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Rural Tennessee’s Vaccine Hesitators

Hosted by Astead W. Herndon; produced by Asthaa Chaturvedi and Austin Mitchell; edited by Dave Shaw; and engineered by Chris Wood.

White Republican evangelical Christians remain disproportionately mistrustful about coronavirus inoculations. Here’s what that looks like in one community.

michael barbaro

From The New York Times, I’m Michael Barbaro. This is The Daily.

[music]

On Friday, I spoke with my colleague Apoorva Mandavilli about the growing consensus that herd immunity is no longer achievable in the United States. A major reason why is vaccine hesitancy. Today: What that hesitancy looks like inside a single community. Astead Herndon spoke with our colleague Jan Hoffman about her reporting in rural Tennessee.

It’s Monday, May 10.

astead herndon

Jan, tell me about your reporting on vaccines over the course of this pandemic.

jan hoffman

I focused mostly on vaccine hesitancy. In the early months of vaccine development and then the eventual rollout, the concern really had to do with people in Black and Latino communities because of their historic maltreatment on the part of medical researchers and, frankly, the healthcare system. But as the months have continued, because of the efforts of leaders in the Black community, the Latino community, among medical professionals in those communities and also religious figures in those communities, hesitation has decreased in those communities, although it’s still present. And surveys showed that the hesitation remained firmest in people who describe themselves variously as Republican, white, and/or evangelical Christian, and who tend to live in rural communities.

astead herndon

So in your focus on vaccination efforts across demographic groups, you’ve zeroed in on these white conservative communities partly because they’re the firmest or steadiest holdouts that we’ve seen so far.

jan hoffman

Absolutely. And I really wanted to understand what was underlying it.

astead herndon

So what did you do?

jan hoffman

I went a few weeks ago to Greenville, Tennessee, a little town of 15,000 in a very rural community in northeastern Tennessee. It had been hit very hard by Covid, particularly this winter. More trucks were opened in the parking lots of the medical center. And they were considering opening a special second Covid unit in that hospital. And today, Greene County, of which Greenville is the county seat, has a vaccine rate of about 31 percent for adults who’ve gotten at least one shot, compared to the national rate of 56 percent.

astead herndon

Wow.

jan hoffman

So in a community like Greenville, if there isn’t sufficient vaccination, Covid will keep coming round and round and round.

astead herndon

What kind of conversations are people in Greenville having about vaccines? What did you find in your reporting?

jan hoffman

You know, I found that a lot of people had gotten tired of talking about it. I met innumerable people who’d had squabbles and fights in their families. A father was not going to get it, a daughter was. I met an older woman whose husband has multiple myeloma, who had to say to her adult children, if you don’t get the vaccine, you cannot visit your father, even though he’s dying of cancer. And yet, they have refused to get the vaccine.

michael barbaro

Wow.

jan hoffman

So, it’s become basically a painful and silent point of contention, because people feel that there is nothing they can do to change each other’s minds. And studies show that the most effective way to change someone’s mind is by having that person talk with an authority figure whom they know and trust. So what’s particularly difficult is the very complicated position of the pastors in the community. They have a broad range of views about the vaccine. But for the most part, they have chosen not to use their pulpits as a place to speak about their positions. Because they feel, for both religious reasons and for reasons that have to do with the ethos of the community — which is very much you get to make your own decision — that they are not going to speak out about this particular issue. This is not where they’re going to plant their flag. And yet, they are among the most trusted people in the community.

astead herndon

As you say, the pastor is a trusted figure who could talk and sway maybe hesitant people. Are there other figures who are working to do that in places like Greenville?

jan hoffman

Certainly. The family physician, the primary care provider is the quintessential trusted figure on all things health and medical. And I met a number of physicians who are trying very hard.

jan hoffman

So you’re the head of the family medicine clinic.

dr. daniel lewis

No, I’m the chief medical officer for Greenville and three other hospitals in the [INAUDIBLE] system.

jan hoffman

Specifically, Dr. Daniel Lewis, who’s a family medicine physician.

dr. daniel lewis

I grew up in Northeast Tennessee in Carter County.

jan hoffman

Dr. Lewis is 43 years old, has five kids. He’s a devout Baptist.

dr. daniel lewis

I’m sports medicine trained, so yeah, all the athletic trainers and —

jan hoffman

He’s the sports doctor for Lord knows how many teams at the high school and is very much a figure in the community. But he gained an extraordinary amount of gravitas about a year ago this spring when he himself had his own very serious Covid experience.

[music]

astead herndon

And what was that like?

jan hoffman

He told me that —

dr. daniel lewis

One of our team members began to cough. And we kind of jokingly said, so, have you got Covid? And he goes, no, it’s allergies or whatever else.

jan hoffman

— he had been exposed to the virus by a colleague, who, at the time, did not know that he was positive.

dr. daniel lewis

And so he came back positive. And then I developed symptoms, began to feel a little short breath, sat down and said, not a physician heal thyself situation. I need to defer to somebody else. And I’m not objective enough. So I called my boss. I said, I’m going to the hospital to get checked out.

jan hoffman

And while he was at the hospital, it became harder and harder for him to breathe. His oxygen saturation levels dropped. And his condition became truly dire.

dr. daniel lewis

I recorded voice memos for my kids on the phone in case I didn’t come back.

jan hoffman

Did they think there was a chance that you could die?

dr. daniel lewis

Oh, absolutely. Absolutely.

jan hoffman

He posted a loving and very painful message to his community on Facebook —

dr. daniel lewis

I made a Facebook post at that time that said, I’m going to go on the ventilator. I’m OK. Everything will be fine. God’s in charge. And I’ll see you all on the other side.

jan hoffman

— hours before the decision was made to put him on a ventilator.

astead herndon

In anticipation of his possible passing?

jan hoffman

Yes.

astead herndon

Wow.

jan hoffman

Yes. When he was sick, as a measure of how much this community loves him, they would drop off meals on his front porch for the family, restaurant gift cards. They mulched his flower beds. They fixed his truck, anything to give back to him.

dr. daniel lewis

The community and the area wrapped its arms around me in a way that was just amazing. I can never repay them for that.

