By JAN HOFFMAN THE NEW YORK TIMES | APR 30, 2021 AT 4:04 PM Source: Baltimore Sun Photo Source: Unsplash, CDC
GREENEVILLE, TENN. — “So, have you gotten the vaccine yet?” The question, a friendly greeting to Betty Smith, the pastor’s wife, lingered in the air as the four church women sat down for their regular Tuesday coffee and conversation at Ingle’s Market.
Smith hesitated, sensing a chilly blast of judgment from a never-mask, never-vax companion. She fumbled through a nonreply.
Recalling the moment later, she sighed, “We were there to get to know each other better, but the first thing on the table was the
COVID vaccine.”
The subject makes her husband, the Rev. David Smith, even more uncomfortable. “Honestly, I wish people wouldn’t ask,” he said, chatting after Wednesday night prayer at Tusculum Baptist Church. “I think it’s none of their business. And it’s just dividing people.”
As the beautiful Appalachian spring unfurls across northeastern Tennessee, the COVID-19 vaccine is tearing apart friends, families, congregations, colleagues. “It’s a muddy mess,” said Meredith Shrader, a physician assistant, who runs an events venue with her husband, another pastor, and who notes that the choice has become about much more than health care. “Which voice do you listen to?”
Communities like Greeneville and its surroundings — rural, overwhelmingly Republican, deeply Christian, 95% white — are on the radar of President Joe Biden and American health officials as efforts to vaccinate most of the U.S. population enters a critical phase. These are the places where polls show resistance to the vaccine is most entrenched. While campaigns aimed at convincing Black and Latino urban communities to set aside their vaccine mistrust have made striking gains, towns like these will also have to be convinced if the country is to achieve widespread immunity.
But a week here in Greene County reveals a more nuanced, layered hesitancy than surveys suggest. People say that politics is not the leading driver of their vaccine attitudes. The most common reason for their apprehension is fear — that the vaccine was developed in haste, that long-term side effects are unknown. Their decisions are also entangled in a web of views about bodily autonomy, science and authority, plus a powerful regional, somewhat romanticized self-image: We do not like outsiders messing in our business.
According to state health department statistics, 31% of the vaccine-eligible population in Greene County has gotten at least one dose of a COVID vaccine, still below Tennessee overall, which has one of the lowest rates in the country, and far below the Centers for Disease Control and Prevention’s national tally of 55%. While many older residents have been inoculated, now that eligibility is open to all adults, vaccination sites are almost desolate.
Still, conversations here show that for many people, resistance is not firm. Roiled by internet fallacies, many hunger for straightforward information from people they trust. Others have practical needs, like paid time off to recover from side effects, which the Biden administration has urged employers to offer, or the opportunity to get the shot from their own doctor.
What is also lacking is a groundswell that might encourage the hesitant to make the leap: Many people who have gotten vaccinated are remaining tight-lipped.
Dr. Daniel Lewis encourages patients Rita and Jim Fletcher to get vaccinated for COVID-19 in Greeneville, Tenn., April 6, 2021. Lewis was himself hospitalized for a month with COVID and has a practiced pitch, but many of his patients remain unconvinced. (Erin Schaff/The New York Times)
Pastor David Smith leads a Wednesday service at the Tusculum Baptist Church in Tusculum, Tenn., April 7, 2021. Smith is vaccinated but won't to use the pulpit to advocate for it. "Honestly, I wish people wouldn't ask," he said. "I think it's none of their business. And it's just dividing people." (Erin Schaff/The New York Times)
A Matter of Trust Greene County is carpeted with hundreds of evangelical churches that range from steepled 19th-century edifices to back-roads barns. People scrape by on subsistence farming, jobs in small factories, welfare checks and cash flow from retirees who are moving onto the cheap, vista-blissful land. Drug busts for heroin and methamphetamine sustain a humming cottage industry of lawyers and bail bonds services.
COVID smacked the region hard this winter. Eleven people in Jim and Rita Fletcher’s extended circle died from it.
