FAYETTE, Miss.—For Dr. Adrian Hammitte, COVID was never an abstract. When he speaks about the long days of 2020, he talks in terms of concrete harm—harm to children from days out of school, harm to families through sickness and death. The funeral of his own employee comes to mind first.
“He was one of our custodians at Jefferson County Junior High School,” Hammitte told the Mississippi Free Press. “We’re still not sure where he contracted the virus.”
The disease progressed, as it often does, with a baffling rhythm.
“Initially we heard that he was doing OK. And then the next conversation, he was on a ventilator. He didn’t survive. An amazing dad, an awesome employee—he had two kids attending the junior high,” Hammitte recalled, sighing heavily. “A great, great guy.”
Jefferson County, where Hammitte is superintendent, is a small community, mostly centered around the town of Fayette. People know each other in the southwest Mississippi county. “Typically, not only do you know the person, often you’re related to them in some capacity,” Hammitte said.
The COVID deaths in Jefferson County reverberated through the community. “We saw it several times. Losing people from the nursing home who would still be here, I believe, if not for COVID. At the time, we just didn’t have the mechanisms to protect ourselves,” he said.
That changed as 2021 dawned, and Jefferson County emerged with the rest of Mississippi from the harsh winter surge. The vaccine was the first real weapon against the virus, an opportunity to avoid the isolation and pain of 2020.
But, first, the people had to use it.
‘Early On, It Was Slow’
Dr. Crystal S. Cook watched the vaccination numbers trickling in for Jefferson County early in 2021 and knew that more could be done.
“We noticed early on that it was slow,” Cook, medical director of the Jefferson Comprehensive Health Center, told the Mississippi Free Press during a visit to the southwestern Mississippi county. “There was pressure, a sense of urgency,” coming from the clinic’s board of directors. “The administration and our board wanted us to be the primary source of vaccination in this community. There were conversations around us being a productive resource,” she said.
So, the clinic adapted its strategy in concert with the Mississippi State Department of Health. “We pulled our staff to work on our mobile unit,” Cook said. “We started going out into the community. And that’s when it really started to take off.”
Take off is understated language. These days, Jefferson County isn’t just a moderately successful rural example of COVID-prevention outreach—it is the most vaccinated county in all of Mississippi, approaching full vaccination for three out of every four adult residents.
First In the State
Jefferson County is one of the smallest counties in Mississippi, with a population of only 7,260. On paper, it has many of the challenges commonly associated with low vaccination rates across the U.S.: rural, poor and removed from the state’s denser, better-equipped urban cores. It is also one of the Blackest counties in Mississippi and the U.S., a population with a vaccination rate roughly 7% lower than the overall white rate across the country.
In the earliest days of the vaccination campaign, after the pandemic’s long first year, Jefferson County lingered behind Mississippi, just as the state was behind the rest of the nation. Shots at the Mississippi State Department of Health drive-through were available in the parking lot of Jefferson County Hospital in Fayette, but uptake was markedly behind the state and national trajectory.
But something changed dramatically over the month of February 2021. The vaccination program didn’t just rise to match Mississippi’s pace—it exceeded the state. Jefferson County’s vaccination rate surged so far past the state average that, within a few months of the vaccine’s availability, it was the statewide leader in vaccinated residents per capita, a spot it holds to this day.
While the ebb and flow of the pandemic has led to sluggish vaccination rates in many areas as the year has progressed, Jefferson County responded to the rising delta variant by vaccinating so many new residents that, during August and September, the Solutions Journalism Network found it to have the second-highest rate of new vaccinations of any rural county in the United States.
The story of Jefferson County’s success is, in part, the story of Mississippi’s success. Black vaccination rates nationwide are, per capita, far behind white rates, with the vast majority of U.S. states struggling to reach vaccine disparity. In Mississippi, however, Black vaccinations per capita exceed the state average. As of today, more than 50% of all Black Mississippians have received one shot.
Jefferson County is one manifestation of that success, but as the statewide leader, it represents more than just the downstream effects of a vaccine equity campaign. Part of the answer looms behind Cook, obvious and physical. The Jefferson Comprehensive Health Center Mobile Unit is a fitting tool for a population as dispersed as Jefferson County’s. Cook and her team brought the unit from town to town, to apartment complexes and school parking lots.
The Mississippi Free Press met Cook outside the mobile unit in October, parked at the Jefferson County High School and awaiting visitors still looking to get the shot.
“We made ourselves mobile,” Cook said. “We targeted housing authorities, school districts, town squares, rural districts.” The nurse practitioner credits the mobile unit with reaching otherwise unreachable populations, a direct response to the slow growth of vaccination rates in the early days of the campaign. “That’s when we started targeting, for example, housing authorities.”
