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What’s behind Eastern Washington’s low coronavirus vaccine rates? The answer may not be simple

By Kip Hill and Arielle Dreher The Spokesman-Review

The individual choices guiding residents of Eastern Washington on getting COVID-19 shots – and why the region is lagging behind other parts of the state – may best be shown by two local mothers.

Marilyn Mott, of Airway Heights, said she has continued concerns about the vaccine’s development and what recourse she can take if her child is harmed. Kelsea Baltins who lives on Spokane’s South Hill has spent the past year listening to her husband, a doctor at MultiCare Deaconess Hospital, and his experience up close with the virus.

“It’s a luxury for us to choose not to get vaccinated,” Baltins said.

“I’m glad that people are doing it,” said Mott, who’s kept her child out of preschool because of the virus. But, she adds, “I’m a little worried about all vaccines.”

Eastern Washington is trailing the other side of the state in inoculating residents against COVID-19, and the reason is as complicated as the efforts to convince a wide range of communities to get their shots.

Young parents may not be concerned about the risk to themselves and their children. Efforts reaching young people, who only recently became eligible for the shot, have had varying success, organizers say. Still other issues beyond choice, including access and longstanding concerns about public health pushes, may also be to blame.

The numbers are clear, though. The Washington statewide goal is to reach 70% of residents 16 and over with at least one dose by the end of June. Seattle hit that goal last week. Spokane has a ways to go.

As of Wednesday, 52% of Spokane County residents 16 and older have had at least one dose.

Mott and Baltins talked about their views of the vaccine while watching their young ones tumble over play equipment at Discovery Playground in Spokane Valley, an area of the region that has seen lower vaccination than, say, Baltins’ neighborhood on the South Hill. Their convictions and reservations align with patterns of health beliefs observed by sociologists, said Kevin Estep, assistant professor of health administration and policy and medical humanities at Creighton University.

Some may see Mott’s position, pleased that others are getting the vaccination but concerned about getting it herself or her child, as irrational, Estep said.

But it demonstrates the type of individualistic thinking, particularly about our own family’s health, that may explain why some are resistant to vaccination.

Such decisions don’t have to be seen as selfish, Estep said.

“When it comes to childhood vaccination, people think, ‘I’m the expert on my kid,’ ” he said.

In explaining her decision, Mott noted she’d received a degree in chemistry and her concerns included a belief that, if there were adverse effects to vaccination, there would be no consequences for the producers.

“There’s no repercussions if there’s a bad batch,” she said. “There’s nobody to sue if they kill your kid.”

Moderna, Pfizer and Johnson & Johnson have been shielded from some liability due to the federal government’s invocation of the Public Readiness and Emergency Preparedness Act in February 2020. There are two federal compensation funds that may pay damages to people harmed by the vaccines through a claims process.

People also tend to trust their personal convictions when making decisions about their own health. Estep pointed to what’s known as the Health Belief Model, an idea generated by social scientists in the 1950s who were trying to determine why few people were getting screened for tuberculosis even as such tests became more readily available.

The model attempts to examine why people make certain health choices, and is based in part upon one’s perceived risk or risk to their loved ones. That’s what inspired Baltins to quickly get her shots once they became available earlier this spring.

“The majority of the people that we’re around are vaccinated,” Baltins said as her son scampered over the play equipment.

Some of those people are her husband’s coworkers with family in India, where a surge in COVID infections in May killed more than 4,000 people in the country a day. The United States is reporting fewer than 400 deaths per week, according to the Centers for Disease Control and Prevention.

“I am for people choosing what they want to do,” said Baltins, who lives in the Rockwood neighborhood that has among the highest vaccination rates in Spokane County. She will get her child vaccinated when the vaccines are approved for use in kids.

Rockwood is part of a ZIP code where 62.5% of residents have initiated vaccination as of Wednesday, according to the Spokane Regional Health District. In the ZIP codes making up Spokane Valley, vaccination initiation rates range from 38% to 42%. Airway Heights has a 34% vaccination rate, though that number may be affected by nearby Fairchild Air Force Base, where data is being handled by the Department of Defense and is not reflected in SRHD’s numbers.