But no, the Fletchers, lifelong Greenevillians, will not get the vaccine. What is the point, they ask? The government still wants you to wear a mask indoors. “I just don’t see any benefits,” said Rita Fletcher, as the couple waited to see their family doctor. Neither the science nor statistics of the new vaccine daunt them. Now retired and in their 70s, Jim Fletcher was a telecom engineer, Rita Fletcher, a secretary and accounting clerk. But the Fletchers, Free Will Baptists, worry the vaccine includes aborted fetal parts (it does not). They do not trust the government, convinced it has long manipulated COVID case numbers.
“I just think we have been hornswoggled,” Jim Fletcher said. People do not put much stock in pronouncements by politicians, but they do trust Walt Cross, proprietor of the Mustard Seed, a shop in Newport just over the county line, that takes its name from the Gospel of Matthew and carries herbs, nutritional supplements and local produce. Eva Fields, a nurse-practitioner who treated one of the first local patients to die from COVID, talks with Dr. Theo Hensley at the Old Oak Taproom in Tusculum, Tenn., April 7, 2021. Hensley is vaccinated, Fields is not. "When someone pushes something really hard, I sit back, because I don't like people telling me, 'This is what you need to do,' " she said.. (Erin Schaff/The New York Times)
Cross, who is also a volunteer fire chief for Cocke County, is a tall, lanky east Tennessean with a blue-eyed focus and a warm mountain drawl, whether he is describing his preferred method to rouse people who have overdosed (ammonia rather than Narcan) or answering questions from COVID patients about how to treat their symptoms (hydrate, eat, take herbal extracts, apply hot and cold compresses).
Before going to the doctor, many people phone Cross. Or after the doctor’s medicines do not seem to be working. Although his father died of COVID, Cross will not get the vaccine. “We jumped into bed with the vaccine too fast!” he said. While he will not tell people to get it or not, he says pointedly, “Do your due diligence.”
Cross, who lectures around the country and in Rwanda about preventive wellness, is studying for an advanced degree in naturopathic medicine. His shop evokes themes dear to Appalachians, with people calling these early April weeks the “redbud winter” — the spring chill during which redbud trees swell with mauve-pink blossoms. A store wall is lined with Mason jars filled with herbaceous plants like jewelweed, passionflower and elderberry, which Appalachians were taught to use by the Cherokee. Dr. Daniel Lewis, who was hospitalized for a month with COVID, outside his home in Greenville, Tenn., April 7, 2021. Lewis now speaks about the vaccine, visiting nursing homes, addressing churches, making videos. He honed his pitch to meet every pushback, from faux-scientific to conspiratorial to spiritual. (Erin Schaff/The New York Times) He scoffs at the perception that people here are vaccine-hesitant simply because they, like him, are Republicans.
“That doesn’t make sense to me,” he said. “Trump brought the vaccine in.” If this was about political affiliation, he continued, “you’d jump and take it!” Instead, he said, people think the vaccine is too entwined with politics.
In Appalachia, Cross explained, the fervor with which people sidestep the vaccine is ratcheted up by history and tradition. For centuries, Scots-Irish settlers tucked into the mountains to evade army conscription and tax collectors. Jeremy Faison, a longtime Republican state representative who grew up in the area, agrees: “Throughout the pandemic, there are a lot of us who are like, ‘It’s a serious situation, but me and my family can take care of ourselves.’”
Faison, a libertarian and an evangelical Christian, added, “So we take exception with the government putting mandates on us, pressuring us to do something.” That view is bolstered by a religious, near-joyous fatalism. People say that if they have not caught COVID a year into the pandemic, they will take their chances. True, they might get COVID and die. But either way, a win-win: longer life on Earth or, for the faithful, eternal life in Heaven.
“There’s a time appointed for every person to die,” said Reuben Smucker, a Mennonite pastor in Greeneville who works as a garage door installer. “We should take care of our bodies physically, emotionally and spiritually, but if it’s my time to go and it’s by COVID, well then, it’s my time to go.”
