North Carolina counties with the highest risk for severe COVID-19 lagging in vaccination efforts

The early phases of the state's COVID-19 vaccination plan targeted North Carolina's most vulnerable populations, however, months later data shows many of these same communities are still at risk.

An analysis by the ABC11 I-Team found the top 25% of NC counties with high levels of chronic conditions have an average vaccination rate below the state average. Almost half of these same counties reporting the lowest vaccination rates in the state.

The ABC11 I-Team using data from the National Institute of Environmental Health Science's Pandemic Vulnerability Index alongside state COVID-19 data.

For counties with a higher prevalence of smoking, diabetes, obesity and premature death, the average vaccination rate is 35%.

These are the same conditions associated with an increased chance of catching a severe case of COVID-19. This doesn't mean that all the unvaccinated residents in these areas have chronic conditions but it does mean the community as a whole is at a higher risk.

Meanwhile, in the state's healthiest counties the average vaccination rate is 43%; higher than even the state average.

"It's a worrisome finding. And I think, not surprising, given the trends of how the pandemic has progressed," said Dr. David Reif, an NCSU professor and lead of the Pandemic Vulnerability Index. "All the things that go into vaccination rates and people getting them, I think, are reflected in a lot of the things that are unfortunately associated with their vulnerabilities."

In central North Carolina, Halifax, Edgecombe and Wayne County have some of the lowest vaccination rates but the highest risk for comorbidities.

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Edgecombe County health director Karen Lachapelle said since January the county has worked to combat hesitancy by opting for one-on-one vaccination sessions over mass clinics.

"Not only did it benefit that patient, it benefited when that patient left here and went home to their family or their community, they had the right information to give," she said.

Lachapelle said she thinks the county did well in vaccinating residents who were most at risk and qualified early on, but now is trying to figure out ways to reach the rest of the residents.

Chronic conditions or comorbidities aren't the only elements that contribute to an area's vulnerability.

The Pandemic Vulnerability Index (PVI) also factoring in population density, demographics, insurance and intervention measures to determine an area's overall risk.

"What we are saying is that where you live, affects your vulnerability to disease because what everybody is doing affects what everybody else is doing," Reif said. "Our concept of vulnerability was more than just how many people are being afflicted with the disease or how many people are dying with the disease but we're trying to make a measure that cut across all of those, so vulnerability is a very inclusive concept."

The I-Team again finding the counties with the highest overall risk of contracting COVID-19 also vaccinating on average 6% fewer residents then the counties with the least risk.

Dr. Ruth Gillian Phillips is the executive director at the Community Health Coalition. Her organization has tackled healthcare inequities across central North Carolina long before the pandemic. She said so many factors contribute to an area's vulnerability and those factors are playing out now.

"I don't believe people want to be sick. I don't believe people want to be in poverty, but those things play a factor when it comes to health and education. And so it's you really can't talk about one without topic without addressing the other ones," Phillips said.

She said while a lack of resources have impact healthcare access to these communities in the past, the issue now is not supply.

"At the end of the day, even though the resources are there and we know we went there and gone there and canvased there at the end of the day you have to change the mindset of someone to want to take the vaccine," Phillips explained.

The North Carolina Department of Health and Human Services (NCDHHS) is very in tuned with the changes these vulnerable counties face. Last week, the department announced the creation of a similar mapping tool that allows health officials to view these disparities within counties.

NCDHHS' mapping tool targets communities with the highest risk for disaster-relating suffering while also identifying low vaccination rates.

A NCDHHS spokesperson said the mapping tool has enabled providers to increase vaccinations by 50% in 89 underserved communities in the last month.

Lachapelle said Edgecombe County is using this data to target areas within the county to go door to door handing out additional informational material. She's not sure what will convince people but said her department is going to keep doing what it does best.

"I just wish I had the answer but, that's what we're going to try to do, hit the pavement and continue to hit the pavement," Lachapelle said.

Reif believes using tools like the PVI can help health officials deliver more targeted messaging to the communities most in need.

"We're fortunate that there are vaccines available and that messaging though is still important to get the vaccines in the people's arms because there are going to be some people who can't get the vaccine or won't get the vaccine," he said.