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Geographic gaps in COVID-19 vaccination taking shape in Wisconsin
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WISCONSIN | VACCINE ROLLOUT

Geographic gaps in COVID-19 vaccination taking shape in Wisconsin

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Double shots

Mark Hanson, a registered nurse and volunteer with the Benevolent Specialists Project Free Clinic, vaccinates Aristides Rivera, left, while Dr. Tim Docter, the free clinic's medical director, immunizes Paul Griesbach, right. The vaccination clinic, held last week at Jessie Crawford Recovery Center in Madison, is one of many efforts in Dane County to inoculate diverse populations. The county's COVID-19 vaccination rate is among the highest in the state.

Geographic gaps in Wisconsin’s COVID-19 vaccination effort are solidifying four months after immunizations began, with more than half of residents inoculated in Bayfield, Dane and Door counties, more than double the rates in Clark, Rusk and Taylor counties in the central-northwestern part of the state.

Access to vaccine, demographics, hesitancy about injections and political beliefs contribute to the differences, experts say. As health officials strive to vaccinate roughly 80% of the population for “herd immunity” to protect against outbreaks and enable a return to normal life, places with low vaccination rates could become a concern for everyone.

“We’re only as good as our worst areas,” said Dr. James Conway, a UW Health pediatrician and vaccine expert, because counties that remain relatively unprotected are ripe for outbreaks that could spread elsewhere. “It’s essentially an open can of gasoline that’s waiting for somebody to throw a match in.”

Syringes

Doses of Moderna's COVID-19 vaccine are assembled at Jessie Crawford Recovery Center, where the Benevolent Specialists Project Free Clinic provided about 45 vaccinations last week in Madison.

The differences in COVID-19 vaccination rates around Wisconsin mirror those for annual flu shots, with Dane and Door counties typically leading the state in uptake of flu vaccine and Clark and Taylor counties at or near the bottom.

But the stakes are higher with COVID-19 shots, said Ajay Sethi, a UW-Madison infectious disease epidemiologist. Not only is the risk of physical harm or death from the coronavirus greater than from flu, the vaccines available against the coronavirus are considerably more effective than those for flu so the benefit from immunization is greater, Sethi said.

“We have to somehow convince people of the importance of getting this particular vaccine even if they haven’t been in the habit of getting vaccines in the past,” he said.

Priority groups

Early variation in COVID-19 vaccination rates had much to do with a county’s proportion of health care workers, the first group able to get vaccine. With people 65 and older becoming eligible in late January, a county’s share of seniors has also played a large role in its overall rate, experts say.

But with everyone 16 and older approved for vaccination early this month, such factors are beginning to wane. However, a county’s racial makeup can also influence its immunization rate, given that rates statewide are significantly lower for Blacks and Hispanics, and somewhat lower for American Indians and Asians, than for whites.

As of Saturday, Taylor County had the state’s lowest vaccination rate, with 21.8% of residents receiving at least one dose, followed by Clark County, with 22.2%, and Rusk County, with 26.4%.

Door County had the highest rate, with 56.7%, followed by Bayfield County, with 53.0%, and Dane County, with 52.4%.

“We are doing the best we can to offer vaccines to those who are eligible,” said Brittany Mews, director of the Clark County Health Department, which has been holding mass vaccination clinics since January. “With less vaccinator options, the vaccine opportunity is not as great.”

Clark County has 11 vaccinators open to the public, according to the state Department of Health Services. Taylor County has three, and Rusk County has five.

COVID-19 vaccination by county

Another factor in Clark County is having a sizable Amish and Mennonite population, a group that is typically reluctant to be vaccinated, Mews said. Health officers in Taylor and Rusk counties didn’t respond to messages seeking comment.

“I think there is a little bit of vaccine hesitancy” in the three counties, said Christina Writz, vaccine coordinator for the Eau Claire City-County Health Department and leader of the regional Chippewa Valley Immunization Coalition.

Hanson preparing syringe

Mark Hanson, a registered nurse, is one of many retired volunteers who help the Middleton-based Benevolent Specialists Project Free Clinic provide COVID-19 vaccinations and a wide range of specialty medical care.

