One county’s struggle to control COVID-19 highlights challenges in rural North Carolina

Rufus Duckworth, the mayor of Bladenboro in southeastern North Carolina, said he was shocked when he learned about a COVID-19 cluster in his town. 

But, he said, “A lot of people are weary of the vaccination.” 

Bladen County, home to about 33,000 people, including 1,600 in Bladenboro, is the only North Carolina county currently designated by state health officials as having “critical spread” of COVID-19. 

Nearly 60% of new cases in Bladen County in the past three weeks were reported in one ZIP code in the Bladenboro area, the N.C. Department of Health and Human Services said Friday. 

Dr. Mandy Cohen, the state’s top health official, pointed to the county’s vaccination rate of 33%. The statewide rate is 42%. 

“What’s happening in Bladen County is preventable,” Cohen said in a news release. 

As the number of coronavirus cases continues to drop across the United States and North Carolina, Bladen County serves as a stark reminder of the challenges rural communities face in battling the pandemic, particularly when it comes to convincing people to get vaccinated.

The COVID-19 vaccination rate in rural U.S. counties is 38.9%, while the rate in urban counties is 45.7%, the Centers for Disease Control and Prevention said in a report published in May. 

People are hesitant to get the vaccine for a variety of reasons, said Dr. Terri Duncan, director of the Bladen County Health and Human Services Agency.

Some say they don’t want it if it’s not 100% effective, she said. Others, particularly young people, have concerns about potential impacts on fertility. 

In addition, Duncan said, “Some of the folks that have had COVID don’t see the need to be vaccinated.” 

Duckworth, who is in his eighth year as mayor, said he chose not to get vaccinated because he likely had COVID-19 in February 2020, when he experienced a low-grade fever and lost his sense of taste and smell.

“Honestly, I’m afraid I’m going to have a bad reaction,” he said of the vaccine. (The CDC recommends that people who have had the virus still get vaccinated.) 

Bladen County’s lagging vaccination rate is not the lowest in southeastern North Carolina, which includes some of the poorest and most remote areas of the state.  

Robeson and Sampson counties, which border Bladen, each has a vaccination rate of 24%. To the south in Columbus County, the rate is 31%. 

Drop in demand

More than 13% of COVID-19 tests were positive in Bladen County as of June 28, according to health department data. Statewide, the positivity rate was 2.7%. 

The county had 97 active COVID-19 cases, and 15 people were hospitalized with the virus. 

Since the start of the pandemic, Bladen has had about 3,500 positive cases, and 44 people have died. 

State health officials said Friday that about 81 cases and one death have been linked to the Bladenboro area. 

Duncan said Bladen County had a “model” vaccine clinic earlier this year, when vaccinations began to be distributed. More than 300 people were vaccinated a day, including those who came from other counties, she said.  

A nurse with the Bladen County health department administers the COVID-19 vaccine.
Photo courtesy of Bladen County Department of Health and Human Services

The University of North Carolina at Pembroke even took its mobile vaccination clinics “to the blueberry fields in Bladen County” to serve farm workers, said Cherry Beasley, chair of the school’s nursing department. 

But demand for the vaccine has dropped, as it has in much of the state and nation. Thirty people got vaccinated at the Bladen County health department on Monday, and seven on Tuesday, according to Duncan. 

To help ramp up vaccinations, the agency is hosting a clinic Thursday at the Bladenboro Fire Department. Participants don’t need to schedule an appointment. 

While officials hope people of all ages take part, the recent spike in cases in the county involves younger, white adults. More than 64% of cases are in people younger than 50, and 63% of cases overall are white people, according to the state health department.  

UNC Pembroke’s efforts

The mobile vaccination units were a big hit at UNC Pembroke, said Crystal Moore, director of the school’s Brave Health Center. 

Students “wanted to go to someone they trusted” for the vaccine, Moore said. “We tried to make it as convenient as possible.” 

The university is also offering vaccines this week during the annual Lumbee Homecoming, a celebration of culture among the Lumbee Native American tribe in Robeson County. Beasley said the goal is to administer 300 vaccines on Saturday.

UNC Pembroke has two mobile vaccination units.
Photo courtesy of UNCP

A big part of encouraging young people to get the vaccine is understanding their thinking, Moore said. “Why are they hesitant? What is their concern? And then I try to address that.” 

Much of the struggle in southeastern North Carolina is distrust of the government, Beasley said. From false claims about the pandemic being a hoax to the temporary halt of the Johnson & Johnson vaccine, many people had doubts. 

Some say they are worried because the vaccines have emergency use authorization by the U.S. Food and Drug Administration and have not gone through the full approval process. 

To ease fears, Beasley said she shares her personal experiences. She and her mother both got the vaccine and did not experience adverse side effects, she said. 

“I say to people, ‘I understand your reasoning. Please continue reading. Reach out to me if you have questions,’” she said. “I respect their opinion.”

‘My responsibility’

Duckworth, the Bladenboro mayor, said he continues to wear a mask in public and avoids large gatherings since he is not vaccinated against COVID-19. 

“I just go about it my way, protecting myself,” he said. “It’s my responsibility to take care of myself.” 

However, Duckworth said, a lot of people go to Walmart and other stores without masks, and he doubts all of them are vaccinated. 

Residents should get the vaccine or practice safety measures, he said. 

Health officials have not been able to identify the source of recent cases in Bladenboro, Duncan said. But Duckworth suspects they might be the result of a social event, such as a graduation party or beach trip. 

Duncan is confident the community will turn things around.

“Bladen County lowered the curve before,” she said, “and we can do it again.”