Local health officials think it’s still possible to get to 70% throughout Spokane County, but it will take more time. While some communities had a big surge in people getting vaccinated that has now dropped off, Spokane County has had a slow but sure gain in vaccine rates.

“We’ve continued with a fraction of a percent increase every day,” Interim Health Officer Dr. Francisco Velazquez said. “We’re slower, but we’re steady.”

Access and convenience are vital hurdles in getting vaccinated, and community groups appear to be leading the charge.

While the Spokane Arena and other vaccine providers, like pharmacies, continue to be open, community organizations hosting events paired with vaccine clinics appear to be driving local vaccination .

On June 8, during the third “Happy Hour” at the Spokane Arena, the parking lot was fairly empty, and lots of free cookies and swag were left untouched.

Despite the fanfare and the opportunity to win free tickets to see the Weeknd, fewer than 30 people came to be vaccinated from 5 p.m. to 7 p.m.

The Happy Hour events, sponsored by the Spokane Regional Health District, Greater Spokane Inc. and others, are geared toward young adults, who have the lowest vaccination rate to date among adults in the county.

As of Thursday, just 33% of 18- to 29-year-olds have received at least one dose of a vaccine in Spokane County.

Estep said there’s no evidence targeted incentive efforts will have a profound effect on vaccination uptake.

But it could reflect use of the persuasive strategy while also demonstrating the severity of the outbreak and the need for large-scale vaccinations to protect public health.

“I don’t think there’s a strong precedent,” he said. “It’ll be interesting to see if it works.”

On June 5 at a pop-up vaccine clinic hosted by Spectrum Center in partnership with Spokane Pride, SAN and the Range Community Clinic, 232 people were vaccinated, including some kids and teens. The outreach and preparation were intentional and effective.

The clinic was on the weekend. One of the most common concerns vaccine providers hear from people at clinics is the potential they will fall ill after receiving the vaccine and be forced to miss work.

At the Arena mass vaccination site, which can still see up to 40 walk-in vaccine appointments on some days, Fridays and Saturdays are their busiest days, when they are open from 9 a.m. to 3 p.m.

“Right before close is our busiest time, with people trying to get it before their day off,” said Chris Greiner, patient care pharmacist at Safeway-Albertsons who is helping operate the Arena site.

Offering the clinic on the weekend and at the Pride event, which also included a maker’s fair, a drag show and food, was intentional.

“People were concerned if they got sick from the second dose that they would need so much time off of work that they’d fall behind on bills,” said Anne Johnson, community health worker at the Spectrum Center.

To alleviate the potential stress of needing to call in sick, the Pride clinic also offered gift cards and incentives to people who got their shots. Everyone who got their first dose received a $25 gift card and a free meal. The second-dose clinic on June 26 will offer those getting their second shots $50 Visa gift cards.

“Our whole point was, how do we make this a safe and affirming event, and how do we reduce barriers?” Johnson said.

While the Arena or other larger vaccine sites might be convenient for some Spokane County residents, for communities with historic distrust or adverse experiences in the health care system, or with little access to health care before the pandemic, seeking a vaccine at a clinic they’ve never been to may be unlikely.

The Spectrum Center is hosting a second-dose clinic at the Washington Cracker Building on June 26, and the organization plans to host a few more clinics this summer.

This is where community organizations and the flexibility for providers to move doses throughout the county and state comes into play.

Latinos en Spokane hosted a clinic recently, in partnership with Range Community Clinic, and about 30 people got vaccinated, including young people.

Convenience is important, but so is trust. The Spectrum Center clinic was open to everyone, but Johnson and her team really tried to focus on reaching queer and trans communities, as well as partnering with the Asian and Pacific Islander Coalition in Spokane.

“Making this by the community and for the community, we can make it a safe space,” she said.

Even though some clinics might vaccinate dozens of people at a time, it’s reaching people who wouldn’t get vaccinated otherwise.

Estep said it might be tempting to use easy cultural narratives, or politics, to explain why some people are getting their shots and others aren’t. But the reasons are often more complicated, and political divides are a recent development.

“Skepticism about vaccines has not historically been partisan,” he said.

In fact, it was Republican President Gerald Ford who pushed for vaccinations against the swine flu in 1976, famously receiving the shot when it became available that October.

