Even though Mary Helen Wissinger has been fully vaccinated against COVID-19 since the spring, she avoids indoor dining and going inside public spaces when they appear crowded or the parking lot seems full.
The 67-year-old volunteer church secretary is still social distancing to some degree, choosing curbside pickup at big-box stores and takeout at restaurants.
“I just try to be overly careful,” she said. “Even though I’ve been vaccinated and I should be OK.”
Wissinger lives in Cairo, the southernmost city in Illinois and the seat of the county with the lowest coronavirus vaccination rate in the state.
Roughly 15% of the population of Alexander County is fully vaccinated, far lower than the near 50% statewide, according to Illinois Department of Public Health statistics.
Wissinger said the low uptake isn’t due to lack of access or availability: Vaccine has been abundant at mass vaccination sites and clinics for months. She received her shots in town and believes most of her friends, relatives and members of her small parish at St. Patrick Catholic Church in Cairo have also been immunized.
“You can walk in and get one,” she said. “I would have gotten mine earlier if it had been available. But that’s just me, that’s not everybody, obviously.”
As the nation battles a surge in COVID cases in predominantly unvaccinated parts of the country, some public health experts worry about sections of Illinois with particularly low vaccination rates, which are at risk for outbreaks and pose a challenge to herd immunity.
While Alexander County’s vaccination numbers are strikingly low, other counties in southern and western swaths of the Illinois also fall well below the state average.
In Fayette, Hamilton, Henderson, Pope and Pulaski counties, fewer than a quarter of people are fully vaccinated. In about two dozen counties statewide, less than a third of all residents have been immunized.
The numbers in these largely rural, less-populated areas are in stark contrast to the Chicago area, where more than half of residents are fully vaccinated in the city, suburban Cook and the collar counties.
In southern Illinois, home to some of the least-vaccinated areas in the state by population, the number of COVID cases has been already been creeping up.
The Southern Seven Health Department — which serves Alexander County and a half-dozen others on the state’s southern tip — reported 11 coronavirus cases in the week ending June 25; the following week, just before the July 4 weekend, the public health department reported 40 cases.
“We definitely started sounding some warning bells,” said Nathan Ryder, community outreach coordinator for the health department.
He points to the recent spike in cases in neighboring Missouri, just over the Mississippi River from Alexander County, as an ominous warning.
Overwhelmed hospitals in the southwest section of the state have sent COVID-19 patients to St. Louis and Kansas City. Caseloads and hospitalizations in the Ozarks area have reached levels unseen since the winter, largely driven by the highly infectious delta variant of the virus first found in India.
“There’s definitely cause for concern, especially with the lack of individuals getting themselves vaccinated here in the southern region,” Ryder said. “What’s going on in southern Missouri is not a pretty situation. We’re just coming out of a bad situation in Illinois. Things are looking good. Though we could very easily slip backward on the slope and go back to where we were in November and December. And we do not want to be there. I don’t think anyone wants to go through that experience again.”
One Alexander County resident said she doesn’t have a compelling reason to get immunized against the new coronavirus.
“I decided not to,” said the woman, who wanted to remain anonymous. “I put some thought in it. It was kind of obvious to me. I’m not too concerned. I’m pretty healthy.”
She works at a local grocery store in Olive Branch, an unincorporated area of about 500 residents. While she knows a few people who caught COVID-19, their cases weren’t severe.
To her, the vaccines seemed to come out very quickly; even though research shows the shots are safe and effective, the young woman feared side effects or long-term health consequences. She added that she feels safer from the virus because she lives in a small, less-dense area as opposed to a crowded city — although COVID-19 has hit urban regions and rural communities alike.
“Because we live in a very open place,” she said. “It’s pretty country. Houses aren’t close together.”
When vaccines came out in December, the Southern Seven Health Department had a waitlist of 7,000 names eager to get the shot, Ryder said. The health department covers about 69,000 residents spread out across 2,000 square miles, roughly the size of Delaware.
At first, six nurses were trying to vaccinate residents in seven counties. Then two Illinois National Guard teams came to help in March, and the health department was at times vaccinating 140 people in a two-hour period, Ryder said.
Vaccine was available at pop-up clinics, mass vaccination sites and health department clinic offices, he said. A Wellness on Wheels mobile clinic went from county to county each day, offering vaccine.
But by about mid-April, demand seemed to dry up.
“Then it was like crickets after that,” he said. “It was like the faucet was turned off at that point.”
When vaccine rollout began in the winter, the health department polled residents from the seven-county area about their intentions to get vaccinated. The results weren’t promising: About 60% of respondents said they weren’t interested in getting the shot, Ryder said.