[music]

jan hoffman

He ended up staying in the hospital for over a month when he finally was released and went home.

archived recording (dr. daniel lewis)

Hey, everybody. So this is clearly outside my comfort zone.

jan hoffman

He made an extended video that he posted on Facebook —

archived recording (dr. daniel lewis)

The story actually starts in early March.

jan hoffman

— narrating his experiences.

archived recording (dr. daniel lewis)

I was one of the 15 percent that required hospitalization. I became one of the 5 percent that required ventilation and a ventilator.

jan hoffman

He really wanted patients — his own patients and the community at large — to understand what a grueling and terrifying experience it could be for them.

archived recording (dr. daniel lewis)

But please, as you go out and go about your daily activities, do all you can to protect yourself from this virus. Do all you can to protect others from this virus. Thanks for taking the time to watch this video. I hope it’s been helpful. Hit me up with any questions. And again, thanks and love you all.

jan hoffman

The video went viral.

archived recording

This doctor in Greenville is finally back to work after spending six weeks in the hospital sick with Covid-19.

jan hoffman

Local news came to his doorstep. National news figures picked up on it.

archived recording

Tonight, a blessing and a curse. That’s how my next guest describes his experience as a doctor in —

jan hoffman

The video and his experiences really helped cement his presence in the community as someone who had absolute authority to speak about this experience and why it should be avoided at all costs.

dr. daniel lewis

At that point, I began to think, OK, so how can this story be used? What is the purpose of this? And again, a lot of questions, from the faith perspective, why did I go through this?

jan hoffman

He and his wife prayed about why God had put him through such an ordeal.

dr. daniel lewis

And then I realized just that people were listening and that I had influence. And so, you know — and that was maybe the purpose of this whole thing.

jan hoffman

And he told me that he realized it was truly his mission to advise patients about how to take their own precautions and to counsel them about getting the vaccine.

dr. daniel lewis

So if you really want to protect your neighbors and your community, we need everyone that will take the shot to get a shot. Because the sooner we get to that 70 percent —

astead herndon

So here’s a doctor, Dr. Lewis, in a unique position in this community. Not only as a trusted physician, but as someone who can speak personally to what it’s like to be sick, very sick, from the virus. And he has decided that it is now his mission to use that position to encourage others in this community to take both virus and vaccine seriously.

jan hoffman

Absolutely.

astead herndon

When you talk to Dr. Lewis, what does he say comes up in these conversations he is having with residents of Greenville?

jan hoffman

This, I think, really gets to the heart of the issue. People have many different questions and reasons for not wanting the vaccine.

dr. daniel lewis

So the biggest argument I get is, it was just too quick. It was just too much too fast. How did this happen?

jan hoffman

The primary concern most people have is they feel it was developed far too quickly. And that makes them uneasy. I mean, the very title Operation Warp Speed reinforces that point of view. They are expressing religious concerns. They have heard that the vaccine was developed from stem cells from aborted fetuses. This is fundamentally not true.

dr. daniel lewis

But the land is more libertarian and anti-government. I feel like it’s more their assault on their individual freedom.

jan hoffman

They have also soaked up a great deal of misinformation from far right sources.

dr. daniel lewis

I’ve said to more than one person, I don’t need to put a chip in to track you. Bill Gates doesn’t have to chip you if he wants to track you.

jan hoffman

So that you will hear people ask about the conspiracy theory that Bill Gates has put microchips in the vaccines to track anyone who’s gotten them, which is patently false.

dr. daniel lewis

But yeah, there is that fear. There’s —

jan hoffman

But there are plenty of people who are still concerned about that.

astead herndon

Hm. So that seems like a mountain of concerns for Dr. Lewis to address. How does he do that?

jan hoffman

He talks to them one on one. He has conversations easily three or four times a day every time a patient walks into his office for a consultation. And he opens that door to them and says, what are your thoughts about the vaccine? And Dr. Lewis, as well as the patient and the patient’s wife, allowed me to sit in during one such consultation, where the couple really expressed their concerns about the vaccine. And Dr. Lewis attempted to answer them.

[music]

michael barbaro

We’ll be right back.

astead herndon

So Jan, you got the opportunity to sit in Dr. Lewis’s office while he was talking to people who were not sure whether they wanted to get vaccinated or not. What happened in that room?

jan hoffman

I went to the family medicine clinic on a Tuesday morning.

jim fletcher

I’m Jim, and this is Rita.

jan hoffman

And I met Jim and Rita Fletcher.

jan hoffman

OK, and are you here from Greenville?

jim fletcher

Yeah, yeah, yeah, we were born and raised here.

jan hoffman

OK, do you mind telling me how old you are?

jim fletcher

I’ll soon be 74.

jan hoffman

You are not.

jim fletcher

Oh, yes.

jan hoffman

Oh, no. And Ms. Rita, how old do you pretend to be?

rita fletcher

I’m 70.

jan hoffman

They are in their early 70s. They’re both retired.

jim fletcher

I’m a retired telecommunications engineer.

jan hoffman

Oh, wow. What kind of trouble did you get into?

rita fletcher

I just did accounting work and secretarial work.

jan hoffman

Uh-huh, OK.

jan hoffman

And they’ve been married for more than 50 years.

rita fletcher

We were kids.

jim fletcher

Yeah, we were just kids.

jan hoffman

They’re both very devout Baptists.

jim fletcher

We’re Free Will Baptists. I was raised Methodist, and I married a Baptist.

jan hoffman

And they certainly believe Covid is real.

jim fletcher

Look, we know it’s a real disease.

rita fletcher

It is.

jim fletcher

And we know it’s really bad. And from Thanksgiving to just after Christmas, we lost a lot of people that we knew within our circles.

jan hoffman

They know at least 11 people in their circle who have died of Covid.

astead herndon

Wow, 11.

jan hoffman

11.

jan hoffman

Have you ever had any shots?

rita fletcher

We’ve had all the normal vaccines, you know, of kids and everything.

jan hoffman

That’s what I was wondering, yes.

rita fletcher

Yeah, we’ve had all those. But —

jim fletcher

And our children, we had them vaccinated.

rita fletcher

Always vaccinated, yes.

jan hoffman

They had fully vaccinated their sons with the traditional vaccines. But this is one vaccine they absolutely don’t want to get.

jim fletcher

But I think that we have been hornswoggled.

jan hoffman

I love that term, hornswoggled.

rita fletcher

We have — I think a lot of it has to do with — they’ve made it political. And a lot has to do with control.

jan hoffman

They had so many reasons to be apprehensive.

jim fletcher

My concern is more of the religious position.

rita fletcher

Mine would be, I don’t trust it at my age. I don’t know what will come down the road, what it will do to me three to five years from now.

jan hoffman

They did not trust the speed of development and, frankly, didn’t quite understand how a vaccine could have come together so quickly. And they also were very concerned about being microchipped.

astead herndon

Well, considering those concerns, how did their conversation with Dr. Lewis go?

jan hoffman

Dr. Lewis walks into the room.

dr. daniel lewis

Did Jan tell you why you should take the vaccine? Did she tell you all that, or is that my job?

jan hoffman

No, that’s your job.

jan hoffman

He’s a shirtsleeve kind of doctor. And he sits down, pulls up his stool and then he begins.

dr. daniel lewis

All right. I’m going to go backwards and take the fetal tissue one first, OK?

jan hoffman

And the first thing he answers then is their concerns about fetal stem cells.

dr. daniel lewis

The vaccines themselves don’t have those cells in them. When stem cells were beginning to be used as a potential tool in medicine, they did take some tissue potentially from an aborted fetus that they then put in a lab and they’ve grown. And they’ve used that in medical research 30 to 50 years, OK?

jan hoffman

Then he says that the vaccine is absolutely not related to those initial stem cell developments.

dr. daniel lewis

The two things that I’ve heard most prominently is the newness of the vaccine and then also the speed at which it was developed, how the government helped develop that quickly.

jan hoffman

And then he explains to them that the model for the vaccine that has been currently developed was really begun to be established 15, 20 years ago, so that even though the vaccine appears to be pulled out of a hat like a rabbit, in fact, it’s been cooking for quite some time.

dr. daniel lewis

So in particular, two of the vaccines out now use mRNA technology. So they use a piece of genetic material of the virus to then deliver part of the code for the protein of the virus into your body. OK?

jim fletcher

Now you speak of the code, does that alter our DNA?

dr. daniel lewis

Not at all. So our bodies are made of proteins that are built off of genetic material, right? Your body uses your DNA. It unzips the DNA. It makes a copy of that with the mRNA —

astead herndon

As you were sitting there, what stood out to you about the conversation?

jan hoffman

I was struck by how respectful and caring his tone was.

dr. daniel lewis

It’s essentially a recipe. We’re adding an ingredient into your body so your body can then read that like a recipe card and develop something that fights against it.

jan hoffman

He used clear metaphors, straightforward analogies.

dr. daniel lewis

The reason why this virus is so deadly is because we haven’t seen it before. I equate it to, essentially, it’s like your home being broken into for the first time, OK? If you never had your home broken into and you never thought about that, never been concerned, you’re going to be caught unaware the first time. Its kind of the same with the virus. When your body’s never seen it before, it doesn’t know how to respond. But the second time, your body retains a memory of that, and it knows it. So the second time if it was to see it again, most likely, it’s not going get affected at all. Or if you do, it’s not going to be very sick at all.

jan hoffman

It was really accessible language, so that he was describing fairly complicated scientific concepts, but they were easily understood.

jim fletcher

What about treatment? If you get Covid, we were hearing early on that hydroxycloroquine with zinc and vitamin D and other things would defeat the virus.

dr. daniel lewis

I wish. I tried.

jim fletcher

You tried that?

dr. daniel lewis

I had those. Didn’t do anything for me.

jan hoffman

He also spoke from his personal experience as a patient, which is something that he has, of course, this terrible authority that he can hold forth on.

dr. daniel lewis

I had hydroxycloroquine. I took it as soon as I went in the hospital. It didn’t prevent. I tell people I did not die. So I don’t know if it had a piece in that or not. I think God had more a piece in that than anything else. I didn’t die. I don’t think it was the hydroxycloroquine. But I certainly was on the vent. I stayed in the hospital a month and a half. It didn’t prevent those complications.

jim fletcher

Do you think it would have had you taken it earlier in the —

dr. daniel lewis

I don’t think my reports would have changed if I had taken it. Three days —

jan hoffman

But I think what was most important is that he met them where they were at, and they didn’t feel looked down upon. They felt respected.

jim fletcher

How can we be sure there are no — what’s the little devil? The little thing you put in your dog?

dr. daniel lewis

Chips.

jim fletcher

Yeah, how can we be sure there’s no chip involved?

dr. daniel lewis

Well, I would say this. When you get the injection, it comes with a needle that’s got an opening about that wide. We make microchips all the time. We don’t make them that small. You know, it’s, I mean — there has to be some degree, I think, just of faith, I guess, in that regard. But there’s no way to introduce a chip through a needle at this point. Or else, we’d do it to dogs and everything else. When you have a dog, it gets microchipped, for example. There’s a surgery done, right? They don’t inject it into a dog.

jim fletcher

Yeah, it’s just kind of like a grain of rice.

dr. daniel lewis

Yeah.

jim fletcher

But —

dr. daniel lewis

But I can’t inject a grain of rice with a needle.

jim fletcher

Uh, no, no, not unless the needle’s big enough.

dr. daniel lewis

Y’all had the shop class. It ain’t that big a needle, I promise you.

jim fletcher

But —

dr. daniel lewis

I don’t have a needle here big enough and my ability to inject a grain of rice.

jim fletcher

As an engineer, I think of those things.

dr. daniel lewis

I understand. Now listen, and that’s part of this conversation. There’s multiple things. So what other questions do you have about the vaccine or about Covid in general?

rita fletcher

Will these be a yearly vaccine?

dr. daniel lewis

We don’t know that yet either.

jan hoffman

And he answered every question they had and kept asking if they had more questions.

dr. daniel lewis

I just want you to have an informed decision. So I want do the best I can to help you.

jim fletcher

Well, we have some time. There’s been a discussion.

dr. daniel lewis

Absolutely. You can ask, please do. And that’s why I’m here.

rita fletcher

And we do have an informed decision.

jan hoffman

And they paused and said they had some things to talk about and think about, and they would continue to talk about it between themselves.

dr. daniel lewis

That’s all I ask you to do, is to just consider it, OK?

astead herndon

After listening to this conversation, you really get a sense of the time and effort that has to be put in to win over skeptical people about the vaccine. Is that the takeaway that you had?

jan hoffman

I had several takeaways. I was struck by how much time he gave them, which was so much longer than what I would consider to be a typical patient visit in a doctor’s office. But more importantly, I thought how many conversations is he going to have to persuade them to take the vaccine? Is he getting paid for this, which, of course, he’s not? He has to charge for just a regular visit. And then, what’s most frustrating of all is that as he’s told me, when he is successful with patients and is able to talk them into getting the vaccine, they’ll say, OK, are you going to give it to me now? And he’ll say, I’m sorry. I can’t. I don’t have it here.

astead herndon

Wait, really? They don’t have it?

jan hoffman

Most physicians at this point still do not have their own supply of vaccines to be distributed to their own patients. And so that means that patients have to go find a location. They have to go to a pharmacy if it’s available, a vaccination site. And what the travel can mean is that they will have to take off time from work or secure transportation, all of which are obstacles to many, many people to getting vaccinated. And unfortunately, it also means that the moment of inspiration where they decide they’re going to take it can get lost.

astead herndon

So Jim and Rita took time and thought about it more with all that information that Dr. Lewis gave them. Did they end up getting vaccinated?

jan hoffman

I jumped on the phone with them about a week ago. And Jim told me that they had decided at that point not to get the vaccine.

[music]

astead herndon

Jan, after hearing about this long process that Dr. Lewis has gone through, and then to know that some people still choose not to get the vaccine, I think for many people, it’s fairly natural to be confused or even angry at that decision, because it has larger public health ramifications. I think there’s an instinct to see it as a selfish or potentially harmful choice. What do you think, having spent time with these people, having spent time in that room, should be the takeaway from these decisions?

jan hoffman

Well, I certainly know that anger and dismissiveness do not work. I met a patient in Greenville who was on the fence about getting the vaccine. But she told me that she felt that her doctor patronized her and looked down her nose at the patient for not getting the vaccine. And she felt so insulted that she turned and walked out. So collectively, I don’t think that’s a good way to treat people who are hesitant about vaccines. In fact, the research shows that people who are hesitant have the opportunity to see people who are getting the vaccine, enjoying their regained life and doing just fine are more inclined to think, well, maybe I can get it. And maybe I’ll do fine, too. That’s one prompt. And the other, of course, is a trusted source, such as a Dr. Lewis. But that means you’d have to multiply Dr. Lewis endless numbers of times across the United States.

And so, to say that you respectfully disagree, I think, is where you leave it for now and hope for the best.

astead herndon

Thank you so much. I appreciate your time.

jan hoffman

Thank you, Astead.

jan hoffman

Looking back on your conversation with Jim and Rita, they told me, of course, that they are, at this point, not going to take the vaccine. So do you hear that as a hard stop or just an incentive or a go to go at them again when the time is right?

dr. daniel lewis

No, I’ll definitely engage them again and try to ask follow-up questions and help move them and others like them as they go forth. Even lastly, I helped somebody in doing the right thing, or I aided them in their deliberations in determining whether they wanted to take the vaccine, let me say that. I would say that there’s been more successes than there had been failures. So I do feel optimistic that it’s made a difference.

michael barbaro

To encourage reluctant Americans to get vaccinated, the Biden administration says it will now shift its focus away from mass vaccination sites toward smaller local vaccination sites, including doctors’ offices and pharmacies, and said that it would try to enlist the help of trusted voices in every community, such as family physicians.

We’ll be right back.

Here’s what else you need to know today. A major cyber attack has resulted in the shutdown of one of the nation’s largest pipelines, which carries refined gasoline and jet fuel from Texas to the East Coast. The attack demonstrated once again how vulnerable America’s critical energy infrastructure remains to online attacks. The 5,500-mile pipeline carries about half the East Coast fuel supply. But the impact on consumers is expected to be minimal for now because the East Coast has large supplies of fuel in storage. Over the weekend, the owner of the pipeline, Colonial Pipeline, said that its computer system was the subject of a ransomware attack, in which criminal groups hold data hostage until the victim pays a ransom. But the company has yet to say whether it has paid the ransom.

Today’s episode was produced by Asthaa Chaturvedi and Austin Mitchell. It was edited by Dave Shaw and engineered by Chris Wood.

[music]

That’s it for The Daily. I’m Michael Barbaro. See you tomorrow.

Rural Tennessee’s Vaccine Hesitators

White Republican evangelical Christians remain disproportionately mistrustful about coronavirus inoculations. Here’s what that looks like in one community.

Hosted by Astead W. Herndon; produced by Asthaa Chaturvedi and Austin Mitchell; edited by Dave Shaw; and engineered by Chris Wood.
bars
0:00/31:18
-0:00

transcript

Rural Tennessee’s Vaccine Hesitators

Hosted by Astead W. Herndon; produced by Asthaa Chaturvedi and Austin Mitchell; edited by Dave Shaw; and engineered by Chris Wood.

White Republican evangelical Christians remain disproportionately mistrustful about coronavirus inoculations. Here’s what that looks like in one community.

michael barbaro

From The New York Times, I’m Michael Barbaro. This is The Daily.

[music]

On Friday, I spoke with my colleague Apoorva Mandavilli about the growing consensus that herd immunity is no longer achievable in the United States. A major reason why is vaccine hesitancy. Today: What that hesitancy looks like inside a single community. Astead Herndon spoke with our colleague Jan Hoffman about her reporting in rural Tennessee.

