While a majority of U.S. residents are now fully vaccinated against COVID-19, differences between states loom large. As of late December, the share of people fully vaccinated ranged from 46% in Idaho to 77% in Vermont.
Even within states that lag behind, however, there are still communities that stand out. These are the outliers – counties with notably higher vaccination rates than their state. In Jefferson County, Mississippi, for example, 65% of residents were fully vaccinated, compared with 48% of the state, according to data from the Centers for Disease Control and Prevention. That’s despite the fact that Jefferson is one of the poorest counties in the entire U.S., with a median household income of approximately $25,000 and significant health hardships due to high rates of diabetes and high blood pressure.
“We have our struggles. We are last in a lot of things,” says Crystal Cook, medical director of the Jefferson Comprehensive Health Center, a local community health network. “But with COVID-19, I’m proud to say we’re first in something, especially something good.”
Sometimes, a county’s demographic or political characteristics may contribute to it having a significantly different vaccination rate than the state as a whole. But there also can be a deeper explanation for vaccination success. In interviews with public health leaders working in various outlier counties, a few common threads stand out, pointing to lessons for how other communities can boost their own vaccination rates as well. Leaders say they’ve countered misinformation with education, avoided shame and judgment, and used trusted local messengers to spread the word about vaccination.
Jefferson County also has achieved success by bringing vaccines to people, instead of the other way around. Workers from Cook’s health center toured the county in a mobile unit the size of an RV and equipped with a waiting room, a laboratory, and a fridge and freezer for storing temperature-sensitive vaccines. Health care workers set up vaccination sites with the local school district, the correctional facility and in front of public housing, allowing people without access to transportation to walk right up.
“People are familiar with us. They’re very familiar with our services. We gained the community’s trust,” Cook says.
Cook says workers encountered significant misinformation about vaccines, but responded without “vaccine-shaming” anyone. Some people, she says, believed a myth about vaccines containing microchips. Cook, though, explained how the syringe worked, showing how the needle was retractable. This demonstration was enough to quell people’s fears.
“Education was the biggest tool, and being patient, being present, meeting people where they are,” Cook says.
Some places that now have high vaccination rates are also among those that COVID-19 has hit particularly hard.
“We were listed as the worst city in the United States with the highest infection rate per capita,” says Richard Chamberlain, health director for the city of Laredo, Texas.
Webb County – home to Laredo, a border city where about 95% of the county’s population lives – peaked at an average of over 400 new COVID-19 cases and eight deaths per day in January 2021, according to the nonpartisan data center USAFacts. Now, 80% of county residents are fully vaccinated, compared with 57% of Texans overall.
Laredo officials put out a bilingual blitz of communications efforts – using social media, print and TV – to spread information about vaccines and answer people’s questions. The city’s Emergency Operations Center broadcast live question-and-answer sessions three times a week.
“The messaging was continuous, it was flowing. …‘Vaccines are safe, vaccines are effective, and there is no cost,’” Chamberlain says.
Laredo officials also worked closely with the mayor of sister city Nuevo Laredo, Mexico, to help vaccinate around 20,000 people who live right on the other side of the southern U.S. border. The thinking: Outbreaks in one city would inevitably affect the other.
“We absolutely believe in regional immunity … we know we are truly one Laredo,” says Chamberlain. Notably, vaccination rates have been high in Mexican states across from Webb County as well. Nuevo León, for example, had given 91% of its adult population at least one dose as of Dec. 1, according to government data cited by the Mexico Institute at U.S. think tank the Wilson Center. Tamaulipas, home to Nuevo Laredo, had a one-dose vaccination rate of 86%. (Shots given to Mexican residents are not counted as part of Laredo’s vaccination rate.)
The success in Webb County is part of a larger trend in border communities. Among the top 50 outliers in the U.S. – where counties have the largest positive difference between their vaccination rate and the state’s overall rate – six are on the U.S.-Mexico border. These include places like Cameron County, Texas, which has a 72% full vaccination rate.
“I’m super proud of the border. … The border is very different from the rest of the state. We feel responsible, we have this weight on us to protect the rest of the state,” says Esmeralda Guajardo, health administrator for Cameron County Public Health.
Vaccination rates along the border may be somewhat inflated because they’re based on U.S. Census Bureau population data. The bureau historically has had difficulty accurately gathering population data on Latinos and immigrants lacking legal documentation. However, Guajardo still believes that vaccination rates in her area are high, as she says increases in the vaccination rate have consistently tracked with decreases in the area’s case rate.
“I do think it skewed our numbers, but not that much. And this is why: If you look at our vaccination rates in comparison to our case numbers, you’re going to see that it’s pretty consistent,” Guajardo says.
Another eight of the top 50 outliers in the U.S. are counties where at least a third of the population is Native American. That includes Big Horn County in Montana, home to part of the Crow Indian Reservation, and Apache County, Arizona, home to part of the Navajo Nation. They are 83% and 89% fully vaccinated, respectively.
COVID-19 devastated the Navajo Nation, resulting in over 1,200 deaths by March 2021. “The success of getting high vaccine rates has unfortunately been a result of our disproportionately high infection, severe illness and mortality rates,” says Dr. Kevin Gaines, acting chief medical officer of the Navajo Area Indian Health Service.
But public encouragement from both political and spiritual leaders in the Navajo Nation also played a role, Gaines believes. He knows of traditional native healers who announced that they got vaccines and encouraged others to do the same.
“The Navajo Nation leadership from the president down have been very public and open in pushing precautions and measures to prevent the spread of COVID as well,” Gaines notes.
Harley Jones, a senior manager at medical outreach program Project HOPE, helped coordinate efforts to send medical volunteers to tribal areas. Jones attributes the high vaccination rates in places like Apache County in part due to a culture that values community health above individualism: “There was a belief there in the collective responsibility of every single person to get vaccinated.”
“Getting your vaccine was not only how you protected yourself,” Jones says, “but more importantly, how you protected the community and the culture.”
Below are the top 50 counties with the biggest positive difference between the local vaccination rate and the state rate: