Even as rural Texas lags in vaccinations, COVID-19 is diminished statewide

Nicole Cobler
Austin American-Statesman
Julie Chen, 18, receives the Johnson & Johnson COVID-19 vaccine from Sovit Bista, owner of Auro Pharmacy, on April 11, 2021, in Austin, Texas. Auro Pharmacy and Open Eyes Beyond Border hosted the weekend event.

Texas COVID-19 hospitalizations are at their lowest point in over a year as the state has more than half of its eligible residents vaccinated against the coronavirus, a promising sign that comes months after Gov. Greg Abbott lifted his statewide mask order and moved to let businesses operate at 100% capacity.

Abbott has touted the state's vaccination numbers and declining COVID-19 cases, but parts of Texas are still reporting low vaccination rates. Interest in getting the vaccine has waned, and health experts warn that COVID-19 could continue to spread unless local and state health officials find a way to inoculate more Texans.

Roughly 200 of Texas' 254 counties have yet to reach 50% of eligible residents vaccinated with at least one dose of a COVID-19 vaccine, a benchmark set by the Texas Department of State Health Services. That number declines further when including children younger than 12, who aren't yet authorized to receive the vaccine but can still spread the virus.

Even the state health agency's goal of 50% is significantly lower than experts' estimates of the percentage of the population that must be protected from the virus to reach herd immunity, the point at which each infected person transmits the disease to an average of fewer than one other person, and it starts to die out. Dr. Anthony Fauci, the nation's top infectious disease expert, has said the needed number could be as high as 85%.

President Joe Biden has set a national vaccination goal of 70% of adults by July 4, a threshold Texas is not close to reaching, even as several states have already surpassed that mark and others are poised to meet it. In neighboring New Mexico, nearly two-thirds of adults are fully vaccinated and three-quarters of adults have received at least one shot.

Areas with low vaccination rates risk a resurgence of the disease, especially as new variants spread, U.S. Centers for Disease Control and Prevention Director Rochelle Walensky warned earlier this month.

"We have pockets of this country that have lower rates of vaccination," Walensky said. "I worry that this virus is an opportunist and that where we have low rates of vaccination are where we may see it again. And so really the issue now is to make sure we get to those communities as well."

State health officials are strategizing on how to improve the numbers in much of Texas. Imelda Garcia, the state health agency's associate commissioner for laboratory and infectious disease services, said officials regularly monitor vaccination data to determine where to focus outreach efforts.

The rate in East Texas is among the lowest in the state, with fewer than 40% of eligible residents in most counties in that region having received a dose of the vaccine. Meanwhile, vaccination rates in the state's urban counties and the Rio Grande Valley are over 60%.

"We know there are still a lot of Texas counties that are below that threshold," Garcia told the American-Statesman. "We're really trying to think outside of the box. How do we capture more willing individuals in a way that's really simple for them?"

State health officials have shifted efforts to target East Texas, using roving local health officials and military teams to go directly to residents. The Texas Department of Transportation has offered vaccine clinics at some rest stops and will expand the program in the coming weeks, Garcia said.

MORE: Texas health officials launch $1.5M ad buy to encourage COVID-19 vaccinations

The state health agency also made a $1.5 million investment to encourage Texans to get vaccinated as demand declines. The agency launched TV and radio ads and 22 pop-up events in Walmart parking lots. 

"In the rural areas, it may take a little bit more of a lift to get it done," Garcia said, adding that those areas have seen a promising uptick in vaccinations among older populations. "They are continuing to increase the numbers that are being vaccinated collectively."

Early surveys showed a gap between Black and white Americans, but more recent polling found that political party and geography best reflect the nation's vaccination gap, with Republican men least likely to get vaccinated over skepticism about the danger of the coronavirus and general distrust of vaccines. 

That divide is clearly illustrated in the vaccination map of Texas, which echoes the outcome of the 2020 presidential election: Counties carried by Biden are seeing much higher vaccination rates than many of the rural counties that preferred former President Donald Trump by wide margins.

Lagging behind

On the Texas-Louisiana border, Newton County has one of the lowest vaccination rates in the state with just over 21% of the county's 11,888 eligible residents vaccinated with at least one dose, according to state health data Friday.

