COLFAX — Mike Campbell wasn’t particularly interested in getting the vaccine. 

He’s lived in this central Louisiana town of 2,500 his whole life, and he doesn’t feel obligated to take many precautions. He’s not around people much, except for when he goes offshore for work as an explosion technician on oil rigs. Campbell, 56, reasons that he hasn’t caught COVID-19 yet, and when his father did, he only had the symptoms of a mild cold, despite only having one lung.

He is annoyed that the government is pressuring people like him to get vaccinated. “I just don’t like anybody forcing me to do something,” Campbell said.

But there he was, climbing out of his truck on a sweltering Friday into the parking lot of the Grant Parish health unit in Colfax. He donned a blue surgical mask and ambled into the nondescript building where a nurse and some National Guard troops were giving out free shots.

Campbell’s company had given him a choice: get vaccinated or quarantine for five days before leaving for a job. Miller relented. Getting the shot beat jumping through those hoops.

By now, eight months after vaccines became available, health leaders hoped the U.S. would have achieved something close to herd immunity. But the effort has been anything but a success in Louisiana. Getting shots in arms is still maddeningly difficult for health leaders. And in some rural areas, the vaccination rates are stunningly low.

In Grant Parish, for instance, only 24% of the roughly 22,000 residents are fully vaccinated, the third-lowest rate in the state. And that’s after the region saw a notable recent uptick in vaccinations, prompted by the delta variant’s rapid spread, which took the pandemic to never-before-seen levels of hospitalizations in Louisiana.

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Louisiana’s vaccination rate is now just under 40%, well above Grant Parish, but well below the U.S. as a whole, where nearly 52% of people are fully vaccinated.

Residents and experts cite a variety of reasons for the low vaccination rate. Many rural areas include some of the most conservative White voters in Louisiana, the demographic group that tends to be most resistant to the shots. Low education levels can help online misinformation take deep root, and a lack of internet access can make finding an appointment difficult. Some say they don’t feel like the virus is a threat because they hardly ever gather in large groups, aside from church services or high school football games.

“Some people probably don’t want to be told; they want to have a choice,” said Don Arnold, the president of the Grant Parish Police Jury, who is vaccinated. “There could be a price to pay for that.”

A vaccination gap

Rural Louisianans do have a choice, of course, and most have chosen not to get the shots.

Vaccination rates in Louisiana’s urban and suburban areas — where about five-sixths of the state’s residents live — are an average of 25% higher than in the state’s rural areas.

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The gap in vaccination rates appears to have had tragic consequences for rural areas since the shots first began rolling out at the beginning of the year, though it remains too early to know exactly how that trend will play out in the devastating fourth wave now gripping the state.

Since January, the death rate in rural parishes has been more than a third higher than in the more densely populated areas of the state.

So far, the divide during the fourth wave — which started at the beginning of July — is not as clear cut, and rural parishes are actually faring slightly better with 559 deaths per 100,000 residents. Urban areas, which saw their cases spike earlier in this wave and thus have seen more deaths so far, have recorded about 637 fatalities per 100,000. It remains to be seen whether, in the final tally, rural areas will again see more severe outcomes from the current surge.

Colfax is a majority-Black town that is perhaps best known for a massacre of at least 60 and as many as 150 Black people in 1873 that represented the bloodiest single episode of Reconstruction. The state of Louisiana helped whitewash the “Colfax Riot” with a racist historical marker that was recently removed. The town is the seat of Grant Parish, which is mostly White.

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Farms dot the town’s perimeter, and the woods that ring the area are broken in parts by logging operations. “Save Colfax Elementary” signs dot several lawns, harking back to a debate this spring over whether to shutter the school because of declining enrollment and storm damage.

Like many rural places in central and north Louisiana, Colfax is economically troubled. Nearly half the population is in poverty, more than double the statewide rate. Median household income is $22,000, about half the amount in the rest of the state. Only 11% of residents have a bachelor’s degree.

Those economic ills have major implications for health care.

Dr. David Holcombe, the state’s medical director for the region that includes Grant Parish, said the region has historically had poor health outcomes, owing to low incomes, low educational levels and high rates of poverty.

That has made it hard for state health leaders to convince people of the vaccines’ efficacy and safety by promoting the overwhelming consensus of the medical community, and data.

“It makes them very resistant to intellectual argumentation,” Holcombe said. “Because most of the fears and anxieties are emotional.”

The more rural places, in particular, reached a point of diminishing returns pretty early in the vaccination effort. Delta has changed that somewhat, resetting the “anxiety level” as people saw more friends, neighbors and kids come down with COVID, he said.

