The bearded man in a t-shirt and jeans, leaving his house one morning last week, nodded politely as Annaliese Schroeder handed him a door tag.
She told him the Springfield-Greene County Health Department was holding a COVID-19 vaccine clinic at nearby Dickerson Park Zoo in two days. It was free. Did he have any questions?
He didn’t. He took the door tag, thanked Schroeder and continued on his way.
When a reporter followed up, he was dismissive.
“Nah, I’m not getting vaccinated,” he said, declining an interview request.
Schroeder, a community health advocate for the department, and her colleague Kelsey Conner, a public health information specialist, split up a stack of handouts. They continued their morning canvass in a neighborhood of modest one-story homes near the city’s northern edge.
This is door-to-door outreach in the age of COVID. For all the alarming images conjured by critics — federal agents dispatched to “compel vaccination,” as Missouri Gov. Mike Parson put it, “Beijing-style surveillance,” according to Sen. Josh Hawley, and “KGB style” efforts to “knock down your door,” as Rep. Jason Smith wrote on Twitter — the reality is much more mundane. It is rarely confrontational or insistent. “No” is always taken for an answer.
Those who open their doors are greeted by a woman in her 20s holding nothing but a door tag. The script is simple: a brief spiel about an upcoming clinic, the door tag and a handful of gentle questions. Do you want information about the clinic? Do you know someone who does? Do you have any questions about other clinics, or the vaccines?
The entire interaction can take less than 30 seconds. But the soft-sell belies the urgency of the effort.
Springfield hospitals are buckling under a weeks-long surge in COVID-19 cases, driven by the more contagious delta variant. The health department has asked the state for aid to set up field hospital beds. Missouri, along with Arkansas, Florida and Texas, have generated 40% of the nation’s new cases. The state’s epidemiologist has warned that the unvaccinated are at risk of getting sick themselves, and of allowing the virus to mutate into new variants and spread further.
The vaccination rate in Greene County crept up to 40% this week, matching the proportion statewide. Of the rest, it’s impossible to know how many can be persuaded — by door-to-door or any method.
But demand for vaccines that drove the state to set up a network of mass sites in the early spring has long since ebbed. Instead there are local clinics where, even in the state’s third-largest city, two dozen people showing up is considered a good day. Misinformation and the politicization of vaccines have turned local health officials to a slower, house-to-house person-by-person campaign.
Josh Gollaher and Nikki Schaub turned down a flyer as they walked home to their apartment complex down the street from the zoo. Both told a reporter they were adamantly against taking a vaccine.
“I just don’t want to,” Schaub, 42, said. “I’d rather wear a mask.”
“I’ve gone so long without one,” Gollaher, 29, said. “I know my body.”
Gollaher repeated the internet-baked canard that the vaccine contains a government tracking device. He’s seen it on “every social media.” He said he doesn’t trust the doctors who have studied the spread of the virus, or the city officials who show up to public meetings with whiteboards and data.
“Their studies could be wrong,” he said. “It’ll blow over.”
Schroeder said encounters like that are uncommon for her. Most people, she said, simply have questions about the vaccine. She and Conner are careful not to push back when residents turn them down. They never ask the resident’s vaccination status.
“If somebody is already a little uncertain, being aggressive … is not something that’s going to make them feel more comfortable to come in and get vaccinated,” she said. “It’s a lot about creating that community bond … so when they see us they don’t feel unsafe or threatened.”
Some residents were willing to be enlisted to convince their neighbors.
One woman, holding a garage sale, eagerly accepted some handouts and promised to distribute them to her shoppers. Another said she worried about the man next door, and pointed Schroeder in that direction.
Katie Towns, acting director of the Springfield-Greene County department, called door-to-door “an age-old public health practice” that the department has used for years.
“We have members of the communities that we serve, so people that look just like us will be showing up to possibly talk about vaccines, to answer questions,” she said. “It’s a good, sound public health practice where we can meet people where they are.”
The state health department has said that there are communities where door-to-door simply is not an option. In low-vaccinated Shannon County 135 miles east of Springfield, anti-vaccine sentiment is so high a clinic has offered private rooms for patients who don’t want to be seen getting a shot.
“We’re not going to go knocking on doors,” Shannon health department administrator Kandra Counts said. “We’ve made that very clear to the public.”
In Greene, health officials said they’ve held nearly 10 door-to-door canvasses so far. They’re using surveys at clinics to track the impact in driving turnout, but said there’s not enough data to report yet.
Door-knocking is just one piece of outreach. The rest is equally painstaking: urging conversations between family members, getting local clergy and other non-government community leaders involved.
Last week in Springfield, two pastors appeared with the health department at a press conference urging vaccination.
The Central Assembly of God, whose downtown Springfield church has a congregation near 1,800, hosted a clinic with the health department in June and will do so again this week.
James River Church this week held a clinic at each of its four Greene County locations with the Jordan Valley Community Health Center. More than 200 people came to one.
Carter McDaniel, executive pastor at Central Assembly, said hosting the events has prompted some congregants to ask him questions as they consider getting vaccinated.
“Some people say, ‘OK, well if they’re hosting this here, they must feel OK about it. Let me talk to them about it,’” he said. “A lot of people here have mutual respect for each other … I’m seeing right now an openness from part our congregation that, you want to learn more.”
‘I wanted it to be my choice’
Louella Smith didn’t want anyone to pressure her.
“I was totally against it,” she said.
It wasn’t that Smith, a 60-year-old from rural Aurora southwest of Springfield didn’t understand the dangers of COVID. But like many who chose not to get vaccinated, the stay-at-home caretaker of a niece and nephew said she had “heard so many negative things about” the vaccine and believed it to be dangerous and untested.
The one-dose Johnson & Johnson had been temporarily halted in April over blood clots, which scientists concluded were extremely rare. A family member, she said, died within three weeks of being fully vaccinated. She didn’t know the details, but it scared her.
“Friends at my old church were mad at me. I was like, ‘I’m not putting that in my system!’” she said. “I thought it was something else they were making us do. I wanted it to be my choice.”
Community leaders are well aware it’s a delicate topic.
“I do have some deep personal feelings about it,” McDaniel said, explaining his father is a physician. “I’m pretty careful because there’s nothing in our statement of faith [on vaccines]. I don’t feel like I’m answering that question necessarily always as a spiritual leader or an authoritative person from our church. I think it’s more, ‘Here’s why I made the decisions I made.’”
It was ultimately many conversations with family members that persuaded Smith to get her first dose of the Pfizer vaccine on Thursday at a Springfield fire station.
By last week, her daughter and son-in-law had already been fully vaccinated and she saw that they did not experience complications. Smith said she often travels to see family in Kansas City, and did not want to bring the highly contagious delta variant with her.
She has other relatives who remain opposed to being vaccinated, but hesitated when asked if she would try to persuade them to take the shot.
“For me it was a personal thing and I wouldn’t pressure anybody to do it,” she said. “I try to give them the information I found so that they would think about it as well. I prayed about it, and this is what I felt like I had to do.”