After Gov. Mike Parson rejected the idea of federal assistance with door-to-door COVID-19 vaccine outreach, advancing the non-existent possibility that agents would “compel vaccinations,” communities across Missouri are staking out divergent stances on the strategy.
“I don’t think that having somebody come knock on your door and give you a pamphlet is going to make you decide you’re going to go get vaccinated,” Cole County Presiding Commissioner Sam Bushman, a Republican, said during a commission meeting last week. Another GOP commissioner, Harry Otto, added that if you don’t know about the vaccines by now, “you either live in a cave or a van by the river.”
About 39% of residents in Cole, home of Jefferson City, are fully vaccinated. Cases are rising there: the Missouri Department of Health and Senior Services reports a 13% week-over-week increase.
Cole’s more liberal neighbor to the north, Boone County, is taking a sharply different tack. On the same day that Cole officials dismissed the idea of going door to door, health officials Boone unveiled a “vaccine ambassadors” program to promote shots. Residents can enlist to participate in outreach activities, including door-knocking.
About 47% of Boone County residents are fully vaccinated. Cases have also surged in the county, but the week-over-week rise is just 2%.
“They will help build vaccine confidence with their family, friends, neighbors, faith communities and the businesses next door so that as many people get vaccinated as possible to keep our community safe,” the Columbia-Boone County Health Department said in a statement announcing the program.
The door-knocking divide is the latest example of how mixed messaging by Parson or other state-level leaders can ripple across the Missouri. Amid a statewide surge driven by the delta variant, the tone set by the governor, and echoed by other officials, oscillates between two points: acknowledging the seriousness of the situation but stipulating that how citizens should respond remains a matter of personal choice.
The current moment marks a continuation of the rhetoric the former sheriff from Bolivar has used over the past 17 months as Missouri experiences its biggest health crisis of the modern era. The latest challenge is vaccine opposition and hesitancy, which is driving the wave of cases pushing hospitals in Kansas City and Springfield to the limit.
Nationally, Republicans are more likely than independents and Democrats to say they definitely won’t get vaccinated, according to ongoing polling by the Kaiser Family Foundation. About 57% of rural residents say they have already been vaccinated or plan to as soon as possible, compared to 76% of urban residents.
Those looking for permission not to get vaccinated can sometimes find it when the governor asks only that people “consider” getting a shot. Conservatives with conspiratorial views about forced vaccinations can see their worries validated when Parson talks about not welcoming “federal agents” that were never going to go door-to-door forcibly vaccinating people in the first place.
At the same time, others can find encouragement to roll up their sleeves through the governor’s new incentive program, which offers $10,000 cash prizes. Talk of “personal responsibility” may appeal to those not swayed by scientific or medical experts.
On Monday, Parson said on Facebook that residents must “do right by our own health and that of our friends and family.”
It was more assertive, but still lacked the higher levels of urgency shown by some state and local leaders.
Amber Reinhart, a researcher in health communication at the University of Missouri - St. Louis who is studying vaccine hesitancy, said some of Parson’s messages appear to “hedge bets” on urging vaccination, leading some to distrust factual information or feeding their uncertainty about getting a shot. She said it’s “not helpful” to raise doubts about door-to-door outreach efforts.
“We are in an all hands on deck situation … Clear and consistent messaging to help people wade through that misinformation is something that should be done more frequently than messaging that’s mixed,” she said.
After the Centers for Disease Control and Prevention announced in early July it would send personnel to Missouri to help the state’s pandemic response, Parson tweeted that he had directed DHSS to tell the federal government that “sending government employees or agents door-to-door to compel vaccination would NOT be an effective OR welcome strategy in Missouri!”
Rep. Jason Smith also said President Joe Biden “wants to knock down your door KGB-style to force people to get vaccinated.”
The claim that the federal government has proposed deploying agents to force people to get vaccinated is flatly false. Jeff Zients, the White House COVID-19 response coordinator, has told reporters any door-to-door outreach was being conducted on a local level by doctors, faith leaders and other trusted community messengers in partnership with the administration.
But during a conference call of DHSS and local public health officials last week, the moderator read a question from an unidentified local official that, citing Parson’s comments, indicated a petition is circulating in their county to ban door-to-door vaccination outreach and any government aid supporting those efforts.
A DHSS official responded by suggesting Parson feared military involvement — something the White House has never proposed.
“From a level of what the governor’s concern was, was that there were numerous contacts that his office was receiving that were seeming to indicate that the CDC was going to be bringing in essentially federal troops to do vaccinations at doors in communities with low vaccination rates,” said the DHSS official, who wasn’t identified before answering, according to a recording of the call reviewed by The Star.
“My understanding is that his communication about that was specifically aimed at indicating that the state of Missouri does not need federal troops to come in for the purpose of doing vaccination,” the official said.