These efforts—constant, targeted availability of a roving vaccine clinic at the most local level possible—worked well in an environment like Jefferson County. Although there was an MSDH drive-through site in the county itself, Cook said the vaccination program had to go further.
“You would think that most people would have a car to drive to the local hospital for the shot, but many don’t. So we went straight to them,” she said. “They could leave their apartments and walk to the mobile units.”
But the rest of the story is not so material. The physical presence of a roving vaccination clinic across the parking lots and unincorporated communities of Jefferson County is only part of its success. Cook credits relationships—hard-earned trust with the people of the county, as well as unity of purpose among Jefferson County’s leadership—with making the rural community Mississippi’s vaccination leader.
“We pride ourselves on interventions,” Cook said. “On outreach.”
As a federally qualified health center, Jefferson Comprehensive Health is used to being the last line of medical defense for a community that struggles with chronic health disparities. That role made it critical for a pandemic where misinformation and distrust were as rampant as the virus.
“To decrease disparities, we have so much networking we do beforehand,” Cook added. That means taking the same mobile unit they would later use to vaccinate the dispersed residents of the county, and using it to build an investment in wellness so often lacking in underserved communities where health care is distant, prohibitively expensive and insensitive to the populations they serve.
Part of that relationship building is scaffolding an ongoing relationship with health care. That means individual contact. “When our patients haven’t come in in a while, we call them. Come in and see us. Your flu shot is due. You’re eligible for the shingles vaccine,” Cook said.
“Patients are waiting for us to reach out.”
Much has been made of vaccine hesitancy—an active aversion to taking the shot for fear of side effects, complications, or theories about its origins and purpose. Black vaccine hesitancy in particular has been floated as a specific explanation for lingering racial disparity in vaccine campaigns nationwide, a theory Jefferson County—and Mississippi in general—counters soundly.
Protecting the Incarcerated
Sheriff James E. Bailey arrived in the middle of the Mississippi Free Press’ interview with Dr. Cook. Stepping out of his cruiser in a straw hat, dark sunglasses and a tight mask, he joined the conversation, animated even with his features covered when he spoke about the vaccine program.
“I said, ‘I have 270 inmates here. Can you vaccinate them?’” Bailey told the Mississippi Free Press. “I got in contact with the warden, and I got with all my inmates. I asked ’em who was willing to take a vaccination?” In the confines of a correctional facility, few people were interested in remaining unvaccinated, even with cases dwindling after the harsh winter surge of 2020.
In this way, not all of the leadership in Jefferson County’s vaccination program was top-down, from the medical authorities to the rest of the community. Some community leaders came to Cook to become a part of the solution.
“Sheriff Bailey came to us,” Cook said. “He wanted his detainees to have a higher rate of vaccination to deter outbreaks.” These detainees are incarcerated at the Jefferson-Franklin County Correctional Facility, which houses a little less than 300 state inmates and pre-trial detainees.
Of the 270 inmates and 54 employees at the Jefferson-Franklin County Correctional Facility, Bailey and Cook estimate that at least 95% have been vaccinated since the early effort to protect the prison from outbreaks.
“And we’re getting more and more,” Cook added. “We vaccinated eight more detainees last week.”
The ebb and flow of inmates at the correctional facility poses an ongoing risk of infection. In fact, as Bailey and Cook met with the Mississippi Free Press outside the Jefferson County High School, a breakthrough outbreak had just ended at the Jefferson-Franklin County Correctional Facility.
In spite of a mostly vaccinated population, 42 cases of COVID-19 came from that outbreak alone. Bailey confirmed that the majority were breakthrough cases, unsurprising given the near-full vaccination of the facility. August’s outbreak at the correctional facility was a live demonstration of the infectiousness of the delta variant—and evidence that the vaccines show some waning against transmission prevention four to six months after the second shot.
But it was also a testament to the enduring protection that the shots provide. None of the 42 individuals infected had severe symptoms of COVID-19. Zero were hospitalized, and zero died. Detainees who displayed mild symptoms were given monoclonal antibodies at Prime Health and Wellness Center in Fayette, Cook said.
‘Be Proactive About It’
Another stakeholder in the vaccine project has been the Jefferson County School System. Four schools, from elementary to high school, serve as the core of the public education system in Jefferson County. Shutdowns from the pre-vaccine days of the pandemic were a disruption for the entire community.
“I think we all experienced the nightmare of students being out of school from COVID first,” Superintendent Hammitte explained. “Even last school term we were in and out because of COVID. All of us were determined to make sure that we did everything we could to keep our kids in school.”
