ST. PAUL -- Minnesota health officials are increasingly worried that pockets of the state with low vaccination rates could become breeding grounds for coronavirus variants and lead to future COVID-19 outbreaks.

It’s likely already happening. A St. Paul Pioneer Press analysis of the rate of new cases and vaccinations in April and May found that counties with the lowest rate of vaccination had some of the highest numbers of new cases per capita.

More than 85% of new infections are believed to be caused by variants of the coronavirus that can be more contagious and cause more severe infections.

While it’s true that overall case numbers and hospitalizations have receded dramatically, to levels not seen since early in the pandemic, thanks to vaccines and warm weather that welcomed many outside activities.

But the coronavirus is still out there. It’s mutating. And it seeks out those who are most susceptible.

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“If we have pockets of the state where the virus is able to spread more easily and spin off additional variants possibly, that’s of concern to the whole population,” said Jan Malcolm, state health commissioner.

It’s a key reason why health officials are constantly pushing residents to get vaccinated in hopes to hit 70% of the 16-and-older population with at least one dose by the end of the month.

The pace of vaccinations has slowed to a point that it is unlikely the state will reach that goal.

“When we meet and exceed that 70% goal we are going to keep going,” Malcolm said. “We’ll strive to get as large a percent of the population vaccinated as possible because it does matter.”

Where rates are low

There are multiple parts of the state where health officials face challenges in their campaign to improve vaccination rates.

Rural counties have some of the most obvious low rates of vaccine uptake. Compared with the Twin Cities metro where rates already above 70%, rural Minnesota stands at roughly 57%.

There are 15 rural counties at or below 50% and Kanabec and Todd counties having the lowest rates in the state respectively.

It’s not just rural counties with low rates.

Anoka County has the lowest rate in the seven-county Twin Cities metro at about 58%, state data shows. It was also in the top 10 counties for rates of new infections per capita during April and May.

Jonelle Hubbard, director of Anoka County Public Health, said in a statement that coronavirus vaccination rates are higher there than what is typically seen for influenza vaccines.

Hubbard noted that the county has been successful reaching residents at the most risk with about 67% of residents 16 and older in communities with the highest social vulnerability index receiving at least one dose.

State health officials use the social vulnerability index, created from U.S. Census data, to understand the overall vulnerability of communities and target vaccination efforts.

Dr. Nathan Chomilo, who leads vaccine equity efforts for the state Department of Health, said while the state is having success reaching residents at highest risk, challenges remain. Gaps are found across Minnesota, including in the Twin Cities metro where vaccination rates are highest.

On average, residents living in communities with high social vulnerability scores are less likely to be vaccinated than their less vulnerable neighbors.

There are also racial disparities with Black, Native American, Hispanic and multi-racial residents having lower rates of vaccination than Asian and white residents, state data show.

“Our work really won’t be done until we reach deep into our communities to make sure they all have an opportunity to make the best decision to keep their communities safe,” Chomilo said of the state’s vaccine push.

Why there’s hesitancy

There’s myriad of reasons why Minnesotans are not getting vaccinated. Barriers to accessing vaccines remain, especially in high-risk communities, and there are some residents who are continuing to take a “wait-and-see” approach and will likely get their shot eventually.

But there are others who still don’t believe the risk. COVID-19 has sickened more than 600,000 Minnesotans since March 2020 and nearly 7,500 have died.

Nicole Ruhoff, public health manager for Sherburne County health and human services, said residents have voiced concerns about how quickly the vaccines were developed and that they have only received emergency authorization from the U.S. Food and Drug Administration. Sherburne County has one of the state’s lowest vaccination rates and one of the highest recent infection rates per capita.

Health officials in Minnesota and nationally have repeatedly said that no safety measures were overlooked during the approval process. Vaccines were available more quickly because former President Donald Trump’s administration paid pharmaceutical makers to conduct trials simultaneously that are typically done in a linear fashion.

Nevertheless, Sherburne County’s relatively low hospitalization and death rate has many residents forgoing vaccination.

“I think what we have heard is pretty typical. I’ve heard a lot about: ‘Is the vaccine better than just having COVID?'” Ruhoff said. “People are taking their risk on having COVID and hoping for the best.”

That attitude worries health care providers. People who catch COVID-19 can experience long-lasting effects, even if they had a mild initial infection.

“We try to counsel people that we don’t know how long your immunity will last after illness,” Marlee Morrison, public health director for CHI St. Joseph’s Health and Hubbard County. Just 47% of Hubbard County’s residents 16 and older have been vaccinated.

“Now with variants, you may be protected from the particular strain of COVID that you had, but that doesn’t necessarily mean you (are immune),” Morrison said. “We just try to provide good information to people.”

Politics at play

State leaders and public health officials don’t know for sure how much of a role misinformation and politics is playing in vaccine hesitancy, but they agree it is part of the reason.

Democratic Gov. Tim Walz has faced repeated criticism from Republicans for his handling of the pandemic and the restrictions he put in place to slow its spread. Walz said the mitigation measures were needed to save lives, but critics have characterized them as overly onerous and economically devastating.

Republicans in the state Legislature have voted nearly 20 times to end the governor’s emergency powers that have been in place for more than a year.

Walz acknowledged that the pandemic might not have seemed as dangerous in less populous parts of the state. But the impact has been real — rural counties have had some of the worst rates of infection and death per capita.

There’s ongoing efforts to “divide us,” Walz says, reflecting back on his “One Minnesota” campaign promise to govern the entire state equitably. He’s urged local leaders throughout the state to encourage their constituents to get vaccinated.

“I need some folks to step up,” Walz said. “There are folks who, if I say something, they’ll do the opposite. I need folks who are a trusted voice for them, to tell them to get vaccinated.”

There’s also a lot of misinformation circulating about vaccines. Health officials say that may be one of their biggest challenges to increasing vaccination rates.

“That’s been one of the biggest nemeses to public health, the less than reliable sources some people are looking at,” Morrison said.

Local public health officials have used mailers, media campaigns and other strategies to address misconceptions about vaccines that often begin on social media.

What’s being done

State officials say they’ll continue to push for residents to get vaccinated, even after the self-imposed July 1 deadline to hit 70% has passed.

The campaign will continue to be multi-facetted. Minnesota has used community sites and mobile vaccination clinics to reach into communities typically with limited access to health care.

The state is offering incentives, such as fishing licenses, tickets to attractions and gift cards, to the recently vaccinated. Some breweries and wineries are offering free or discounted drinks to patrons with vaccination cards.

And there’s ongoing efforts to connect with local community organizations — from churches to social service providers — to better understand where vaccine access and hesitancy needs to be addressed.

“They are the eyes and ears of the communities that they serve and have helped guide and facilitate outreach,” said Hubbard, of Anoka County health and human services. “Some of our most robust community clinics have been in communities with barriers.”

Walz said he’ll continue to use the platform he has as governor to encourage vaccination.

“I’m going to continue to push it,” Walz said. “We are continuing to offer it to them. We are going to offer incentives. Until the last person we could possible get to gets (vaccinated). We got more work to do.”