When Washington County Public Health first offered COVID-19 vaccines in February, their phone lines were tied up for hours and completely overwhelmed. Appointment slots for the first vaccination clinic, for those 65 or older, filled up within about four hours, with many callers unable to get through to the department even after hours of calling.

But within months, the public health department was having to decline allocations of vaccine for lack of demand.

“We couldn’t fill clinics and we didn’t want to see vaccine wasted,” county Public Health Administrator Danielle Pettit-Majewski said. “We saw demand drop off when there were more places to get vaccines. For a while we were the only ones getting anything—all of the vaccine that came into the county went to the local health department. Once we started to see HyVee start to get some, that helped and when we started to see Walmart get some, that reduced the demand on our stockpile as well.”

Pettit-Majewksi said the demand also began to drop off after the populations of those 65 and older and those with underlying health conditions had a chance to be vaccinated.

But still only 42.3% of Washington County is fully vaccinated. Pettit-Majewski said her department is now working to address reasons why the vaccine uptake has slowed, whether that be hesitancy or barriers.

“We hear a lot of concern that the vaccine was developed too quickly. I understand that typically vaccines take a lot longer, however, I don’t think people typically understand that they were doing work on mRNA vaccines for that last 10 years,” Pettit-Majewski said. “This is not a new technology; this was just an opportunity to utilize it. This was also the opportunity where essentially the entire world was focused on finding a solution to a problem. Also, rather than going step-by-step through all of the red tape to get authorization, they were able to do a lot of those steps concurrently so they were able to speed up the process because speeding up the process meant lives lost or not.”

In Kalona, Pleasantview hosted a walk-in vaccination clinic on Friday, June 11, hoping that an easy-to-get-to vaccination site in the community would help some people get the vaccine who might have had barriers, such as not being able to get time off work for an appointment or not being able to travel far for one.

“Community is one of our core values here at Pleasantview, so anything I can do to benefit the community is a big priority of mine,” said Director of Nursing Holly Lear. “I know that the vaccination rate in Kalona is pretty low compared to other areas. I know that there are a lot of reasons it can be difficult to get vaccinated, so I thought we’d have a walk-in clinic so people can stop by and not have to worry about getting an appointment. I hoped that it would make it easier for some people who have had a hard time finding a place to get a vaccine.”

Lear said she asked the clinic staff to bring 200 total doses—100 Pfizer, which is approved for children age 12 and up, and 100 Johnson & Johnson, which only requires one dose.

“I wanted people to be able to choose which vaccine they wanted, which one would work best for them and their lives,” Lear said.

Phil Ostrem, a pharmacist from RX4Prevention who helped run the Pleasantview clinic said there are many reasons for vaccine hesitancy, but one of those is politics.

“A lot of it is a political thing,” Ostrem said. “It does have a lot to do with it. Depending on what information source people are watching or reading, whether it’s promoted on those information sources as good or bad, they believe it.”

Karri Fisher, a nurse from Washington County Public Health, said her organization’s role in fighting vaccine hesitancy is providing information.

“From a public health standpoint, we do a lot of teaching, whether it’s a COVID vaccine or a tetanus shot, that’s our job,” Fisher said. “Our job isn’t to say, ‘You should get this,’ but our job is to say, ‘This is what could happen if you don’t, and this is the benefit if you do.’ We do a lot of teaching in the community; a lot of information pushes through our website and Facebook and other sources.”

Pettit-Majewski also said that the public health department’s role is one of an educator.

“We hear a lot of different rumors about impacts on fertility or that [the vaccine] alters your DNA and whenever we hear myths like that we try to ensure to people that there has been absolutely no data to show an impact on fertility, that mRNA does not change your DNA,” Pettit-Majewski said. “The mRNA doesn’t even go into the nucleus of your cells, which holds your DNA. We try to counter some of those myths as we hear them but ultimately, we need to hear from folks if there are different reasons why some people want to wait. We try to answer those questions and see how do we convince more individuals to get vaccinated.”

Pettit-Majewksi said she expects her department to continue focusing on vaccine hesitancy and uptake for the next year or so.

“We really need to look at our targeted populations and see where we have hesitancy and target messaging, maybe, for women in their childbearing years or rural men aged 30-50 or Latino men. We need to figure out how do we message, how do we target them,” she said. “We need to think about different ways that we can message. If we send a generic message, we reach nobody, so we need to figure out how we’re going to target our message to populations.”

Pettit-Majewski stressed that anyone desiring a vaccine but encountering barriers should reach out to the public health department.

“Ultimately, we can find ways to work around those barriers,” she said. “We can help them find a solution. Our goal is to vaccinate anybody who wants to do that and we can work together to figure it out.”