Zients said earlier this month that efforts to mischaracterize outreach work was “doing a disservice to the country and to the doctors, the faith leaders, the community leaders and others who are working to get people vaccinated, save lives and help end this pandemic.” The CDC doesn’t have the power to send in troops.
The reference to federal troops is more specific than what Parson has said publicly. On the call, the DHSS official quickly pivoted to welcoming locally-driven door-to-door outreach efforts.
“I certainly think that’s an acceptable premise and activity to be occurring,” the official said.
Spokeswomen for the governor’s office and DHSS didn’t respond to questions about the basis for the “federal troops” remark or who discussed the matter with Parson’s staff.
At a news conference last week, Parson indicated he supports local efforts to explain the vaccine. “I’m supportive of that. I am fine with that,” he said.
In that respect, Parson and the White House are in agreement. The Biden administration has stressed the importance of respected local figures in persuading individuals to get vaccinated.
“Because whether it’s the president of the United States or the governor, sometimes those aren’t the people you trust. Sometimes that is too partisan or political for people. We understand that,” Jen Psaki, the White House press secretary, said last week. “That’s why we rely on and we’re funding, and empowering, local trusted voices who aren’t seen through a political prism.”
Vaccination soft sell
Parson’s response to door-to-door outreach, where he lobbed an explosive suggestion that he and his administration later softened, resembles his approach to vaccinations, but in reverse.
The governor has stuck to a soft sell approach, even as delta’s grip tightens, refusing to adopt the hard sell of other leaders.
His incentive program, which will ultimately award $10,000 cash prizes or scholarships to 900 winners, has generated significant early interest: 250,000 have registered in the first week.
Vaccinations have been rising in Missouri since early July, from an average of 7,234 shots per day on July 5 to 11,988 on Friday. DHSS reported 15,948 vaccinations on Friday, the largest number of shots given on a single day since June 9. On Monday, Parson said on Facebook the number of doses requested across the state tripled over the past week.
Still, it is not certain that the sign-ups will translate long term into substantially more vaccinations.. The daily volume is still is well below spring levels of 40,000-80,000 shots a day and unlikely to ever reach those levels again.
When it comes to his spoken comments, Parson regularly encourages Missourians to consider getting a shot. His official social media presence also features messages such as, “we encourage anyone age 12 and up to get vaccinated to help protect themselves and those around them.”
He has avoided the more forceful exhortations of some other Missouri leaders, however. When speaking publicly, he tells Missourians to “consider” getting the shot, and in late June told reporters people would have “to take responsibility, to take the vaccine, if you so choose to.”
“Most certainly, we’re not going to mandate anybody take the vaccine,” Parson told reporters last week when asked why he qualifies his appeals. “I mean, at the end of the day, we’re not going to do that.”
Reinhart, the health communications researcher, said it makes sense that he doesn’t want to pressure Missourians into getting the shot, but that state officials should pair that message with positive ones about vaccination.
“Any time that you’re telling people, ‘You have to,’ there’s always the chance that they’ll boomerang back the other way and say, ‘You can’t tell me what to do,’” she said. “So I think it’s positive to say, ‘I’ve gotten vaccinated,’ and to make it more of a social norm that people are getting vaccinated.’”
In the meantime, other officials have become more unequivocal proponents of vaccination. On Monday in south St. Louis County, Republican state Reps. Jim Murphy and Michael O’Donnell hosted a back-to-school vaccination clinic with the Mehlville Public School District. Six Springfield lawmakers, both Republicans and Democrats, are hosting a similar event at Missouri State University this weekend.
Even a top Parson administration official, acting health director Robert Knodell, issued an outright plea for Missourians to get the shot last week, on his personal Twitter account.
“Enough is enough. All this rhetoric against COVID vaccines is a bunch of baloney,” Knodell wrote. “You don’t have to trust me...consult your family physician or pharmacist. If you don’t want to protect yourself, do it to protect your family, neighbors, or strangers who may have vulnerabilities putting them at grave risk you may not even know about.”
Parson himself rebuked vaccine misinformation the day prior, when announcing the incentive program. Speaking directly to Missourians, he asked the public to turn off “all the misinformation, all the people that have a political agenda to talk about this virus.”
But he later said he meant The Star, the St. Louis Post-Dispatch and the Missouri Independent.
Reinhart said as governor, Parson’s role should be to point out the urgency of the situation, and that local outreach workers and community members could take on the soft-sell instead.
But she emphasized that leaders at all levels needed to impart a consistent message, “ensuring that everybody comes out saying, ‘For sure it’s your choice, but the preferred way to go is to get vaccinated,’ especially in those areas which are in really, really tough shape.”
“I understand that the governor doesn’t want to create fear, but at the same time I think we’re in a situation right now where we need to be honest about how bad things are,” she said.