Tennessee faces more reluctance to take the COVID vaccine than just about any state in the country, judging by the state’s comparatively low COVID vaccination rates. But even the surveys don’t allow for people to explain the nuance of their hang-ups.

So WPLN asked listeners to put their most complicated concerns into words.

A handful told us they’re anti-vaxxers: They don’t take other shots, so why would start with this one?

Quite a few people said that, simply, there hasn’t been enough research on the long-term effects of the vaccines or that they’re approved only for emergency use right now. There’s truth to both of those points, though experts say there’s far more risk associated with COVID than the vaccine.

Then a fair number cited the roughly 1% mortality rate of COVID in the U.S., which to them, felt low even though it’s resulted in 12,200 deaths here in Tennessee and is 10 times that of seasonal influenza. Ultimately, they’re more afraid of the vaccine than the virus.

“I only know a hand full of people that have had it, and none of them have had severe,” says Chris Freeman of White House. “Risk getting it: moderate; severe disease: low; death: miniscule. Concern for others is zero because managed risk.”

Some misgivings are complex

Pregnant women and new mothers have had special concerns. One from South Nashville said she was encouraged by the recent studies showing the vaccines are safe for pregnant women. But she was just a few weeks away from delivery and figured it wouldn’t hurt to wait. Not to mention she doesn’t want to deal with the potential for side effects, which could make you feel crummy for a day.

A breastfeeding mother from Lebanon wanted more information on what she’s passing to her child and notes that there has not been much research on this front.

Many of the issues are related to personal health conditions. A woman in West Nashville said she wants the shot but her doctor discouraged it because she’s had some strange symptoms lately that they want to get figured out. Another from North Nashville has had a strange reaction to cortisone injections — she lost the ability to speak for a while — so she just didn’t want to test her luck with the vaccine.

A woman from Bradyville in Cannon County said she wants the vaccine, but she has anxiety about medications — an irrational fear that they could be life-threatening. She says she’s working up the courage.

A wait-and-see vaxxer

There is also a sizable “nobody can convince me to take this shot” crowd in Tennessee. About 45% of white, rural conservatives said basically that, when the Tennessee Health Department conducted its more scientific survey a few weeks ago.

Other surveys and even real-world vaccination data in the South have linked support for President Trump to hesitancy.

“There’s a rabid subset of conservatives who just go into panic mode and ‘trust no one’ becomes their motto. And when you have friends who are like that, it’s weird,” says Daniel Sinclair of Spring Hill, a recent transplant from California who works in software development.

He responded to WPLN’s callout to hear from people who have held off on getting vaccinated. And he’s thoughtful about his reasons for reluctance. Sinclair says he doesn’t totally trust pharmaceutical companies. But he generally trusts scientists and public health experts. And he’s done his homework.

He knows that there is a second generation of shots around the corner. So he’s starting to think he may hold out, because they’re supposed to be more protective against the new strains of the coronavirus.

“If we wait longer, maybe more of the things that were missed in the very quick testing may come out,” he says. “So if we wait, instead of just getting a booster [in a year], we’ll be able to get just that one [shot] and avoid any complications with the ones that were first to market.”

But it’s getting increasingly hard to find people like Sinclair.

Despite surveys finding that a majority of holdouts remain convincible, researchers at Vanderbilt University Medical Center are having a difficult time locating them. The hospital is one of the trial sites for Moderna’s variant vaccine. They need people like Sinclair who are willing to get the vaccine and just haven’t yet. They’re finding that most people who were highly motivated to get vaccinated have already done it.

We’re still listening

Last week, Gov. Bill Lee removed the authority of most of Tennessee’s county mayors to impose mask mandates in their local communities. But what does that mean for schools?

Chalkbeat’s Marta Aldrich reports many are likely to keep them, at least for the rest of the school year.

Lee said it’s time to shift Tennessee’s focus away from COVID-related restrictions — and toward recovery. Lifting mask mandates is a key step in that direction, he said. But Lee’s press secretary clarified later that school systems have the authority to set their own mask policies based on local public health conditions.

Dale Lynch, who heads the Tennessee Organization of School Superintendents, says most Tennessee school leaders expect to continue mask and social distancing requirements for the rest of the academic year — if that’s been their policy so far during the pandemic.

“Obviously our students, our staff, and entire communities have worked with local boards of education and superintendents and administrators to put these safety protocols in place, and they’re working,” he says. “That’s how we got back in school in the first place here in Tennessee. That’s how we’ve been able to stay in school. And so I think that being so close to the end of the school year … we’re almost to the finish line and we don’t want to stop.”

Still, there may be some changes ahead, according to Lynch. He says district and school leaders will need to decide whether to require face coverings during summer school, graduations, and other end-of-year programs — especially those that are held outside.

The U.S. Centers for Disease Control and Prevention continues to urge schools to prioritize universal and correct use of masks and physical distancing, even outdoors if in crowds.

The 10-day safety pause on the Johnson & Johnson COVID vaccine didn’t seem to weaken demand in Nashville. The city resumed using the one-shot vaccine in the past week and has seen it become the preferred option.

