In the US, vaccination rates are low, for different reasons.

In the United States, more than 204 million people are fully immunized, but this is still only 62% of the population, much lower than most other wealthy nations.

At the county level, vaccination rates fluctuate from about 83 percent in places like Montgomery County, Md., a densely populated area just outside Washington, DC, to about 15 percent in rural places like McPherson County in northern South Dakota.

As the Omicron variant surges and experts say vaccination strongly protects against severe illness, US public health officials are closely examining ways to reach under-vaccinated areas. Best. But the barriers are not the same everywhere. Some are clearly politically connected: Republican-leaning areas are often the ones that lag behind on vaccines. But the country’s pocketbook can have its own quirks that aren’t partisan.

Here are the challenges facing three counties, where, according to Centers for Disease Control and Prevention data, vaccination rates are among the lowest in the nation. (State figures for those counties may differ from CDC data due to methodological differences, reporting lags, and other factors.)

Resistance to vaccines is not new in LaGrange County, a rural area along Indiana’s border with Michigan. Only 22 percent of residents are fully vaccinated against the coronavirus, and according to Dr. Tony Pechin, county health officer, only 15% of children in the county are up to date with standard vaccines by age 2.

Dr. Pechin says he’s run into the usual conspiracy theories about vaccines and that even some longtime patients don’t heed his advice to get vaccinated.

But the most important factor, he said, is that about half of the county’s 40,000 residents are Amish, a group that outright rejects vaccines. Among non-Amish residents, he said, vaccination rates are 45 to 48 percent.

Pechin said that a pharmacy frequented by Amish residents was one of the first in LaGrange County to receive the dose but has only vaccinated eight people in six months.

The state health commissioner sent a delegation to meet Amish leaders in the spring, and the CDC sent another in the summer.

Dr. Pechin said of the envoys: “When they were done, they called me and just said, ‘Good luck, Tony. ”

When Hurricane Laura landed near Cameron Parish in August 2020, many residents have left their damaged homes behind and hid inland – and have yet to return.

According to CDC, vaccination rate is only 17 percent. But Louisiana health officials say those numbers don’t account for population displacement.

Dr Lacey Cavanaugh, a regional health officer for the Louisiana Department of Health, said: “Although the numbers look dire, they are not as bad as they seem, because a large number of people are affected by the disaster. “.

But if the statistics were calculated to reflect the current population of Cameron Parish and other places ravaged by recent storms, she said, they would likely still show vaccination rates below national average. Laura destroyed much of the parish’s limited medical infrastructure, so for months health officials administered the vaccine in a tent in the hospital parking lot. And for residents consumed by home repairs and businesses, getting vaccinated is low on the priority list.

State health officials have been working to bring vaccines directly to disaster recovery events, and are warning residents that getting sick with Covid-19 could make the road back even worse. even more difficult.

“Once you’re protected” from the virus, Dr. Cavanaugh said, “it’s less of a worry.”

A rural county with a history of going its own way – it refused to join Alabama in seceding from the Union during the Civil War – faces many challenges that have impeded the state’s adoption of vaccines.

Dr Karen Landers, a regional official with the state’s Department of Public Health, said vaccine misinformation was still circulating on social media, said despite months of efforts with leaders. local, faith-based organizations and pharmacies. County immunization rates have stagnated at about 21 percent, According to CDC

Convincing young people that they are susceptible and need vaccinations can be a particularly acute issue, she said. But Dr. Landerssaid, she remained adamant: “We know that not everyone will listen to us, but that doesn’t lessen our responsibility.”

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