LONG PRAIRIE, MINN. – Like some of the regulars who frequent his barber shop, Datrick Mitchell doesn't see much reason to get vaccinated against COVID-19.
"I just figure I never got a flu shot either," said the 37-year-old Texas transplant, who was elected last year to the Long Prairie City Council. "I'm just going to take my chances."
Mitchell's reluctance speaks to the challenge health officials face here and across the United States in boosting immunizations in low-vaccine counties, where residents run an increased risk of sickness, hospitalization and death from COVID-19. The concern nationwide is amplified by the recent spread of the much more infectious delta variant.
As delta is driving higher case counts and hospitalizations in some rural counties across the country, there are worries that similar trouble could come to central Minnesota and places like Long Prairie and surrounding Todd County, where there's a decided lack of urgency among many about getting shots.
"The vaccination coverage level is such that I worry about what could happen in that area ... because they have less protection," said Kris Ehresmann, director for infectious disease at the Minnesota Department of Health.
Among Minnesota's 87 counties, Todd ranks second-to-last in the percentage of residents age 16 and older who've received at least one dose of vaccine. At 42%, it falls well below the roughly two-thirds of state residents overall who have received a shot and far off the 80% or better numbers posted in Cook and Olmsted counties, the most immunized counties in the state.
"It's disappointing," said Jackie Och, director of Todd County's Health & Human Services division.
To improve the county's standing, public health officials have taken to social media, radio, the local newspaper and church bulletins, urging residents to get vaccinated. They've knocked on doors and sent informational postcards to every county address. They hopped on a bus to deliver vaccines to four cities over four days in May and wound up administering 130 shots — a bit short of what they had hoped for.
They've set up booths at community events, too, to promote immunization and give shots, and later this month they plan to offer free ice cream at the county fair to sweeten the incentive for getting vaccinated.
Still, their challenge is formidable.
In a three-hour stint at a recent community festival in Browerville, only three people took advantage of the opportunity to get a shot.
"We just don't see a lot of interest," said Katherine Mackedanz, Todd County's community health manager.
Reluctance and resistance
Two hours northwest of the Twin Cities, Todd County is situated in the geographic heart of Minnesota, "where the forest meets the prairie," according to a county slogan.
Tiny towns dot two-lane highways that slice through the countryside, and miles separate many residents from the nearest neighbor or clinic, creating an isolation of sorts that makes some question the need to be vaccinated at all.
"A lot of people live 10 to 12 miles from the nearest community and may only come into town for groceries and church," said Jason Brown, owner, publisher and editor of the Long Prairie Leader. "They say they don't need to be vaccinated because they hardly interact with people outside their immediate family."
For others, reasons for reluctance range from skepticism and misinformation about the vaccines to political differences that go beyond the pandemic.
Cutting hair, Mitchell says he has heard all sorts of opinions on the subject.
"Some are vaccinated because they want to be safe," he said of some customers. "Others are leery because they think [the vaccine] was developed so fast."
Sitting in the barber chair as Mitchell snipped away, Mark Bleess said he got vaccinated in part at the urging of his wife, a retired nurse.
"I probably would have gotten vaccinated anyway because I'm out and about in public and now other people don't have to worry about being around me," he said.
That the county has one of the lowest vaccination rates in the state doesn't surprise him. A lot of people question whether the vaccines are safe, he said. Some, too, harbor resentment over DFL Gov. Tim Walz's handling of the pandemic, which brought statewide restrictions, mandates and a lockdown to slow the virus' spread.
"A lot of people thought he stretched his authority further than he should have so I think a lot of this is anti-Walz," Bleess said. "This is a conservative area, and people don't like being told what they can do and can't do."
In a county where more than 70% of voters backed Donald Trump for president in 2016 and again in 2020, anger and even disbelief that he lost his re-election bid frequently spill over into testy conversations about the virus and the vaccine.
