Garrett County, home to about 29,000 people in the westernmost corner of Maryland, has the lowest vaccination rate in the state. Just over 38% of residents are fully vaccinated against COVID-19, a number that hasn’t changed much over the last several weeks. Efforts by medical professionals and government officials to change that by vaccinating residents have been stymied by rampant misinformation and distrust in government.

“I’m very frustrated. I have friends, I have family members who don’t want to get the vaccine,” said Bob Stephens, Garrett County’s health officer. “They have their reasons, and once they’ve decided that they don’t want to get the vaccine, it’s very, very hard to convert those folks over.”

Stephens, as the county’s top public health official, has become a public face of all sorts of health-related messages during the pandemic, including reminders to wear masks, social distance and get vaccinated. He said his picture is in the newspaper weekly, something he never really wanted as a public health official.

“I've had lots of people — tremendous number of people — who have thanked me for what I've done, yet me, personally, I feel like a failure because our percentage of people vaccinated is still lower than most other places,” Stephens said.

When the vaccines first became available, they were in high demand, Stephens said. However, that demand began declining after most people older than 55 got their shots.

Stephens said the county has tried a variety of tactics to boost the vaccination rate.

With help from the state and the Federal Emergency Management Agency, the county began holding mobile vaccine clinics in May. They have held clinics in every zip code, some of which have only 150 residents. Each clinic was prepared to give out up to 100 vaccines, but Stephens said the most given at any single site was 11.

“We had posters up. We had people knocking on doors,” he said. "We specifically partnered with the volunteer fire companies, and that’s where we had most of the sites because the volunteer fire companies tend to have their fingers in the community.”

They also offered to hold vaccine clinics at every church in the community, so long as they could muster five people who wanted shots.

“We've had zero takers on that,” Stephens said.

More recently, his team has discussed offering cash as a reward for getting the shot, though he said he doesn’t want to do that.

“We've already heard this in the community when they started doing it in West Virginia — I heard so many people that said, ‘Well, see, that just proves what I'm saying that, if they have to pay you to get it, that it must not be any good for you,’” Stephens said.

Medical providers in the community are likewise frustrated.

“I am unbelievably concerned that this community is going to have a surge, they're going to get hit with delta, and that the younger people — so that, you know, 30 to 50 [age group] — are gonna get hit,” said Marjorie Fridkin, the chief medical officer at Garrett Regional Medical Center, a small, 55-bed hospital that is part of the West Virginia University Health System.

That age group has a particularly low vaccination rate, Fridkin said. Meanwhile, the delta variant is more contagious than previous versions of the virus and potentially more lethal.

Fridkin is still scarred by her experiences last fall and winter, when she cared for patients she has known for decades as they lay dying from COVID-19.

“First time around, there was nothing we could do. You know, we could mask, we could social distance, we could stay home, close the schools — that was it. Now there's actually something we can do,” she said. “It is just so frustrating and heartbreaking to me that I don't feel like we're taking advantage of it, and if we get a surge, as I fear we will, it will just be doubly awful because we could have stopped it.”

Fridkin said she knows what to expect by watching urban communities, which tend to see outbreaks first.

In fact, since she spoke with WYPR earlier this month, Garrett County has already seen a spike in cases. Last Wednesday, the county’s positivity rate passed 10% for the first time since January, and it has continued to rise since.

The vaccines are the answer, Fridkin said.

But Stephens said many Garrett County residents avoid interactions with the healthcare system.

“Some of the COVID fatalities that we've had have been people that have died in their homes, even though their neighbors say, ‘They told me how sick they were. I told them to go to the doctor, and they wouldn't go to the doctor because they don't believe in going to the doctor,’” Stephens said.

When asked why they don’t want the vaccine, many say they don’t know what’s in it, or they need to do more research.

“We have people who are in recovery for IV drug use — for heroin and fentanyl,” he said. “And they won't get a vaccine because they don't know what is in the vaccine. That is hard to wrap your head around.”

People who have had the virus also say they don’t need the vaccine because they have naturally occurring antibodies, which goes against medical advice.

Fridkin said she hears two main types of resistance.

“It's either no one's gonna tell me what to do … like, I don't want to be told I have to have a vaccine. The government's not going to tell me, you're not gonna — I just — I'm going to make my own decisions,” she said.

The other type of resistance is fear-based. Patients say they don’t understand how the vaccine works, so they are afraid of it.

“They've heard stories that this person died, or that person had a stroke, or it's gonna make me infertile,” she said.

All the misinformation patients read online or hear from friends and family members only makes it worse.

“They look at it and say, ‘Well, if I get COVID, and something bad happens, that's just the way it was supposed to be. But if I take this action of getting a vaccine, then I've done it to myself,’” Fridkin said.

She said the good news is the second group — the people who are afraid or misinformed — seems to be bigger.

“Someone who says, ‘I'm afraid,’ like, ‘I have fear of what the vaccine might do,’ you can reach that person, so you can educate that person,” she said. “You have to be willing to do it in a non-threatening way, and do it over and over again, until the message is received.”