FARGO — Pop-up vaccination clinics in Walmart stores. Town halls to answer questions about vaccine effectiveness and safety. Trusted community leaders serving as vaccine champions.

These are among the steps public health officials are rolling out to overcome a major obstacle North Dakota confronts in controlling the spread of the coronavirus: vaccine hesitancy.

North Dakota, in fact, harbors one of the highest rates in the nation of vaccine hesitancy: 29% of the state’s residents are hesitant to take a vaccine to protect against COVID-19, including 19% who are very hesitant.

That reluctance stands in the way of the single most effective way to end the pandemic and restore life to normal — accepting vaccines that studies have shown are safe and highly effective in preventing illness from the virus, according to medical experts.

Only Wyoming has greater reservations about COVID-19 vaccines: 31% are hesitant, including 17% very hesitant, as measured in surveys by the Census Bureau and compiled by the Centers for Disease Control and Prevention.

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Minnesota, by comparison, is much more accepting of the vaccines, with 11% hesitant, and even South Dakota is less resistant than its sister state, with 22% hesitant, according to the surveys.

The North Dakota Department of Health has set a goal of vaccinating 70% of the state’s residents, the level medical experts believe is the minimum required to halt the spread of the virus by achieving herd immunity.

“We knew that was going to be a lofty goal,” said Molly Howell, North Dakota’s immunization director. “I think it’s going to take a bit of work, a bit of time.”

As the week wound to a close, the state was getting close to giving half of the population at least one dose.

Convenience and persuasion

This week North Dakota gave a “soft” launch to a $1 million education campaign called “Let’s get the vax together” to encourage residents to get the shot. But public health officials aren’t relying on ads and public service announcements alone to sway the reluctant.

The campaign to boost vaccination runs along two parallel tracks: convenience and persuasion.

Around the state, public health units and private providers are making it more convenient for people to get the jab, with expanded walk-in availability and efforts to bring the vaccines into primary care clinics.

Public health officials have experimented with pop-up vaccination clinics in Walmart stores in Bismarck and Mandan, and are encouraged by the results. On the first day, between 60 and 70 customers were vaccinated, said Kylie Hall, project coordinator for the Center of Immunization Research and Education at North Dakota State University.

Similar pop-up vaccination clinics will be conducted at Walmarts around the state on select dates, targeting busy periods, she said. “These little pop-up events, I think, are helpful,” Hall said.

Public health units statewide are working with employers, who can request vaccination clinics or vaccination education sessions in their workplaces to make getting a shot convenient for workers.

Another strategy will be to offer vaccines at large events and gatherings, such as sporting events and concerts.

Besides making it easy to get a shot, major efforts will be made to address concerns that prevent people from getting vaccinated.

To do that, public health officials are planning community talks in a variety of settings, including town halls and smaller groups, to give people the opportunity to hear from health experts about vaccine safety and effectiveness.

“We know from years of data that people trust their health care providers the most,” Hall said.

North Dakota was able to significantly increase uptake of the human papillomavirus vaccine by organizing teams of physicians who traveled around the state and briefed clinical providers, who in turn passed along the information to their patients.

A similar effort will be made to increase acceptance of COVID-19 vaccines, in tandem with sending speakers to address city councils, school boards and church councils in an effort to create vaccine acceptance “ripple effects,” Hall said.

Administering vaccinations in stores and at public events will help to “normalize” getting the jab, which will increase acceptance, said Carrie Anne Platt, an associate professor of communication at NDSU who has researched and published on overcoming vaccination hesitancy.

A conversational approach

People naturally have concerns about new vaccines for a new disease, Platt said. “It’s normal as a human to be fearful about stuff,” she said.

Health professionals should discuss those fears with their patients in a straightforward way, not treating concerns as silly, Platt said. “The most effective approach is a conversational one,” she said.

Dr. Richard Vetter, chief medical officer at Essentia Health in Fargo, said he asks unvaccinated patients what their concerns are and tries to answer questions about safety and effectiveness.

Unfortunately, he said, a lot of myths and pieces of misinformation are circulating on social media, and overcoming that is an ongoing challenge, Vetter said.

Many young women are worried the vaccines could impair their fertility, a myth without a shred of evidence, and some believe the vaccines track the location of those who have been injected, apparently because of photographs showing boxes of the vaccine with delivery tracking tags.

People trust those in their social circles, and that can be a problem if they’re exposed to false information, Platt said.

“We look to people around us for social norms,” she said. “Knowing which myths are circulating in a certain community is going to be very important for reaching a certain population.”

Those who were eager to get vaccinated have by and large gotten their shots. Now the challenge is to reach those who are not highly motivated or who have concerns, said Dr. Doug Griffin, chief medical officer at Sanford Health in Fargo.

“It’s a bit like technology,” he said, with “early adopters” and those who wait.

Sanford now accepts walk-ins at all times at the community vaccination center in the former Gordmans store in Fargo, and will be making the vaccine available in certain clinics.

Now that the vaccine supply pipeline is flowing, hesitancy looms as the primary challenge that must be overcome to control the pandemic, Griffin said. “I think we’re all struggling with it.”

North Dakotans, by their nature, are not always quick to follow what experts tell them, Vetter said.

“There’s an independent mindset in North Dakota,” he said, adding that health professionals maybe haven’t done a good enough job in explaining the vaccines’ high level of effectiveness and safety.

“I got my COVID-19 Vaccine” stickers. Forum News Service file photo
“I got my COVID-19 Vaccine” stickers. Forum News Service file photo

Youthful resistance

Much of the resistance is coming from younger people who believe they don’t need the vaccine. That’s not a safe assumption, Vetter said. Hospitals now are seeing more patients in their 20s, 30s and 40s, he said, and even those who have mild or asymptomatic cases can develop long-term symptoms, including chronic shortness of breath, fatigue, forgetfulness or heart palpitations.

The risk of developing those symptoms is much higher than having an adverse reaction to the vaccine, Vetter said.

Jason Jensen, a professor and executive director of the Institute of Policy and Business Analytics at the University of North Dakota, said surveys indicate high levels of vaccine hesitancy that will be hard to overcome.

A UND survey of 1,600 residents from Sept. 23 to Nov. 24 asked respondents to rank their likelihood of getting vaccinated on a scale of 1 to 10, with 1 “extremely unlikely” and 10 “extremely likely.”

The average response was 5.2, but the most frequent response was 1, “extremely unlikely,” at 27%, with 41% in the 1 to 4 response range, indicating significant reluctance, Jensen said.

The survey was done just as Pfizer was announcing its vaccine, and doesn’t reflect attitudes months after vaccines have been available.

That level of hesitancy means officials will have a tough time vaccinating 70% of the population.

Those who shun the vaccine are not only exposing themselves to unnecessary risk, but they also place others at risk, including elderly relatives or those who have compromised immune systems, Hall said.

“If you aren’t choosing to get vaccinated, you are choosing to get COVID,” she said. “If you’ve already had it, you might get it again.” If unvaccinated, “You could be that link in the chain leading to someone getting sick.”

By getting vaccinated, Hall said, “You can be that spot where the virus can’t go any further.”