The Daily Yonder's coverage of Covid-19 vaccinations in rural America, including the role of business in supporting employees and communities, is supported in part by the Health Action Alliance.
BEAUMONT — Sheran Watkins watched families drift past her tent under picked-clean pecan trees at Fulmer’s Farmstead and General Store. Watkins waved and said hello to attendees at the Mississippi Pecan Festival, but mostly she waited for someone, intrigued by the red-white-and-blue sign next to her, to approach.
Before long, a man walked up to her table. He inspected the shiny blue buttons and the stack of flyers that said: “Get the facts. Get the vaccine. Be a hero!”
“Hey, I’m vaccinated,” he said as he reached for a pamphlet. “Can I take some of these if I need information? I’m trying to get these guys at work vaccinated.”
“As many as you need,” Watkins replied.
When it comes to tabling at Mississippi festivals, Watkins is a seasoned pro, having worked for 26 years as an extension agent for Mississippi State University. In that role, she taught adult canning programs and cooking classes, and went to local high schools to teach food safety courses or host 4-H club meetings.
Watkins had been retired all of five months when, in July of this year, David Buys, the state health specialist at MSU Extension, gave her a call. MSU had received nearly $1 million in grant money to do vaccine outreach in 32 counties in eastern Mississippi. Buys needed someone who could hit the ground running, and he wanted Watkins to come on board to work on vaccine outreach.
“It’s so important because every one of us knows somebody that has passed away from Covid-19,” she said. “There has been nothing in my adult life that has affected the closing of the church in this way — it affects every aspect of our lives. If I can do one thing to try to help someone, I want to be on the frontline.”
Public health experts say it’s “abundantly clear” that vaccination is the only way out of the pandemic. In Mississippi, 44% of the population is fully vaccinated, and the vast majority of Covid deaths in the state were of people who did not receive a shot.
But it’s not that simple. The Centers for Disease Control and Prevention estimates that between 25-32% of Mississippians are hesitant or unsure of the Covid-19 vaccine, with an earlier study conducted by the Mississippi State Department of Health finding most were concerned about the vaccine’s safety, potential side effects and effectiveness.
MSU’s efforts are part of the Mississippi RIVER Project, a larger endeavor by DHA to increase vaccination rates among rural and low-income communities, and communities of color (“RIVER” stands for recognizing important vaccine and education resources). With about $10 million in funding from the U.S. Health Resources and Services Administration, a federal agency focused on expanding health care for rural and low-income communities, the Mississippi RIVER Project is working with colleges and universities around the state.
For MSU’s part, its work is operating from the premise that people who are vaccine hesitant can be convinced: The more accurate information people get, the more likely they are to get vaccinated. Watkins, one of eight organizers on the project, is not a health worker, but she’s worked in rural Mississippi for decades. Buys hopes that Watkins and other organizers can leverage their ties to rural and agricultural communities to reach vaccine hesitant communities and convince them to get the shot.
“We have a special focus and concentration on agricultural-related work in the state, so the health and safety of our farm families is of utmost concern for us,” Buys said. “We try to stay in our lane but do some education where we can, reach the folks we have trust with and leverage our trust to get them science-based information so they can make the best decision for their family.”
Other universities in the state are utilizing similar partnerships to do Covid vaccine education. At the University of Southern Mississippi, Susan Johnson, an associate professor of public health, spearheaded an initiative called the “Community Engagement Alliance Against Covid-19 Disparities,” also known as “CEAL.” With funding from the National Institutes of Health,Johnson created a six-week curriculum to train people interested in becoming community health advisors, or CHAs.
At the end of the course, the newly minted CHAs organized events to spread vaccine awareness. In Hattisburg, a CHA whom Johnson trained held a “vaccination block party” at DeWitt Sullivan park where volunteers gave out popsicles and watermelon.
“In every community, there are people who naturally, when they tell you something, you just believe them,” Johnson said. “With this initiative, we were looking at people who you know in your family, in your neighbor, in your churches, at your workplace — if we can get (them) the right information, (they) will naturally share that information with other people and help to dispel those myths.”
Community health workers sometimes have to tread carefully, though, because the vaccine “is so politicized in Mississippi,” Buys said.
That’s why Buys turned to retired extension agents, like Watkins, as opposed to agents actively working in the field.
“We’re having to be very cautious,” he continued. “We’ve already got relationships built, people that trust us, that we trust, and that we work with, and we recognize that our relationships in those cases are of high, high, high importance. If we burn those bridges, those relationships, then what do we have?”
Rather than run away from politicization, DHA decided to tackle vaccine outreach like it is a political campaign.
“Political campaigns focus on GOTV, ‘get out the vote,’” Buys said. “Well, this is ‘get out the shot.’”
And just like with political campaigns, there’s a script, which DHA based on research from the World Health Organization, the De Beaumont Foundation, the Kaiser Family Foundation, and other health groups. It goes like this: First, educators are instructed to open the door to a conversation with an open-ended question, such as “You may be hearing a lot about Covid vaccines. Tell me what you think about them?” Then, validate their concerns — without playing into misinformation. That’s done by utilizing what’s called the “truth sandwich” approach: Start with the truth, acknowledge misinformation, then return to reality. DHA advises Covid educators to emphasize the benefits people will gain from getting vaccinated, such as the ability to gather safely with family.
Finally, educators help people make a plan to get vaccinated, much like a canvasser would help a voter identify their polling place.
At the Pecan Festival in Perry County, Watkins didn’t have time to walk people through her script. In that kind of environment, her work was more about listening to the folks who chose to come up to talk to her, like one family of five, who asked about taking some of the pamphlets home.
“We’re trying to get my parents to get vaccinated,” the dad told Watkins.
“Make sure they know it’s ‘cause you love them and you want them to be around,” Watkins said.
“Yeah that’s what I say,” he replied.
As the family walked away, one of the kids told Watkins, “You have a good time and I hope you don’t get corona!”
On Saturday, just one person who wasn’t vaccinated came up to Watkins, a woman who wanted to say that she wasn’t going to get vaccinated. “That’s your choice,” Watkins told her.
“That was the right thing to say,” she replied before walking away.
Watkins shrugged off the encounter: Her goal is to provide information, not judge people who don’t want to get vaccinated.
“Sometimes people just don’t know,” Watkins said. “To me, you can’t blame them for those things they just don’t know.”
“Being an extension agent for so many years,” she continued, “you learn that you’re gonna hear a lot, you’re gonna deal with a lot. There’s no reason for me to get upset at someone who got themselves in a financial mess — they’ve still got to take that class to get out of that mess.”
Watkins knows her job is not without risk. She is in communities weekly meeting new people where the risk of transmission is high, and she worries about bringing the disease home to her husband who has heart stents. Still, Watkins wants to help.
“It does still make you nervous because Covid is real and people have died,” she said. “Sometimes you have to put that in the back of your mind to try to share the information and let people know there are resources.”
“But again, it is about being safe,” she added. “I put on a seatbelt and think nothing about it, because it’s for my good. … We’ve been vaccinated all our lives. What’s one more?”