest of the nation.
“Well, you’re booing yourselves,” she responded.
Awash in Skepticism and Misinformation
Demand for shots has cratered across the Midwest and the South. Scott Harris, Alabama’s state health officer, said the vaccination campaign was progressing well until the first or second week of April. “It’s almost like the switch just flipped. And then it was just crickets,” he said in an interview.
It was around then that the Federal Emergency Management Agency contacted Alabama officials about setting up a “Type 1” mass vaccination clinic, the biggest kind, distributing 6,000 shots a day, he said.
Local officials said there was no way they’d get that much traffic. FEMA settled for a clinic able to give 1,000 shots a day, and the state promoted it heavily. It never exceeded about 250 patients a day.
“We did everything you can imagine to try to market that site,” Harris said. “There just wasn’t much uptake.”
People decline shots for a range of reasons, according to health officials interviewed across the region. Some question the vaccines’ safety and believe development was rushed. The Biden administration retired Trump’s moniker for his vaccine program, “Operation Warp Speed.”
Misinformation circulates unfettered on Facebook, TikTok and other social media platforms. Remote and rural populations in the U.S. face longstanding barriers to obtaining health care and hold deep skepticism of institutions. Thomas Dobbs, Mississippi’s state health officer, says that the region suffers a “culture of illness,” a general rejection of preventive care.
The officials say some residents still believe that hydroxychloroquine, a malaria treatment Trump promoted without evidence as a coronavirus remedy, can cure Covid-19. Some cite the vaccines’ emergency authorization by the Food and Drug Administration, rather than full approval, as a concern.
All of the public health officials now regard the vaccination campaign as a door-to-door effort, with local progress measured in single digits per day. In interviews, their exhaustion was evident.
“In January, it was, ‘We’re landing on Normandy, and we’re going to save people, and we’re going to rush in — I don’t care about risking my life because this is my community,’” said CoxHealth’s Edwards. “And now: ‘We thought it was over, we’re going back in.’ It’s our own fault as a community.”
All Shots Available, Few Takers
Last week, the Biden administration announced a new push to expand testing and aid in delta variant hotspots. The vaccination campaign, meanwhile, has shifted from stadiums and drive-through sites to small clinics, vans and doctors’ offices.
In Springfield, the Jordan Valley Community Health Center operates one such clinic. Demand has made it a low-volume operation — a registration table and a single room for shots — with perhaps half a dozen patients per hour. They have their choice of all three authorized U.S. vaccines. A handful of chairs sit outside the room for people to wait 15 minutes before leaving, in case of side effects.
Alexis Brown, the health center’s director of clinics, says people who decline the vaccine often say that no one can tell them what to do with their bodies. “We didn’t have the struggle that the coasts had. We just didn’t. So, we’re the show-me state,” she said, referring to Missouri’s unofficial state motto. “They still haven’t come to a realization that it could happen to them.”
Sara Hunter, a registered nurse giving shots at the clinic, left CoxHealth earlier this year after working in its Covid-19 unit. “I just need to help with the effort in a different capacity,” she said.
She sounded weary as she discussed battling the pandemic in a place where so many people doubt both the threat of the virus and the safety and efficacy of the vaccines designed to stop it.
“When you see people going maskless, or having these rallies — it’s hard as a frontline worker. You empathize with them, and they have the right to free speech, but at the time, it’s, ‘you know, you don’t want this,’” she said. “It shouldn’t be such a political issue, but it is.”
She remembers the day the specialized Covid unit closed in February, before reopening. “That was a great day,” she said. “And here we are, right back there. It’s hard.”
Sometimes, the health center can give about 50 shots at special events. “One person is better than none,” Brown said. “My message is to be vaccinated. That’s the only way out of it.”
Lexie Winfree, 22, arrived at the clinic to get her second shot from Hunter one day last week after a friend, age 21, was hospitalized with Covid-19.
“I was a little skeptical. After seeing that, they told me she might not make it, she’s only 21, this is crazy,” she said. “A lot of people are just scared, is what it comes down to.”
She said she’s the only person in her family to seek vaccination.
Brown’s own son, age 14, appears on posters encouraging local teenagers to get vaccinated. Immediately after he got his shots, he went looking for a magnet — one myth, featured in TikTok videos, is that the vaccines can magnetize people. His mother had to disappoint him. The Centers for Disease Control and Prevention has gone so far as to debunk the rumor on its website.
Krauck, the Covid-19 survivor, received about $1.5 million in hospital care so far, roughly $15,000 of it paid out-of-pocket. While in treatment, he missed Thanksgiving, his daughter’s, son’s and granddaughter’s birthdays and the U.S. presidential election.
When he woke up, a breathing tube protruded from his neck. His muscles had atrophied, leaving him weak. He’s back at work as events manager at Ozark Empire Fairgrounds, and is still rehabilitating. Some of the damage from the virus is permanent, including a series of scars.
“It’s all irrelevant. I’m alive,” he said. “I’ll never be the guy I was, there’s no way, but I’m alive.”
Even Krauck wonders what led him here. Days before he fell ill, he had gone to the doctor for annual, unrelated vaccinations. He questions whether the shots weakened his immune system. Davis, his niece, calls it “a huge red flag.”
“In his shoes, I’d be the last one lining up for another shot,” she said. “Out of his shoes, that makes me extremely skeptical.”
Krauck eagerly got his own Covid shots anyway. He hears often from people who’ve said they aren’t planning to get a shot, even after seeing what the virus did to him. But he picks his moments, preferring to share his story directly with people who ask, or in response to questions.
“You can’t blowhorn this thing” because it only angers people, he said. “People would rather die on the sword of being on that side of the politics of this, versus the other side of the health of this.”
He calls himself a political moderate. He voted for Trump in 2016, and was undecided in 2020, but didn’t like Biden. His illness kept him from casting a ballot.
Sometimes he breaks through. After a recent Facebook post, he got a message from a friend — who declined to be interviewed — who said he and his wife had decided to get shots after hearing Krauck’s tale.
“That’s two people,” he said. “If that’s all I changed, that’s two people. I’ll take it. That’s a win.”