It’s Monday, May 10.

astead herndon

Jan, tell me about your reporting on vaccines over the course of this pandemic.

jan hoffman

I focused mostly on vaccine hesitancy. In the early months of vaccine development and then the eventual rollout, the concern really had to do with people in Black and Latino communities because of their historic maltreatment on the part of medical researchers and, frankly, the healthcare system. But as the months have continued, because of the efforts of leaders in the Black community, the Latino community, among medical professionals in those communities and also religious figures in those communities, hesitation has decreased in those communities, although it’s still present. And surveys showed that the hesitation remained firmest in people who describe themselves variously as Republican, white, and/or evangelical Christian, and who tend to live in rural communities.

astead herndon

So in your focus on vaccination efforts across demographic groups, you’ve zeroed in on these white conservative communities partly because they’re the firmest or steadiest holdouts that we’ve seen so far.

jan hoffman

Absolutely. And I really wanted to understand what was underlying it.

astead herndon

So what did you do?

jan hoffman

I went a few weeks ago to Greenville, Tennessee, a little town of 15,000 in a very rural community in northeastern Tennessee. It had been hit very hard by Covid, particularly this winter. More trucks were opened in the parking lots of the medical center. And they were considering opening a special second Covid unit in that hospital. And today, Greene County, of which Greenville is the county seat, has a vaccine rate of about 31 percent for adults who’ve gotten at least one shot, compared to the national rate of 56 percent.

astead herndon

Wow.

jan hoffman

So in a community like Greenville, if there isn’t sufficient vaccination, Covid will keep coming round and round and round.

astead herndon

What kind of conversations are people in Greenville having about vaccines? What did you find in your reporting?

jan hoffman

You know, I found that a lot of people had gotten tired of talking about it. I met innumerable people who’d had squabbles and fights in their families. A father was not going to get it, a daughter was. I met an older woman whose husband has multiple myeloma, who had to say to her adult children, if you don’t get the vaccine, you cannot visit your father, even though he’s dying of cancer. And yet, they have refused to get the vaccine.

michael barbaro

Wow.

jan hoffman

So, it’s become basically a painful and silent point of contention, because people feel that there is nothing they can do to change each other’s minds. And studies show that the most effective way to change someone’s mind is by having that person talk with an authority figure whom they know and trust. So what’s particularly difficult is the very complicated position of the pastors in the community. They have a broad range of views about the vaccine. But for the most part, they have chosen not to use their pulpits as a place to speak about their positions. Because they feel, for both religious reasons and for reasons that have to do with the ethos of the community — which is very much you get to make your own decision — that they are not going to speak out about this particular issue. This is not where they’re going to plant their flag. And yet, they are among the most trusted people in the community.

astead herndon

As you say, the pastor is a trusted figure who could talk and sway maybe hesitant people. Are there other figures who are working to do that in places like Greenville?

jan hoffman

Certainly. The family physician, the primary care provider is the quintessential trusted figure on all things health and medical. And I met a number of physicians who are trying very hard.

jan hoffman

So you’re the head of the family medicine clinic.

dr. daniel lewis

No, I’m the chief medical officer for Greenville and three other hospitals in the [INAUDIBLE] system.

jan hoffman

Specifically, Dr. Daniel Lewis, who’s a family medicine physician.

dr. daniel lewis

I grew up in Northeast Tennessee in Carter County.

jan hoffman

Dr. Lewis is 43 years old, has five kids. He’s a devout Baptist.

dr. daniel lewis

I’m sports medicine trained, so yeah, all the athletic trainers and —

jan hoffman

He’s the sports doctor for Lord knows how many teams at the high school and is very much a figure in the community. But he gained an extraordinary amount of gravitas about a year ago this spring when he himself had his own very serious Covid experience.

[music]

astead herndon

And what was that like?

jan hoffman

He told me that —

dr. daniel lewis

One of our team members began to cough. And we kind of jokingly said, so, have you got Covid? And he goes, no, it’s allergies or whatever else.

jan hoffman

— he had been exposed to the virus by a colleague, who, at the time, did not know that he was positive.

dr. daniel lewis

And so he came back positive. And then I developed symptoms, began to feel a little short breath, sat down and said, not a physician heal thyself situation. I need to defer to somebody else. And I’m not objective enough. So I called my boss. I said, I’m going to the hospital to get checked out.

jan hoffman

And while he was at the hospital, it became harder and harder for him to breathe. His oxygen saturation levels dropped. And his condition became truly dire.

dr. daniel lewis

I recorded voice memos for my kids on the phone in case I didn’t come back.

jan hoffman

Did they think there was a chance that you could die?

dr. daniel lewis

Oh, absolutely. Absolutely.

jan hoffman

He posted a loving and very painful message to his community on Facebook —

dr. daniel lewis

I made a Facebook post at that time that said, I’m going to go on the ventilator. I’m OK. Everything will be fine. God’s in charge. And I’ll see you all on the other side.

jan hoffman

— hours before the decision was made to put him on a ventilator.

astead herndon

In anticipation of his possible passing?

jan hoffman

Yes.

astead herndon

Wow.

jan hoffman

Yes. When he was sick, as a measure of how much this community loves him, they would drop off meals on his front porch for the family, restaurant gift cards. They mulched his flower beds. They fixed his truck, anything to give back to him.

dr. daniel lewis

The community and the area wrapped its arms around me in a way that was just amazing. I can never repay them for that.