After Cross, an elder in a Seventh-day Adventist Church, counsels COVID patients, he prays with them. “That’s the most important thing,” he said. “Because it’s God who does the healing.”
Men pray during a Sunday service at the Old Fashion Gospel House in Bulls Gap, Tenn., April 11, 2021. Vaccination skepticism is most deeply entrenched in communities like Greene County in Eastern Tennessee -- rural, overwhelmingly white, Christian and Republican. But it's more complicated than just a partisan divide. (Erin Schaff/The New York Times)
A Topic Too Volatile So charged have the COVID shots become that many people have adopted a resigned silence. A vaccinated 20-something barista has given up trying to persuade her not-now, not-ever father. A retired postal worker just lets her doctor assume she has gotten the shots because he is a family friend. But she has not — and will not.
Mary Hayes, who drove into Greeneville for a reunion lunch with a large group of vaccinated friends, is accustomed to speaking her mind. But she has a moral quandary: should she advocate for the vaccine or keep quiet? She got the vaccine early because so many doses went unclaimed. In her remote corner of the county, people already look at her warily. “A lot of times I have to temper my opinions in order to fit in,” Hayes said, tears welling in her eyes. “I’m walking a line between people refusing to socialize with me or not.”
Hayes grew up here, left and returned to care for her mother. Late in 2019, while teaching English online to students in China, she noticed that some were disappearing from her computer monitor. They were succumbing to a mysterious virus. Morning customers at Tipton's Cafe in downtown Greeneville, Tenn., April 10, 2021. Vaccination skepticism is most deeply entrenched in communities like Greene County in Eastern Tennessee -- rural, overwhelmingly white, Christian and Republican. But it's more complicated than just a partisan divide. (Erin Schaff/The New York Times) Later, when her family went into lockdown, neighbors dismissed her fears.
“Appalachians were raised to believe they must work and can’t get sick, no matter what,” said Hayes, who has a graduate degree in Appalachian studies. She wept in frustration as familiar names appeared on her prayer chain, deathly ill from the virus.
On the door of her church, someone recently posted a newspaper letter. It derided COVID mask mandates, “the Prophet Fauci” and vaccines “made in part from aborted children.” The topic of the vaccine has even muted the most influential leaders in Greene County: evangelical pastors. There are many who have been vaccinated, like David Smith at Tusculum Baptist, but will not use the pulpit to support it. He does not want to risk alienating anyone, he explained, at a time when he hopes people will return to the church itself to worship. After a year of Zoom services, which people call “pajama church,” he fears in-person attendance will drop.
Daniel Shrader, who leads a small Baptist congregation, is all-in on the vaccine. He wants church to be safe for the older, hard-of-hearing ladies to whom he has been preaching during the pandemic by shouting from their porch steps. In conversation, he will share his vaccine views; in larger gatherings, he sticks to prayer. The pastors’ perspectives run the gamut. Smucker, the Mennonite pastor, believes that natural herd immunity — let the disease run its course — is a better path than vaccination. But he will not preach about it. Chelsea Daugherty’s father, a Free Will Baptist pastor, is unsure about getting vaccinated. Daugherty, a sophomore at Tusculum University who got the shot, said her father tells worshippers, “The Lord gave us common sense, so we’ve got to use it.” Make up your own mind.
So, which trusted person will speak for the vaccine? Eva Fields? She is a nurse practitioner who treated one of the first local patients to die from COVID. Greeneville-raised, she has 24 relatives who had the virus.
When she asks patients if they will get vaccinated, about half reply, “No, and I’m not going to.” Assuming she will be angry, they add, “I’m so sorry if that upsets you!” Fields responds, “That’s OK, honey. I’m not planning to, either.”
Her gut tells her to believe a video someone sent her from a far-right misinformation group, in which a ranter said studies showed that vaccines caused plaque in the brain. Like others here, she is suspicious of Bill Gates’ involvement in vaccine development. One evening at supper, Dr. Theo Hensley, a vaccine proponent in her office, retorted, “I don’t know Bill Gates, but I do know that Dolly Parton gave a million bucks.” (Parton is northeast Tennessee’s favorite daughter.)