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Still, the uptick hasn’t moved the needle nearly enough. Holcombe said while people who live in more isolated, rural areas like Grant Parish tend to have fewer interactions, it doesn’t take many big gatherings — whether a sporting event or a religious service — to spread the Delta variant, which is far more transmissible than previous iterations of COVID. He worries the only way some rural places will ever get close to herd immunity is if the virus runs wild and infects most of the unvaccinated population.

“The tragedy is you don’t have to do that,” Holcombe said. “You don’t have to let people get sick to achieve herd immunity.”

'A lot of fertile ground'

Stephanie Bruce, who lives in Dry Prong, outside of Colfax, drove her Sheriff’s Office vehicle to the health unit Friday to finally get her first shot. A deputy for the last eight years, Bruce said she was scared of the vaccine because she thought it was too new, even though she isn’t generally opposed to vaccines. Delta’s surge finally tipped the scales.

“It’s definitely spreading like wildfire now,” she said.

Bre Felton, a day care worker who lives in Colfax, said she was exposed to the virus at a recent kids’ birthday party where the child’s dad and sister tested positive. Felton still doesn’t plan to get vaccinated, though many of her family members have relented.

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“I’m concerned, but I don’t have any underlying health issues, so if I get it, I think I’d be OK,” Felton said. “I have trust in God.”

Bobby Morrow, 67, retired to Colfax — a “nice, quiet, peaceful place” — a few years ago with his wife, Karen. Morrow said he “didn’t have any real legitimate excuse” not to get vaccinated, other than the fact he doesn’t go out much. But the Veterans Administration convinced him to get the shot, and his wife’s son, a nurse, convinced her to get it.

They don’t ask their friends if they’ve been vaccinated, and Karen said she still social-distances at church. An unvaccinated friend of theirs is now “fighting for his life” in the hospital with COVID-19, she said.

The hospitals in the region are crowded with patients and are running into the same dire problems as facilities in Baton Rouge and New Orleans.

At Christus St. Frances Cabrini Hospital in Alexandria, a half-hour southeast of Colfax, Chief Medical Officer Dr. Jose Zapatero said he’s had to refuse transfers from smaller rural hospitals because he doesn’t have the bed space.

The positivity rate of tests at the hospital has soared from 3% in early July to 36% last week, Zapatero said. Nearly 90% of COVID patients in the hospital are unvaccinated, he said.

“There’s a lot of fertile ground for this virus to take off,” he said.

A raft of challenges

Lana Francis, the CEO of LaSalle General Hospital, next door to Grant Parish, said she has struggled to keep enough staff on hand because so many employees are infected. The hospital has started sending sicker patients to Texas, Arkansas and Mississippi.

The latest surge of the pandemic has created huge challenges for some rural schools. A little more than a week after school started, around 240 of Winn Parish’s 2,000 students were in quarantine, said Al Simmons, the superintendent. An entire sixth grade class was in quarantine.

Simmons hopes schools can stay open for in-person learning because the students need it. But he also noted: “We are doing distance learning when you consider how many students are in quarantine right now.”

Sharing the same building as the state health unit for Grant Parish is a federal health center that offers similar services, including vaccinations and testing. The center didn’t have any vaccines scheduled Friday, but was offering drive-through testing.

Ken Humbels, a delivery driver for the state’s vaccine distributor, Morris & Dickson, pulled up and carried a large white styrofoam box labeled “vaccines” inside. He opened it to reveal a single vial of vaccines: 14 doses. Rachel Wise, the site manager, said they’d use them next week, mainly on adolescents.

Deano Thornton, who runs federal health centers in other rural parishes, said he’s seeing a slight increase in vaccine requests, after “hardly anyone” sought them in June and July.

His board recently met to establish new protocols, requiring employees to get tested once a week if they’re not vaccinated, and to test daily if they’ve been exposed. But he said he’s already short of employees, and worried that if the centers mandate the vaccine, many workers will quit.

Thornton said health workers are “tired” after 18 months of the pandemic. Transmission in rural areas is primarily driven by schools and churches, Thornton said, and schools were largely online last year. With in-person learning, he worries the virus will run rampant.

“Our fate’s in our own hands, it looks like to me,” Thornton said. “We can lead them to water, but we can’t make them drink.”

Staff writer Jeff Adelson contributed to this story.

Editor's note: This story was changed on Aug. 23 to correct the estimated death toll in the Colfax massacre.

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