[music]

jan hoffman

He ended up staying in the hospital for over a month when he finally was released and went home.

archived recording (dr. daniel lewis)

Hey, everybody. So this is clearly outside my comfort zone.

jan hoffman

He made an extended video that he posted on Facebook —

archived recording (dr. daniel lewis)

The story actually starts in early March.

jan hoffman

— narrating his experiences.

archived recording (dr. daniel lewis)

I was one of the 15 percent that required hospitalization. I became one of the 5 percent that required ventilation and a ventilator.

jan hoffman

He really wanted patients — his own patients and the community at large — to understand what a grueling and terrifying experience it could be for them.

archived recording (dr. daniel lewis)

But please, as you go out and go about your daily activities, do all you can to protect yourself from this virus. Do all you can to protect others from this virus. Thanks for taking the time to watch this video. I hope it’s been helpful. Hit me up with any questions. And again, thanks and love you all.

jan hoffman

The video went viral.

archived recording

This doctor in Greenville is finally back to work after spending six weeks in the hospital sick with Covid-19.

jan hoffman

Local news came to his doorstep. National news figures picked up on it.

archived recording

Tonight, a blessing and a curse. That’s how my next guest describes his experience as a doctor in —

jan hoffman

The video and his experiences really helped cement his presence in the community as someone who had absolute authority to speak about this experience and why it should be avoided at all costs.

dr. daniel lewis

At that point, I began to think, OK, so how can this story be used? What is the purpose of this? And again, a lot of questions, from the faith perspective, why did I go through this?

jan hoffman

He and his wife prayed about why God had put him through such an ordeal.

dr. daniel lewis

And then I realized just that people were listening and that I had influence. And so, you know — and that was maybe the purpose of this whole thing.

jan hoffman

And he told me that he realized it was truly his mission to advise patients about how to take their own precautions and to counsel them about getting the vaccine.

dr. daniel lewis

So if you really want to protect your neighbors and your community, we need everyone that will take the shot to get a shot. Because the sooner we get to that 70 percent —

astead herndon

So here’s a doctor, Dr. Lewis, in a unique position in this community. Not only as a trusted physician, but as someone who can speak personally to what it’s like to be sick, very sick, from the virus. And he has decided that it is now his mission to use that position to encourage others in this community to take both virus and vaccine seriously.

jan hoffman

Absolutely.

astead herndon

When you talk to Dr. Lewis, what does he say comes up in these conversations he is having with residents of Greenville?

jan hoffman

This, I think, really gets to the heart of the issue. People have many different questions and reasons for not wanting the vaccine.

dr. daniel lewis

So the biggest argument I get is, it was just too quick. It was just too much too fast. How did this happen?

jan hoffman

The primary concern most people have is they feel it was developed far too quickly. And that makes them uneasy. I mean, the very title Operation Warp Speed reinforces that point of view. They are expressing religious concerns. They have heard that the vaccine was developed from stem cells from aborted fetuses. This is fundamentally not true.

dr. daniel lewis

But the land is more libertarian and anti-government. I feel like it’s more their assault on their individual freedom.

jan hoffman

They have also soaked up a great deal of misinformation from far right sources.

dr. daniel lewis

I’ve said to more than one person, I don’t need to put a chip in to track you. Bill Gates doesn’t have to chip you if he wants to track you.

jan hoffman

So that you will hear people ask about the conspiracy theory that Bill Gates has put microchips in the vaccines to track anyone who’s gotten them, which is patently false.

dr. daniel lewis

But yeah, there is that fear. There’s —

jan hoffman

But there are plenty of people who are still concerned about that.

astead herndon

Hm. So that seems like a mountain of concerns for Dr. Lewis to address. How does he do that?

jan hoffman

He talks to them one on one. He has conversations easily three or four times a day every time a patient walks into his office for a consultation. And he opens that door to them and says, what are your thoughts about the vaccine? And Dr. Lewis, as well as the patient and the patient’s wife, allowed me to sit in during one such consultation, where the couple really expressed their concerns about the vaccine. And Dr. Lewis attempted to answer them.

[music]

michael barbaro

We’ll be right back.

astead herndon

So Jan, you got the opportunity to sit in Dr. Lewis’s office while he was talking to people who were not sure whether they wanted to get vaccinated or not. What happened in that room?

jan hoffman

I went to the family medicine clinic on a Tuesday morning.

jim fletcher

I’m Jim, and this is Rita.

jan hoffman

And I met Jim and Rita Fletcher.

jan hoffman

OK, and are you here from Greenville?

jim fletcher

Yeah, yeah, yeah, we were born and raised here.

jan hoffman

OK, do you mind telling me how old you are?

jim fletcher

I’ll soon be 74.

jan hoffman

You are not.

jim fletcher

Oh, yes.

jan hoffman

Oh, no. And Ms. Rita, how old do you pretend to be?

rita fletcher

I’m 70.

jan hoffman

They are in their early 70s. They’re both retired.

jim fletcher

I’m a retired telecommunications engineer.

jan hoffman

Oh, wow. What kind of trouble did you get into?

rita fletcher

I just did accounting work and secretarial work.

jan hoffman

Uh-huh, OK.

jan hoffman

And they’ve been married for more than 50 years.

rita fletcher

We were kids.

jim fletcher

Yeah, we were just kids.

jan hoffman

They’re both very devout Baptists.

jim fletcher

We’re Free Will Baptists. I was raised Methodist, and I married a Baptist.

jan hoffman

And they certainly believe Covid is real.

jim fletcher

Look, we know it’s a real disease.

rita fletcher

It is.

jim fletcher

And we know it’s really bad. And from Thanksgiving to just after Christmas, we lost a lot of people that we knew within our circles.

jan hoffman

They know at least 11 people in their circle who have died of Covid.

astead herndon

Wow, 11.

jan hoffman

11.

jan hoffman

Have you ever had any shots?

rita fletcher

We’ve had all the normal vaccines, you know, of kids and everything.

jan hoffman

That’s what I was wondering, yes.

rita fletcher

Yeah, we’ve had all those. But —

jim fletcher

And our children, we had them vaccinated.

rita fletcher

Always vaccinated, yes.

jan hoffman

They had fully vaccinated their sons with the traditional vaccines. But this is one vaccine they absolutely don’t want to get.

jim fletcher

But I think that we have been hornswoggled.

jan hoffman

I love that term, hornswoggled.

rita fletcher

We have — I think a lot of it has to do with — they’ve made it political. And a lot has to do with control.

jan hoffman

They had so many reasons to be apprehensive.

jim fletcher

My concern is more of the religious position.

rita fletcher

Mine would be, I don’t trust it at my age. I don’t know what will come down the road, what it will do to me three to five years from now.

jan hoffman

They did not trust the speed of development and, frankly, didn’t quite understand how a vaccine could have come together so quickly. And they also were very concerned about being microchipped.

astead herndon

Well, considering those concerns, how did their conversation with Dr. Lewis go?

jan hoffman

Dr. Lewis walks into the room.

dr. daniel lewis

Did Jan tell you why you should take the vaccine? Did she tell you all that, or is that my job?

jan hoffman

No, that’s your job.

jan hoffman

He’s a shirtsleeve kind of doctor. And he sits down, pulls up his stool and then he begins.

dr. daniel lewis

All right. I’m going to go backwards and take the fetal tissue one first, OK?

jan hoffman

And the first thing he answers then is their concerns about fetal stem cells.

dr. daniel lewis

The vaccines themselves don’t have those cells in them. When stem cells were beginning to be used as a potential tool in medicine, they did take some tissue potentially from an aborted fetus that they then put in a lab and they’ve grown. And they’ve used that in medical research 30 to 50 years, OK?

jan hoffman

Then he says that the vaccine is absolutely not related to those initial stem cell developments.

dr. daniel lewis

The two things that I’ve heard most prominently is the newness of the vaccine and then also the speed at which it was developed, how the government helped develop that quickly.

jan hoffman

And then he explains to them that the model for the vaccine that has been currently developed was really begun to be established 15, 20 years ago, so that even though the vaccine appears to be pulled out of a hat like a rabbit, in fact, it’s been cooking for quite some time.

dr. daniel lewis

So in particular, two of the vaccines out now use mRNA technology. So they use a piece of genetic material of the virus to then deliver part of the code for the protein of the virus into your body. OK?

jim fletcher

Now you speak of the code, does that alter our DNA?

dr. daniel lewis

Not at all. So our bodies are made of proteins that are built off of genetic material, right? Your body uses your DNA. It unzips the DNA. It makes a copy of that with the mRNA —

astead herndon

As you were sitting there, what stood out to you about the conversation?

jan hoffman

I was struck by how respectful and caring his tone was.

dr. daniel lewis

It’s essentially a recipe. We’re adding an ingredient into your body so your body can then read that like a recipe card and develop something that fights against it.

jan hoffman

He used clear metaphors, straightforward analogies.

dr. daniel lewis

The reason why this virus is so deadly is because we haven’t seen it before. I equate it to, essentially, it’s like your home being broken into for the first time, OK? If you never had your home broken into and you never thought about that, never been concerned, you’re going to be caught unaware the first time. Its kind of the same with the virus. When your body’s never seen it before, it doesn’t know how to respond. But the second time, your body retains a memory of that, and it knows it. So the second time if it was to see it again, most likely, it’s not going get affected at all. Or if you do, it’s not going to be very sick at all.

jan hoffman

It was really accessible language, so that he was describing fairly complicated scientific concepts, but they were easily understood.

jim fletcher

What about treatment? If you get Covid, we were hearing early on that hydroxycloroquine with zinc and vitamin D and other things would defeat the virus.

dr. daniel lewis

I wish. I tried.

jim fletcher

You tried that?

dr. daniel lewis

I had those. Didn’t do anything for me.

jan hoffman

He also spoke from his personal experience as a patient, which is something that he has, of course, this terrible authority that he can hold forth on.

dr. daniel lewis

I had hydroxycloroquine. I took it as soon as I went in the hospital. It didn’t prevent. I tell people I did not die. So I don’t know if it had a piece in that or not. I think God had more a piece in that than anything else. I didn’t die. I don’t think it was the hydroxycloroquine. But I certainly was on the vent. I stayed in the hospital a month and a half. It didn’t prevent those complications.

jim fletcher

Do you think it would have had you taken it earlier in the —

dr. daniel lewis

I don’t think my reports would have changed if I had taken it. Three days —

jan hoffman

But I think what was most important is that he met them where they were at, and they didn’t feel looked down upon. They felt respected.

jim fletcher

How can we be sure there are no — what’s the little devil? The little thing you put in your dog?

dr. daniel lewis

Chips.

jim fletcher

Yeah, how can we be sure there’s no chip involved?

dr. daniel lewis

Well, I would say this. When you get the injection, it comes with a needle that’s got an opening about that wide. We make microchips all the time. We don’t make them that small. You know, it’s, I mean — there has to be some degree, I think, just of faith, I guess, in that regard. But there’s no way to introduce a chip through a needle at this point. Or else, we’d do it to dogs and everything else. When you have a dog, it gets microchipped, for example. There’s a surgery done, right? They don’t inject it into a dog.

jim fletcher

Yeah, it’s just kind of like a grain of rice.

dr. daniel lewis

Yeah.

jim fletcher

But —

dr. daniel lewis

But I can’t inject a grain of rice with a needle.

jim fletcher

Uh, no, no, not unless the needle’s big enough.

dr. daniel lewis

Y’all had the shop class. It ain’t that big a needle, I promise you.

jim fletcher

But —

dr. daniel lewis

I don’t have a needle here big enough and my ability to inject a grain of rice.

jim fletcher

As an engineer, I think of those things.

dr. daniel lewis

I understand. Now listen, and that’s part of this conversation. There’s multiple things. So what other questions do you have about the vaccine or about Covid in general?

rita fletcher

Will these be a yearly vaccine?

dr. daniel lewis

We don’t know that yet either.

jan hoffman

And he answered every question they had and kept asking if they had more questions.

dr. daniel lewis

I just want you to have an informed decision. So I want do the best I can to help you.

jim fletcher

Well, we have some time. There’s been a discussion.

dr. daniel lewis

Absolutely. You can ask, please do. And that’s why I’m here.

rita fletcher

And we do have an informed decision.

jan hoffman

And they paused and said they had some things to talk about and think about, and they would continue to talk about it between themselves.

dr. daniel lewis

That’s all I ask you to do, is to just consider it, OK?

astead herndon

After listening to this conversation, you really get a sense of the time and effort that has to be put in to win over skeptical people about the vaccine. Is that the takeaway that you had?

jan hoffman

I had several takeaways. I was struck by how much time he gave them, which was so much longer than what I would consider to be a typical patient visit in a doctor’s office. But more importantly, I thought how many conversations is he going to have to persuade them to take the vaccine? Is he getting paid for this, which, of course, he’s not? He has to charge for just a regular visit. And then, what’s most frustrating of all is that as he’s told me, when he is successful with patients and is able to talk them into getting the vaccine, they’ll say, OK, are you going to give it to me now? And he’ll say, I’m sorry. I can’t. I don’t have it here.

astead herndon

Wait, really? They don’t have it?

jan hoffman

Most physicians at this point still do not have their own supply of vaccines to be distributed to their own patients. And so that means that patients have to go find a location. They have to go to a pharmacy if it’s available, a vaccination site. And what the travel can mean is that they will have to take off time from work or secure transportation, all of which are obstacles to many, many people to getting vaccinated. And unfortunately, it also means that the moment of inspiration where they decide they’re going to take it can get lost.

astead herndon

So Jim and Rita took time and thought about it more with all that information that Dr. Lewis gave them. Did they end up getting vaccinated?

jan hoffman

I jumped on the phone with them about a week ago. And Jim told me that they had decided at that point not to get the vaccine.

[music]

astead herndon

Jan, after hearing about this long process that Dr. Lewis has gone through, and then to know that some people still choose not to get the vaccine, I think for many people, it’s fairly natural to be confused or even angry at that decision, because it has larger public health ramifications. I think there’s an instinct to see it as a selfish or potentially harmful choice. What do you think, having spent time with these people, having spent time in that room, should be the takeaway from these decisions?

jan hoffman

Well, I certainly know that anger and dismissiveness do not work. I met a patient in Greenville who was on the fence about getting the vaccine. But she told me that she felt that her doctor patronized her and looked down her nose at the patient for not getting the vaccine. And she felt so insulted that she turned and walked out. So collectively, I don’t think that’s a good way to treat people who are hesitant about vaccines. In fact, the research shows that people who are hesitant have the opportunity to see people who are getting the vaccine, enjoying their regained life and doing just fine are more inclined to think, well, maybe I can get it. And maybe I’ll do fine, too. That’s one prompt. And the other, of course, is a trusted source, such as a Dr. Lewis. But that means you’d have to multiply Dr. Lewis endless numbers of times across the United States.

And so, to say that you respectfully disagree, I think, is where you leave it for now and hope for the best.

astead herndon

Thank you so much. I appreciate your time.

jan hoffman

Thank you, Astead.

jan hoffman

Looking back on your conversation with Jim and Rita, they told me, of course, that they are, at this point, not going to take the vaccine. So do you hear that as a hard stop or just an incentive or a go to go at them again when the time is right?

dr. daniel lewis

No, I’ll definitely engage them again and try to ask follow-up questions and help move them and others like them as they go forth. Even lastly, I helped somebody in doing the right thing, or I aided them in their deliberations in determining whether they wanted to take the vaccine, let me say that. I would say that there’s been more successes than there had been failures. So I do feel optimistic that it’s made a difference.

michael barbaro

To encourage reluctant Americans to get vaccinated, the Biden administration says it will now shift its focus away from mass vaccination sites toward smaller local vaccination sites, including doctors’ offices and pharmacies, and said that it would try to enlist the help of trusted voices in every community, such as family physicians.

We’ll be right back.

Here’s what else you need to know today. A major cyber attack has resulted in the shutdown of one of the nation’s largest pipelines, which carries refined gasoline and jet fuel from Texas to the East Coast. The attack demonstrated once again how vulnerable America’s critical energy infrastructure remains to online attacks. The 5,500-mile pipeline carries about half the East Coast fuel supply. But the impact on consumers is expected to be minimal for now because the East Coast has large supplies of fuel in storage. Over the weekend, the owner of the pipeline, Colonial Pipeline, said that its computer system was the subject of a ransomware attack, in which criminal groups hold data hostage until the victim pays a ransom. But the company has yet to say whether it has paid the ransom.

Today’s episode was produced by Asthaa Chaturvedi and Austin Mitchell. It was edited by Dave Shaw and engineered by Chris Wood.

[music]

That’s it for The Daily. I’m Michael Barbaro. See you tomorrow.


Vaccine hesitancy is a major reason that many experts now fear the United States will struggle to attain herd immunity against the coronavirus.

And while many initially hesitant demographics have become more open to vaccinations, one group is shifting much less: white Republican evangelical Christians, who tend to live in rural communities.

We visited one such community in Greeneville, Tenn.

In Greene County, of which Greeneville is the county seat, around 31 percent of adults are vaccinated, compared with a national rate of 56 percent.

Dr. Daniel Lewis, the community’s family doctor, is trying to change that. Often, one appointment at a time.


  • Jan Hoffman, a reporter covering behavioral health and health law for The New York Times.

ImageDr. Daniel Lewis of Greenville, Tenn., with Rita and Jim Fletcher, two of his patients who have been deeply hesitant about the coronavirus vaccine.
  • Reluctance to get vaccinated is widespread in white, Republican communities like this one in Appalachia. But it’s far more complicated than just a partisan divide. Read Jan’s reporting here.

There are a lot of ways to listen to The Daily. Here’s how.

Transcripts of each episode are available by the next workday. You can find them at the top of the page.


Jan Hoffman contributed reporting.

The Daily is made by Theo Balcomb, Lisa Tobin, Rachel Quester, Lynsea Garrison, Annie Brown, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Larissa Anderson, Wendy Dorr, Chris Wood, Jessica Cheung, Stella Tan, Alexandra Leigh Young, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, Sindhu Gnanasambandan, M.J. Davis Lin, Austin Mitchell, Neena Pathak, Dan Powell, Dave Shaw, Sydney Harper, Daniel Guillemette, Hans Buetow, Robert Jimison, Mike Benoist, Bianca Giaever, Liz O. Baylen, Asthaa Chaturvedi, Rachelle Bonja, Alix Spiegel, Diana Nguyen, Marion Lozano and Soraya Shockley.

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