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Experts say reluctance to get a COVID-19 vaccination in rural areas is driven by a number of factors. ANDREW CABALLERO-REYNOLDS/AFP via Getty Images
  • More than 20 percent of people in rural areas do not plan to get vaccinated against COVID-19, according to a poll.
  • Experts say this can hamper efforts to achieve herd immunity against the disease in the United States.
  • The lack of vaccinations in a community can cause a COVID-19 outbreak even if the vast majority of the country is vaccinated, experts say.

People living in rural areas of the United States are among the most vaccine-hesitant in the country, a situation that could hamper the nation’s ability to achieve herd immunity and put an end to the COVID-19 pandemic.

More than 1 in 5 rural residents say they will “definitely not” get the COVID-19 vaccine, according to a Kaiser Family Foundation poll. That compared to 13 percent of adults in suburban areas and 10 percent of adults living in urban communities.

To achieve herd immunity — the point in which enough people have immunity to a disease that it can no longer spread throughout the population — between 70 and 90 percent of the population will need to be vaccinated, experts suggest.

Because COVID-19 is a novel disease, the exact number required to achieve herd immunity isn’t certain, making it all the more important to get as many people vaccinated as possible.

If herd immunity needs to be in the 90 percent range, 1 in 5 people saying they won’t get vaccinated is a big deal, particularly for their local communities.

“When these numbers are discussed, we tend to think about them as the proportion of the entire American population that needs to be vaccinated to limit spread. While this is true, consider what occurs if this is achieved by some regions having 100 percent compliance with the vaccine while others have 40 percent compliance,” said Nichole Cumby, PhD, an assistant professor of microbiology at the University of Medicine and Health Sciences St. Kitts in New York.

“This sets up a situation where if the virus finds its way into the area with 40 percent compliance, a local outbreak of disease can occur despite other areas being protected,” Cumby explained. “So, a rural area with poor vaccine compliance is setting itself up for a potential local outbreak of disease. These sorts of local outbreaks can have a huge toll on the community.”

Fare-ups in communities with low vaccine compliance can also threaten the broader population.

“When these local outbreaks occur, the virus is actively replicating in the population. When viruses actively replicate, they get the chance to mutate,” Cumby told Healthline. “In theory, a mutant could therefore emerge from a local outbreak able to infect people who were vaccinated.”

But what drives vaccine hesitancy, particularly in rural areas?

“The reason for vaccine hesitancy varies among these groups, including religious background, age, race, ethnicity, political affiliation, education level, and geographic location, but of those who are hesitant, the majority have reported concern over the potential side effects, worrying that they may be worse than the symptoms of a COVID-19 infection and that it might cause them to miss work,” Dr. Creshelle Nash, MPH, a medical director for Arkansas Blue Cross and Blue Shield, told Healthline.

“In Arkansas, particularly in rural communities, there is also a misconception that COVID-19 may not affect them or that the data on COVID-19 infections or deaths is not accurate,” Nash said.

Recent polling also suggests that vaccine skepticism cleaves sharply among political lines.

For instance, a recent NPR/Marist poll found that more than 1 in 3 self-identified Republican voters said they would refuse a vaccine if offered.

Among this demographic, Republican men were the most likely to say they would refuse a vaccine, with nearly 1 in 2 saying they’d pass on the opportunity.

Rural areas tend to lean more heavily Republican, suggesting that there isn’t anything special about “ruralness” that drives hesitancy.

It’s unlikely that every eligible person in the United States will elect to receive the vaccine. Still, an important aspect of getting as many people vaccinated as possible is meeting them where they’re at, said Nash.

“Community engagement, especially in reaching underserved populations, has been an important tactic to combat vaccine hesitancy. This refers to working alongside organizations that have already established trusted relationships in their communities to ensure the underserved get vaccinated,” she said.

“There will need to be cross-industry collaboration to support not only equitable vaccine access but equitable distribution of reliable and trusted resources on the COVID-19 vaccine,” she added.