"Some felt [COVID-19] was all cooked up to hurt Trump," Mitchell said. "As the number of cases ticked up, people thought they were being fabricated."
But, Mitchell added, "we know the virus is real because people are dying from it."
Still, he isn't convinced he needs a vaccine to protect himself.
"I'll use common sense," he said. "If I'm sick, I'll stay home."
Customers down to a trickle
As of Friday, state health officials reported 2,867 cases and 33 deaths linked to COVID-19 in Todd County since the pandemic's start. Vaccinations among the county's nearly 25,000 residents peaked in March when more than 4,000 people lined up for COVID-19 shots.
Reta Dahlen was among the early arrivals.
"I got the vaccine the first opportunity I could," the 76-year-old Long Prairie resident said while taking a break from weeding her lawn on a hot summer day. "I don't want to get COVID."
The rush to be vaccinated slowed to fewer than 800 shots in June. In the town of Bertha, about 25 miles north of Long Prairie, it feels like the market for vaccine has been pretty much saturated, said Andrew Meyer, a pharmacist at Seip Drug.
There were times this spring, Meyer said, when health officials in Bertha vaccinated 150 or 200 people in a day, including some who drove up from the Twin Cities during immunization events held at the town's community center.
By the end of last week, however, Meyer was preparing for what amounts to a vaccination surge these days — four people scheduled appointments for Friday, saying they wanted to get shots in case immunization becomes a requirement for crossing the border into Canada.
"We do honor walk-ins," Meyer said, "so anyone can come in at any time."
A pause this spring in usage of a single-dose COVID-19 vaccine from manufacturer Johnson & Johnson sapped demand among county residents who were just coming around to the idea of vaccination, said Jenna Anderson, another pharmacist at Seip Drug.
Clinics stopped using the vaccine for a brief period in April after doctors found a very small risk of a blood clot problem in a few recipients. The short-term halt put potential local recipients back on the fence, Anderson said, and reinforced questions about the safety of the new vaccines.
Yet every week, a few people still walk into Seip Drug for immunizations. They're often sent from across the street at the Tri-County Health Care–Bertha Clinic, where nurse practitioner Alison Meyer routinely recommends the vaccine to patients.
Meyer delivers the message carefully, so as not to lecture. While some patients are clearly opposed to the idea, she thinks it's important to mention it because for others "it helps them to say: 'OK, maybe I do need to commit to this because my health care provider is recommending it.' "
Once pharmacists in Bertha open a vial of vaccine, they notify the clinic and take to social media to spread the word, hoping to find vaccine takers before the doses expire.
"The last few people that I have vaccinated have said: 'I finally decided just to get it done with,' " Anderson said. "I think it was just time that took care of their decision."
'Really slow going'
Amid the disappointment of the county's low vaccination numbers, local public health officials do their best to revel in successes.
About 50% of the workers at two local meatpacking plants have been vaccinated, Mackedanz said. Vaccines also have been administered to more than 60% of county residents age 65 and older — the group that has suffered the most from COVID-19.
"They're vaccinating a few people every week and that's encouraging," Ehresmann said of Todd County. "But it's just — it's really slow going."
The pace is particularly discouraging, she said, as the highly transmissible delta variant steadily spreads in Minnesota. In the past two weeks or so, state health officials have reported 34 new cases of the delta variant, which was first identified in India, and 110 cases overall.
Sitting in his Long Prairie newspaper office, Brown guesses the county might be lucky to get about half of its residents vaccinated.
"But that will be a long time coming," he said. "The complacency is discouraging. … [Health officials] have tried everything in the book. If the variants show up here, maybe that will scare people."
Mackedanz and Och, meanwhile, plan to continue to educate and advocate for vaccination. Eventually, they say, the political divisiveness that has hindered vaccine efforts may fade.
"At this point, it's pretty contentious," Mackedanz said. "Maybe in a year or two it will become like getting a shingles vaccination or flu vaccination. It won't be a big deal."