Some seemed on the fence, expressing vaccine hesitancy or a desire to wait until more people got the shot first. Others were more set in their ways.
“They weren’t going to be told to get the vaccine,” Ryder said. “They didn’t think it was necessary to get one. And that’s a hard mentality to work with. That puts you in the position of trying to lead a horse to water and making it drink. You can lead the horse to the water, but you can’t make it drink the water.”
Matt Sullivan, 46, of Cairo said he refuses to get a COVID-19 vaccine, referring to it as “the government implant device shot.”
“They ain’t trackin’ me with a radio implant device disguised as the miracle cure to the COVIDs,” he said. “I read about this in high school in an Orwell novel. No thank you, ma’am. They’re gonna have to get smarter than that to trick me.”
This tracking device myth was among the conspiracy theories surrounding COVID-19 vaccines that Illinois public health Director Dr. Ngozi Ezike addressed and dispelled at a May virtual town hall on COVID-19 for southern Illinois.
“We really have to get away from the misinformation that’s costing us our lives, literally,” she said. “Because everyone has access to this vaccine, right now. There is a pharmacy near you. There’s a mass vaccination site. There’s a pop-up clinic. There’s a religious institution. … There’s something within a few miles of everyone. And to pass it up, unfortunately, and get COVID thereafter and not have a favorable course, it’s really a tragedy.”
At the confluence of the Mississippi and Ohio rivers, Alexander County borders Missouri and Kentucky, another state where COVID cases have recently spiked.
Nearly a quarter of Alexander County’s 5,760 residents live in poverty and it is among the poorest counties in the state, according recent census figures. Almost 8% of those under 65 have no health insurance; only about 65% of households have a computer, compared with 89% of households in Cook County, according to the census.
Poverty, lack of insurance and less access to computers have been factors linked to lower vaccine uptake or intent to get the shot, according to Centers for Disease Control and Prevention research.
The area also skews conservative politically, with nearly 57% of Alexander County voting for Donald Trump in the 2020 election. Research has found that COVID-19 vaccine hesitancy tends to be high among those who identify as Republican.
Other counties covered by the Southern Seven Health Department have higher vaccination rates than Alexander County, though still below the state average.
Nearly 38% of neighboring Union County and just over 33% of nearby Johnson County is fully vaccinated, according to state statistics. Those counties have larger populations than Alexander County; they’ve also had higher COVID-19 case counts and deaths, Ryder said.
He added that the vaccination percentage in Alexander County might be a little higher than Illinois statistics indicate because some residents likely got immunized in adjacent Missouri, particularly in the nearby Cape Girardeau area.
Missouri public health data shows more than 23,500 Illinois residents have received either the one-dose Johnson & Johnson shot or the first shot of a two-dose vaccine regimen in Missouri; more than 1,600 Illinois residents did so in Cape Girardeau County. But none of the data is broken down by the Illinois county where the patient lives, so it’s unclear how many might have gone to Missouri from Alexander County.
One resident who traveled to Missouri for the shot was Joe Aden, 81, who had served for 40 years as mayor of East Cape Girardeau, Illinois.
He got two doses of the Moderna vaccine in Cape Girardeau, Missouri, about a half-mile from his home.
“I just think it protects you from the virus as much as can be,” said Aden, who stepped down as mayor earlier this year.
There were indications that vaccine hesitancy would be a hurdle in southern Illinois even before the shots were available, Ryder said.
Social distancing and adherence to pandemic protocols was spotty, he said. There were areas were masking rules were followed and there were places where the guidelines were largely ignored.
He recalled going grocery shopping at the height of the pandemic in Pope County, where he lives.
“I would put my mask on and I would get strange stares from everyone else in the store, because they weren’t wearing masks,” he said. “We’re talking January, February. People were just wandering without a mask on. That was something you could see all across the region.”
Some restaurants and bars remained open, flouting the state executive order, he recalled.
“So we knew just based on the demographics and makeup of the area, and just the response that was being put out there during the pandemic, that vaccines were, that was going to be a difficult process,” he said.
Despite the low vaccination rate in the region, hair stylist Angie Bell said she feels pretty well-protected.
The owner of Hair Works in Cairo got her Moderna shots earlier this year. She continues to mask at work for her own safety and to put customers at ease, because some are still leery of the virus.
Bell estimated that about three-quarters of her patrons are vaccinated but noted that they come from all over the area, including Missouri, Kentucky and other counties in Illinois.
She said the remaining quarter either fear side effects from the vaccine or equate the shots with some form of government control.
“I get some really bizarre stories,” she said. “I’m a vaccine believer myself and I was not scared of it. I felt lucky to get one.”