Panola County, also on the Louisiana border, has vaccinated nearly 27% of residents with at least one dose.

Both counties are among 11 Texas counties that remain below 30% vaccinated. By comparison, Travis County is poised to hit 70% of eligible residents vaccinated with at least one dose. Harris and Dallas counties are at nearly 60%, and El Paso County is over 73%.

Austin Public Health nurse Nikki Richardson-Rafferty administers a Moderna COVID-19 vaccine to Ruby Fisher at a vaccine clinic for musicians and music-industry professionals at Emo’s on Friday April 16, 2021.   The Health Alliance for Austin Musicians collaborated with Mayor Steve Adler and the City of Austin, Austin Public Health, C3 Presents and Sendero Health Plans on the first of two vaccine clinics where 800 Austin musicians will receive their first dose of the Moderna vaccine.    The next HAAM vaccine clinic will be on April 29.

The Texas vaccination rates are calculated using the state's eligible 12 and older population, rather than the entire population count. Until the vaccines are approved for emergency use for children under 12, expected this fall, it will be difficult to reach herd immunity in Texas and the rest of the country.

Texas lies somewhere in the middle compared with the rest of the country when including children under 12. Roughly 46% of the state's population has received at least one dose and nearly 40% are fully vaccinated. Meanwhile, California stands at nearly 60% vaccinated with at least one dose. Vermont has the highest rate in the country, with more than 72% of the state vaccinated with at least one dose.

Still, coronavirus cases and hospitalizations remain low in Texas.

That's thanks in part to the high vaccination rates in metro areas, said Dr. Rajesh Nandy, associate professor of biostatics and epidemiology at the University of North Texas Health Science Center at Fort Worth. Many of the state's urban areas could be close to 80% immunity, Nandy said, when including those who have natural immunity through a previous infection. 

But rural areas have yet to see significant COVID-19 spikes since the winter surge, early in the vaccination rollout, which Texas health experts attribute to low population density and the large number of Texans who have "natural immunity" because they've already been infected.

But it's not clear how long natural immunity lasts, and health experts say a COVID-19 vaccine can provide more protection than natural immunity. 

"That's even more of a reason that we need to vaccinate as many people as possible," Nandy said.

Vaccinations and natural immunity

Even if the state doesn't reach a target goal for herd immunity, a major outbreak is unlikely, Nandy said. 

"We still need to be cautious, monitor the daily cases, hospitalizations, but I don't think it'd be a sudden jump," he said. 

In June, statewide COVID-19 hospitalizations have hovered slightly above 1,500 patients. It's a sharp decline from numbers posted during the pandemic's peak, in mid-January. The state saw a record 14,218 hospitalizations on Jan. 11.

Vaccination efforts targeted at certain parts of the state can help curb the spread of the virus, Nandy said, adding that it's also important to focus efforts within urban areas. If urban areas can increase vaccinations by another 10%-15%, Nandy expects they'll reach a point where the virus can't easily spread.

MORE: As COVID-19 vaccinations in Texas pick up the pace, how close are we to herd immunity?

"Urban areas are most susceptible to sudden outbreaks because people live in close proximity," Nandy said. "Even though the percentage is much higher compared to rural areas, there are still a lot of people who are not vaccinated. If we can take a more targeted approach in the urban areas, that can also take us a long way."

Spencer Fox, associate director of the COVID-​19 modeling consortium at the University of Texas, said UT models show declining or plateauing hospitalizations in most regions, similar to the picture in spring 2020.

"It's a combination of a lot of factors," Fox said. "There's a significant level of immunity in the population. ... A significant proportion of the state has been infected, so even with low overall vaccination rates, I think there's generally high levels of immunity in the population."

Members of the public are seated during Monday night's Smithville school board meeting. The school board voted, 6-1, to revoke the school district's mask requirement for students, teachers and staff members.

Many Texans also changed their behavior, despite Abbott ending the mask order and expanding business capacity, and they also have been spending time outdoors, where the virus doesn't spread as easily, Fox said.

Vaccination rates in Central Texas are significantly higher compared with much of the rest of the state, Fox said, but historically vulnerable populations in the region continue to lag behind. 

"It's important that even though our vaccination rates are high, that everyone in our community still continues to try to get the vaccine into those pockets of vulnerability that still exist," Fox said.