Part of that was relying on Jefferson Comprehensive Care. The mobile unit has made multiple trips to Jefferson County High School, providing an opportunity for students and parents alike to get vaccinated, now that the vaccine is approved for school-aged children. Vaccination isn’t mandatory for the employees of Jefferson County School District, but that hasn’t been much of a deterrent. Hammitte estimated 94% of his staff across the county was fully vaccinated.
Vaccination, especially of young people, is a difficult subject. The latency between approval of the vaccine for adults and for children is part of the reason vaccination rates are so much lower for children.
“There’s still a hesitancy there. They’re the ones worried about fertility. They’re the ones talking about microchips in the vaccine,” Cook said. The medical director blamed the outsized influence of social media for that strength of some of the conspiracy theories she encounters in that generation. “They’re not listening to the CDC, and they’re not listening to us.”
But for those young enough to still be in school, parents are more likely to determine whether the children are vaccinated, Cook said.
In order to keep school in session and kids in class, Hammitte has had to rely on the whole community. For the majority of the year, the children of Mississippi were ineligible for the vaccine. The result is that the level of community transmission around the schools has determined the experience of districts all across Mississippi.
In Jefferson County, the high vaccination rate and low infections that followed it paid dividends even for mostly unvaccinated children. MSDH data shows the infections and outbreaks across the four school settings in Jefferson County since the beginning of the year. The schools have had a smattering of individual cases, but zero outbreaks, and as a result, zero shutdowns.
Some part of that Hammitte attributes to the precautions the district has taken. With so much competing information over best infection-control practices, many school districts across the country have resorted to ineffective measures, like excessive surface-cleaning, that tackle secondary forms of transmission that medical science has deemed unlikely to prevent outbreaks.
COVID-19 is airborne, and Jefferson County School District treats it as such. “All of our classrooms have Guardian Air Purifiers, which can cover up to 200 square feet,” Hammitte said. “We utilized our CARES Act funds through MDE to purchase those. We discovered that everybody wanted the kids in the classroom. So from day one we tried to identify everything we could do to be proactive about it.”
‘We Can Get It Done’
Data from the Solutions Journalism Network showed that, between Aug. 15 and Sep. 14, 2021, only rural Washington County, Ala., had a higher increase in vaccinations than Jefferson County, Miss. And Washington County had lagged behind Alabama and the rest of the nation before that month. Jefferson County started the month miles ahead of Mississippi, with much less of its population available for vaccination, but still vaccinated another 8.3% of all of its residents in that time.
Jefferson County’s vaccination efforts have presented living, breathing evidence for the vaccine’s effectiveness. Just last week, the New York Times’ COVID-19 tracker showed that, over the course of the pandemic, Jefferson County has had the second least cases of COVID-19 per capita in Mississippi, with 13,734 cases per 100,000 residents. Only Wilkinson County in the far southwest corner of the state, the fourth most vaccinated county in the state, has had fewer cases per capita—12,213 per 100,000.
Comparatively, Neshoba County, with its anemic 33% vaccination rate, neared the top of the state’s list of cases per capita with 22,958 per 100,000. A graph of new cases by date shows that Jefferson County had a virtually unique experience in Mississippi during the delta surge—a heavily blunted spike that harmed far fewer residents than most regions in the state.
But while early, dedicated vaccination efforts kept Jefferson’s case count low throughout the later stages of the pandemic, health disparities that predated the pandemic also put Jefferson County at risk of a relatively high fatality rate, although its low population may make it difficult to draw conclusions from the county’s 34 deaths.
Cook is still fighting to vaccinate the remainder of Jefferson County and to provide boosters for vulnerable populations to keep transmission low. But her team at Jefferson Comprehensive Health Center has more on its plate than coronavirus. The health initiatives—and the disparities they contend with—that have long predated the pandemic are close to her mind.
“It’s a toss-up between hypertension and diabetes. They’re both chronic, and they’re both poorly controlled in our community,” Cook said. She wants Jefferson County to sprint ahead of the state in tackling the big, lingering diseases that extend far beyond COVID. What could the county’s hypertension rates look like with the same federal and state investment as the vaccine program? What could be done to diabetes if Medicaid were expanded?
Cook was adamant that the county and its many partners could replicate the success of its vaccine program, if the support was there. “If given resources, disparities can change. It can be decreased. We can rectify it.”
Each time the Mississippi Free Press spoke to Cook, she was out in the mobile unit, somewhere in Jefferson County, meeting the community at their doorstep. “Give us the means to do the work,” she said, “and we can get it done.”