How 4 of the US’s most vaccinated counties got shots to more than 70% of their residents

Seattle covid-19 vaccine
Worker Scott Zorn holds up a sign to signal an open station at a community vaccination site in Seattle, Washington, on March 13, 2021. Jason Redmond/AFP/Getty Images
  • Officials from four of the US’s most vaccinated counties share their recipes for success.
  • They cite two factors: Residents had easy access to shots and heard about vaccines from trusted sources.
  • Those counties – in Maryland, Pennsylvania, Wisconsin, and Washington – have vaccinated at least 70% of residents.
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In July 2020, health officials in King County, Washington, gathered to discuss a plan for administering coronavirus vaccines – five months before the shots would become available.

At the time, the group didn’t know how many doses the county would get, how many shots would be needed per person, or the temperature requirements for storage. But they did know one thing: The southern part of the county would be hardest to vaccinate.

That area is home to a high concentration of low-income residents, people of color, and people with limited English proficiency – all groups who have been disproportionately hit by the pandemic. Even before 2020, the life expectancy of South King County residents was 10 years lower than among people in North and East King County, due to factors like poverty, obesity, and access to healthy food.

“We knew that our role as public health would be to work with our health-system partners to make sure that vaccine was accessible across King County, but with a special focus on the residents of South King County,” Libby Page, the county’s immunization program director, told Insider.

The county decided to station high-volume vaccination sites in two southern cities, Kent and Auburn. It also dispatched mobile clinics to reach people who couldn’t drive to get shots or afford to take time off work. And it enlisted a team of “community navigators” – people from diverse backgrounds who could educate their neighbors about the vaccine.

The efforts paid off: King County, which includes Seattle, now has one of the highest vaccination rates in the US. More than 71% of the county’s nearly 2.3 million residents have received at least one dose.

Insider spoke with public-health officials in three other counties with even higher vaccination rates – Montgomery County, Pennsylvania; Montgomery County, Maryland; and Dane County, Wisconsin – to find out what has worked so well.

Like Page, those officials credit their success, in part, to efforts to offer residents vaccines near their homes and ensure that people hear about the shots from trusted sources like neighbors, religious leaders, or non-English-speaking media outlets.

In Dane County, where 72% of residents there have gotten at least one dose, mobile clinics went to the same neighborhoods again and again.

“It’s never our job to convince people to get vaccinated,” Tess Ellens, Dane County’s immunization coordinator, told Insider. “It’s to keep showing up and provide reliable information. If you continue to show up, that will eventually build the relationship for people to trust you to get vaccinated.”

Bringing vaccines to the most vulnerable communities

Maryland vaccine clinic
A mobile coronavirus vaccination clinic in Wheaton, Maryland, on May 21, 2021. Chip Somodevilla/Getty Images

Just because shots are available doesn’t mean they’re easily accessible.

In Montgomery County, Maryland – where 76% of residents have received at least one dose – public-health officers made sure that wealthier communities didn’t “gobble up all of the doses,” Travis Gayles, the county’s chief of public-health services, told Insider.

The county set up large-scale vaccination sites at schools and recreation centers near the ZIP codes with the highest levels of coronavirus transmission. It also made sure those sites were located by bus stops and metro stations.

“Folks were saying it was unfair that we were giving some weight to certain ZIP codes,” Gayles said. However, he added, “there was significantly higher COVID-related fatalities in one ZIP code versus another.”

Other successful counties relied on mobile clinics to bring shots to schools, churches, long-term care facilities, homeless shelters, and low-income housing. Since April, Dane County has dispatched more than 60 such clinics.

“We really need to meet people where they’re at,” Ellens said. “Being with people in their communities, near their homes – we’re catching a lot of folks to get vaccinated that way.”

These four counties, however, have another factor on their side. They lean Democratic, which is correlated with lower vaccine hesitancy. In an average US county that voted for Donald Trump, 34% of people are fully vaccinated – whereas 45% of people are fully vaccinated in an average county that voted for Joe Biden, according to data collected by The New York Times.

Jones County, North Carolina, for instance, is largely Republican. Just 40% of residents there have received at least one dose. The county health department canceled its mass vaccination sites due to lack of interest, a local nursing supervisor told ABC12. Advertisements for vaccines haven’t seemed to work, either, nor has the state’s offer to enter vaccinated people in a $1 million lottery. (Boston University researchers recently found that lottery incentives don’t increase vaccination rates.)

Trusted messengers can convince people

Seattle covid vaccine
Byron Saunders holds his wife Joyce’s hand as she gets the Pfizer COVID-19 vaccine in Seattle, Washington, on March 13, 2021. Jason Redmond/AFP/Getty Images

Dane County officials were careful not to be too pushy about vaccines at mobile clinics.

“Even if we don’t vaccinate anybody on [a given] day, we’ll keep going back because we feel like those conversations are more important than us feeling like we’re checking a box or something that looks good on a report or flyer,” Ellens said.

But in some cases, she added, a single conversation can be enough.

“Once people vent some of their fears and frustrations, it’s really helpful to get to a point of like, ‘Hey, we can actually work through some of these,'” Ellens said. “Several people within our homeless community in Dane County have chosen to receive vaccines now because of this continued presence at where they live and work and play.”

Still, public-health officials have found that many people prefer to hear about vaccines from those who speak their language or live in their communities.

“We recognize that in some communities there’s not trust of government, and we’re not going to be the appropriate messenger to counter that information,” Page said.

So public-health officials in King County worked with non-profits like the Somali Health Board to help vaccinate immigrants and refugees. Montgomery County, Maryland, partnered with health programs that focus on minority groups to organize community clinics. In Montgomery County, Pennsylvania, volunteers are asked to inform friends, family, neighbors, or social networks about the importance of getting vaccinated.

But none of these four counties is celebrating yet. All remain focused on getting more shots into arms.

“There are people that will not be vaccinated because they just don’t want to be vaccinated,” Janet Panning, the interim public-health administrator in Montgomery County, Pennsylvania, said. “There are also people that are still on the fence, and those are the ones that we’re reaching out to right now.”