“Well, she’s probably OK,” Fields allowed. “When someone pushes something really hard, I sit back because I don’t like people telling me, ‘This is what you need to do,’” Fields said. Echoing many others, she added, “I need to do my own research.” For now, she neither urges nor discourages patients to get the vaccine. Daniel Shrader, who leads a small Baptist congregation in Greeneville, Tenn., April 6, 2021. In conversation, he'll share his pro-vaccine views; in larger gatherings, he sticks to prayer. (Erin Schaff/The New York Times)
Persuasion The day the Fletchers, the retired couple, spoke about the vaccine with their family physician, Dr. Daniel Lewis, was the one-year anniversary of the day he was put on a ventilator with a severe case of COVID.
Lewis, 43, remained hospitalized for more than a month. He was so gravely ill that he recorded farewell messages for his five children.
Over his 13 years in Greeneville, Lewis, a volunteer physician for school sports teams and chief medical officer for four Ballad Health regional hospitals, accrued a wide community of support. During his illness, people dropped off meals and restaurant gift cards on his porch and kept up a surging prayer chain. They mowed his lawn, mulched his flower beds, fixed his truck.
When he left the hospital, 34 pounds thinner, weak and wobbly, he and his wife, devout Baptists, struggled to figure out God’s purpose behind the ordeal. Patients kept telling him, “I didn’t take COVID seriously until you got sick.” So Lewis began using that hard-earned credibility to speak about the vaccine, visiting nursing homes, addressing churches, making videos. He honed his pitch to meet every pushback, from faux-scientific to conspiratorial to spiritual.
Although many Appalachians used to resist seeing the doctor, family medicine practitioners like Lewis are becoming trusted figures. But discussing vaccines with patients takes time, which many doctors cannot afford, and an established relationship, which many poor patients do not have.
Lewis gives a soft sell that sometimes works. A patient will say, “So, are you going to give me the vaccine now?” He has to respond, “I don’t have it here.” The patient shuts down. “Then I’m not going to take it.”
Could Lewis persuade the Fletchers to get the vaccine? Jim Fletcher does not fret about long-term side effects. His prostate cancer has returned, one more blow in a Job-like year that saw the unexpected death of his younger son, a paraplegic, and the death of a nephew, an emergency room physician. A year in which dear friends severed their relationship with the Fletchers because of the couple’s COVID skepticism.
“When you get older, you think you have no more tears, but then something causes them to come back,” he said in a subdued voice. Lewis patiently addressed the Fletchers’ questions, delineating between what researchers do and do not yet know.
“How can we be sure there are no chips in the vaccine, like the things you put in your dog?” Jim Fletcher asked. Betty Smith and her husband David Smith, a Baptist pastor who is vaccinated but won't to use the pulpit to advocate for it, in Tusculum, Tenn., April 8, 2021. "Honestly, I wish people wouldn't ask," David Smith said. "I think it's none of their business. And it's just dividing people." (Erin Schaff/The New York Times) “We can’t make microchips that small,” Lewis countered. “Well, it’s like a grain of rice,” said Jim Fletcher. “I couldn’t inject a grain of rice with a needle,” Lewis said. Lewis held up his smartphone. If you are worried about being tracked, he said, all the technology is right here, in the very thing you pick up every day. Every hour. Get updates on the coronavirus pandemic and other news as it happens with our free breaking news email alerts. The Fletchers looked abashed. “It’s your decision,” Lewis said gently. “I just want you to be able to make an informed decision, and I want to do the best I can to help you.” Jim Fletcher replied, “Well, we have to spend some time in discussion.” Later, Lewis was optimistic: “I think I can eventually persuade them.” To date, the Fletchers say they will not take the vaccine. Have you received the COVID 19 Vaccine? Why? Why not?
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