Health officials wanted to give people a choice after the J&J doses were pulled for a safety review related to a rare blood-clotting reaction in a handful people, most of them women. So when Metro began using J&J again last Tuesday at the old Kmart site on Murfreesboro Road, they made sure to give people the option of taking the Pfizer shots instead. But they found most people didn’t want it.

“It was the longest line we’ve seen in a couple of weeks, and they were there for the Johnson & Johnson,” says Metro Health’s Rachel Franklin. “It was very promising.”

One the first day, twice as many people asked for the one-dose option. Later in the week, demand was split 50-50 between Johnson & Johnson and Pfizer.

There have been fears nationally and in Nashville that the safety pause would scare people away from getting the Johnson & Johnson vaccine, which just happens to be the easiest to use.

In Tennessee, the city of Nashville has been the biggest user of J&J doses, giving 10,000 in one day at Nissan Stadium and a few thousand at Hadley Park near Tennessee State University, targeting the center of the city’s historically Black neighborhoods.

While the Murfreesboro Road vaccination site will continue offering Pfizer doses as an option, the city is relying on the one-shot J&J vaccine popup events, including over the weekend at Hadley Park and this coming weekend at the Tennessee Craft Fair.

Slowing vaccinations

While Nashville has led most of Tennessee in vaccination rates, the demand continues to slow. Roughly 40% of residents have at least one dose. At the Murfreesboro Road site, fewer than 150 people a day were being vaccinated last week — less than half of what’s expected. And that’s despite no longer requiring appointments.

City health officials say they are encouraged that the numbers are better for anyone 55 and over, with roughly two-thirds having at least started vaccination. Racial and ethic gaps are also shrinking, now with a larger share of Hispanic seniors vaccinated than any other group tracked by the city.

As expected, adults under age 35 are the slowest to get vaccinated. Dr. Gill Wright, the city’s medical director, says getting that group vaccinated would help protect those who can’t be vaccinated and could prevent a surge in youthful patients like has been seen in Michigan.

“This is especially important for parents, older siblings and family members,” he says. “Help protect children for whom the vaccine has not yet been approved.”

Tennessee’s 89 counties where the state controls the local health departments no longer have the authority to issue local mask mandates.

Gov. Bill Lee signed an executive order removing local mask authority Tuesday morning.

He also requested that Davidson, Shelby, Hamilton, Knox, Sullivan and Madison counties lift any remaining mask requirements and COVID-related business restrictions. Davidson County has not announced an end to indoor masking, though on Tuesday morning Nashville did announce an end to all capacity restrictions.

“COVID-19 is now a managed public health issue in Tennessee and no longer a statewide public health emergency,” Lee says. “As Tennesseans continue to get vaccinated, it’s time to lift remaining local restrictions, focus on economic recovery and get back to business in Tennessee.”

A widely available vaccine changes everything and it’s a new season in Tennessee. I am not renewing any public health orders because COVID-19 is no longer a health emergency in our state.

— Gov. Bill Lee (@GovBillLee) April 27, 2021

While vaccines are widely available, the state’s vaccination rates have begun to slow down. And Tennessee already had among the lowest vaccination rate in the country.

Only about 24% Tennesseans have been fully vaccinated statewide. Roughly 34% of residents, however, have received at least one dose.

In response to the tapering demand, county health departments will now offer a walk-up vaccination options for Tennesseans aged 16 and older. Nashville began offering shots without appointments last week but has seen far less uptake than expected.

Nashville will soon have no more limits on the size of gatherings, from restaurants to rock concerts. Tuesday morning, city health officials announced that starting May 14, capacity restrictions are a thing of the past.

Mid-May is six weeks after vaccinations opened to everyone, meaning most who’ve been vaccinated will have their full immunity.

“By us doing this, it’s not us saying mission accomplished,” says Dr. Alex Jahangir, the city’s coronavirus taskforce chair. “The public health emergency is still in effect. But we have to tone things down, and this still is a step-wise fashion.”

The city’s first public health order was implemented March 17, 2020. Each iteration is listed here.

Jahangir has been signaling for several weeks that he feels there’s less and less need to impose restrictions when highly effective vaccines are readily available. The city has even been offering walk-in vaccinations without appointments at the Music City Center, but it isn’t using half the doses allotted for those.

Mayor John Cooper had a goal of 50% of Nashville residents vaccinated by May 1, but the shots have slowed down with roughly 40% having at least one dose. Still, that’s a higher rate than all but a handful of Tennessee counties.

Nashville’s mask mandate will remain in effect for now, even though most other counties in the state are allowing them to expire.

On a sloppy spring day in mid-March, hundreds of Kurdish Americans gathered in a field in Antioch under a sea of black umbrellas. Some of the men carried a stretcher to an open grave, with a yellow backhoe waiting.

In Muslim tradition, the body of Imad Doski was buried within 24 hours of his death — another casualty of COVID-19.

This was just six weeks ago. And it was a wakeup call to Nashville’s Kurdish community — the largest in the U.S.

Doski is one of the founders of the Salahadeen Center, which has served as the primary place of worship and Muslim teaching for Nashville-area Kurds.