Writz said appointments for some vaccinations, such as at the Federal Emergency Management Agency clinic that opened this month at UW-Eau Claire, are generally obtained online, though they can be made by phone. “That might be another barrier to some of the rural populations,” she said.

Political correlation

Polls continue to show more resistance to getting the COVID-19 vaccine among Republicans than Democrats. A Monmouth University poll last week said 43% of Republicans plan to avoid the vaccine, compared with 5% of Democrats, while a Quinnipiac University poll said 45% of Republicans will refuse, compared with 7% of Democrats.

In last year’s presidential election, more than 66% of voters in Clark, Rusk and Taylor counties voted for former Republican President Donald Trump, while Bayfield, Dane and Door counties went for Democratic President Joe Biden, though the race was close in Door County.

“I hate to attribute this to politics, but there is a correlation there,” Sethi said.

Ann Lewandowski, executive director of Wisconsin Immunization Neighborhood, a group that advocates for vaccination, said historically low vaccination rates in certain places can make it harder for people to accept vaccines because there’s no culture of immunizations becoming routine.

“Lower rates can make communities more vulnerable to misinformation because it’s not normal behavior,” said Lewandowski, co-chair of the vaccine subcommittee of the State Disaster Medical Advisory Committee, which advised the state health department on COVID-19 vaccine eligibility groups.

Still, Lewandowski said poor access to COVID-19 vaccines may explain the low rates in the three northern counties more than unwillingness to get them, at least so far.

Hanson vaccinating Merritt

The Benevolent Specialists Project Free Clinic received a state grant to focus its COVID-19 vaccination efforts on underserved populations. That included holding an immunization clinic last week at Madison's Jessie Crawford Recovery Center, where Mark Hanson vaccinates Morris Merritt.

“If it was July and we were seeing these rates, I’d say yes it’s clearly vaccine hesitancy,” she said.

While Door County has only four registered vaccinators, they’re all in centrally located Sturgeon Bay, which may help increase access countywide, Lewandowski said.

Door County also has the state’s third highest proportion of older adults, and Bayfield County has the sixth highest, according to census data. The percentage of seniors in Rusk and Taylor counties is also above the state average, while Clark County’s share is just below average and Dane County’s is third lowest among the 72 counties.

High rates

The predominance of retirees in Bayfield County is likely a significant contributor to the county’s high vaccination rate, said Sara Wartman, director of the county health department. Another: The Red Cliff Band of Lake Superior Chippewa was able to open up vaccination to various priority groups, even outside of the tribe, earlier than the health department, Wartman said.

The county has only five registered vaccinators, but the health department has relied on about 20 extra people — some paid, some volunteers — to staff regular vaccination clinics at various locations, she said.

As vaccination continues, Wartman said the county’s rank will likely drop since a portion of its population is known to be against vaccines. “I think you’ll see our vaccine rate slow down,” she said.

In Dane County, high education levels could be one reason for the high COVID-19 vaccination rate, Conway said. But resistance to some vaccines, such as childhood measles shots, is often highest among the highly educated, he said, and school vaccination waivers are higher in the county than in many other parts of the state.

The Dane County Immunization Coalition, of which Conway is a board member, brings together the Madison area’s multiple health care systems with Public Health Madison and Dane County and other groups to encourage vaccination, he said. During the COVID-19 pandemic, the coalition has held weekly Zoom meetings to share information, recently including tips on everything from where to find syringes to how to frame vaccination messages to different groups of people.

“There’s constant communication,” Conway said. “It’s a very unified approach."

Julie Willems Van Dijk, deputy director of the state health department, said Clark, Rusk and Taylor counties not only have relatively few registered vaccinators, they request fewer doses of vaccine than other counties. A state-run vaccine clinic that opened last week in Barron County, adjacent to Rusk County, may help and the state may increase its mobile vaccination teams in the region, she said.

But if COVID-19 vaccination was a baseball game, we’d be only in the fourth inning, Willems Van Dijk said. It’s too early to say any county won’t achieve high immunization rates.

“We have a long way to go before we declare that we’re not going to do any better there,” she said.

[Editor's note: This story has been updated to correct a reference to the number of counties in the state. Wisconsin has 72 counties.] 

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