Infections never spread beyond the army base in New Jersey where they originated, and the vaccinations were also tied to 450 people contracting a rare neurological disorder known as Guillain-Barre syndrome, an extremely rare side effect that has not been reported with the COVID-19 vaccine, though it has been reported as occurring rarely after COVID-19 infection. Some blame the incident for continued hesitance to public vaccination campaigns today.

Only in the past six or seven years has the vaccination resistance movement become tied to personal liberty, a development hastened by social media, Estep said. Such ties between vaccination and freedom might be encouraging some conservative politicians trying to invoke the argument that getting the shot will allow for a return to the freedom of prelockdown days, he said.

You can see that split in the messaging from former President Donald Trump and President Joe Biden. Trump, in a phone interview in March with Fox News, referenced people’s freedoms in his endorsement.

“We have our freedoms, and we have to live by that, and I agree with that also,” Trump said at the time. “But it’s a great vaccine, it’s a safe vaccine, and it’s something that works.”

The next day, Biden made a pitch to people based on protection of the community.

“I just don’t understand this sort of macho thing about, ‘I’m not going to get the vaccine, I have a right as an American, my freedom to not do it,’ ” Biden told ABC’s “Good Morning America” on March 17. “Well, why don’t you be a patriot, protect other people?”

Baltins said she is in favor of people being able to choose the vaccine, despite her own eagerness to get it. What she can’t understand is people who wouldn’t follow rules to protect public safety, including mask mandates, and now also won’t get the shots.

“People want to complain,” she said.

Some parents who refused to give their names at the park said they were concerned about the origin of both the virus and the vaccines produced to protect against it. One father said he hadn’t received enough information to feel comfortable getting the shot, and a mother expressed concern that the vaccine was an attempt at social control.

Those reasons are common for refusing vaccination, Estep said. Public health officials and political leaders have to navigate the Health Belief Model when trying to convince people to receive a vaccine, he said. If people are making their decisions based on the perceived risk, it’s not mandates that are likely going to have a long-lasting effect – it’s persuasion.

“Coercion gets short-term results, but in this particular instance, it might have backlash,” Estep said.

The model also takes into account what it calls “perceived barriers,” meaning anything that could get in the way of someone making a public health choice. That includes the inconvenience, cost or even impossibility of getting somewhere the vaccines are offered. And while vaccine access has saturated urban parts of Washington, some rural communities haven’t had even one vaccine clinic.

Fairfield, which is just 30 miles south of Spokane, got its first clinic in May, after months of community leaders advocating for doses there.

At the end of May, the Department of Health closed two mass vaccination sites in the state and acknowledged that the strategy was shifting. Mobile vaccine clinics in dozens of counties were planned, and the department has created the “Care-a-Van” program, a van and a team that will bring vaccine doses to partners statewide.

So far, 25 organizations have signed up for a visit from a van, and community groups, places of worship or any organization can request a vaccine clinic from a Care-a-Van to come to their planned event.

State Secretary of Health Dr. Umair Shah said the initiative is the first time the state health department will have the capability to go directly into the communities and offer services. Having this capacity, and partnering with community organizations, he hopes, will help address some of the historical access issues and inequities in the health care system that existed long before the pandemic.

“COVID-19 did not start these health inequities or disparities or outcomes, but it took it to a different level that’s been awful; we’ve got to look at structural and social determinants of health,” he said.

Education centers also acknowledge there’s work to be done getting students vaccinated.

In Spokane County, Spokane Public Schools led the charge for vaccinating students who were 12 and older, as their planned vaccination clinics coincided perfectly with the Food and Drug Administration’s expansion of the use of Pfizer to younger people.

So far, just 19% of Spokane County residents 12 to 17 have received at least one shot. Becky Doughty, director of health services for Spokane Public Schools, said the school district plans to host vaccine clinics all summer long, for not just COVID-19 vaccines, but other immunizations required for students to attend school in Washington.

The school district has hosted 10 vaccine clinics for students specifically, vaccinating about 2,500 kids total. The SPS clinics are serving not only kids in the school district, but kids outside of Spokane and sometimes county limits.

“We wanted to not just focus on our own students but areawide, outside of Spokane county; we feel strongly that this is something we can do,” Doughty said.

Arielle Dreher's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.

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