“Like, it hit people. They saw it happen to one of them,” says Faiza Rashid, a nurse practitioner at the Amed Family Clinic, the largest Kurdish-run practice in town. “It hit home.”

Doski was in his mid-50s, relatively healthy.

That prominent death softened many Kurds to the idea of vaccination, Rashid says. After Doski was in critical condition, the Salahadeen Center even scheduled vaccination events with the city health department.

But even as people have started to come around, new questions are emerging. A top concern is about Ramadan, which runs through mid-May. Many Muslims are careful not to break their daily fast. The local imam weighed in, saying the vaccine does not count as sustenance.

Workers with Metro Public Health provide vaccines at the Salahadeen Center in Nashville.Courtesy Salahadeen Centervia Facebook

Nurse practitioner Redor Abdullah says he’s been telling even more conservative Muslims it’s not worth waiting a few more weeks.

“I would recommend you get it and make up your fast another day,” he says. “It’s better than getting the virus.”

The public health department has had to lean on health care workers like Abdullah to get these messages across because they don’t have Kurdish workers.

At the Salahadeen Center vaccination events, the people giving the shots are mostly white and English speaking. Sumaya Muhamed is a freshman at Belmont University who trained to give COVID shots since she works part-time at a pharmacy.

“About 70% of the people who go to Salahadeen are just Kurdish speaking, so they would all be at my table because nobody else knew how to help them,” she says.

It’s beyond practical questions about safety. Muhamed says they’re dealing with past trauma.

Most came to the U.S. as refugees after spending years in various refugee camps. And while there, vaccinations were not a choice. And they weren’t always safe. Muhamed says many developed infections.

So their questions about the safety of the vaccine, while easily answerable, are understandable.

“I don’t blame them,” she says. “I would be asking the same thing if I went through that too.”

Her own mother, Suad Abdulla, has been among those with too many questions to get her shot early on. Abdulla is now an English language instructor in Metro Schools, but she lived in refugee camps as a child and still has scars from vaccinations on both shoulders.

“As far as I know, the reason we have the scars is they were not switching syringes [between patients]. They were just putting it over the fire to sanitize it and use the same needle to inject us with the vaccinations,” she says.

The distrust is deep. And at this point, it’s not a question of whether COVID is a serious threat.

“That belief is there,” Abdulla says. “But as far as the vaccinations, that it will 100% protect me from this illness, that has not been proven to us.”

And yet, her daughter — the pre-med student and pharmacy technician — kept working on her, explaining how the vaccines work and how effective they’re proving to be.

It took a while to convince her.

“But eventually she gave in, thankfully,” Muhamed says.

Her mother said she would take the vaccine on one condition — that someone Kurdish give it to her. So her daughter saw the opening and, at a Salahadeen Center event, gave her mom the first dose before she could change her mind.

Aegis Sciences, a Nashville-based lab company that has focused on COVID testing since the pandemic began, has now been tapped to help the country track rapidly spreading COVID variants.

Lab director Matt Hardison tells WPLN News that Aegis is one of several national lab companies that have signed contracts with the Centers for Disease Control and Prevention to perform genome sequencing. Aegis will be expected to sequence 10,000 positive tests each week for nearly a year.

The samples would come from around the country and be representative of a local outbreak. For instance, a county might send 100 positive samples, and if 33% are found to be the U.K. variant, epidemiologists could assume roughly a third of new cases are the more contagious variant.

Rapid sequencing did require Aegis to upgrade lab equipment and retrain lab personnel who’ve primarily conducted the  standard RT-PCR test that confirms COVID. Hardison uses an analogy to explain the difference between the two.

“If somebody reads you a few pages out of any one of the Lord of the Rings books and they mention Frodo, and the ring and Gandalf, you’re probably going to have a good idea it’s a Lord of the Rings book. And that’s kind of the RT-PCR,” Hardison says. “But you’re not going to know which book it is without reading the entire thing or at least a large section of it.”

Last week, the Biden administration announced it will spend $1.7 billion to increase surveillance of the variants, which have led to surges in Michigan and the Northeast.

Fewer and fewer people are getting vaccinated at Nashville’s primary hub for COVID shots. So first doses will stop being offered at the Music City Center on May 7.

The site will close completely at the end of May, giving everyone time to get their second dose at the same place. The facility will also be able to return to hosting meetings and conferences.

“We’re just seeing a significant fall off in the number of people that are coming through to get vaccinated, and it doesn’t make sense to have that much space when we’re only seeing smaller and smaller numbers there,” says Dr. Gill Wright, interim health director for the city.

Until closing, the city will also offer as many as 1,000 walk-in vaccinations on weekdays. The option to come without an appointment only started this week, but only about 150 a day have been showing up.

Curious Nashville: Tell WPLN News Why You’re Holding Off On The Vaccine

The Metro Public Health Department will continue its new drive-thru site on Murfreesboro Road and pop-up vaccination events at houses of worship and community centers. Private health systems will also continue to provide vaccines, and they have plenty of supply at this point.

“You literally could walk down the street and get a vaccine right now,” Dr. Alex Jahangir, the city’s coronavirus task force chair, said at Thursday morning’s press conference. “We have made every ample opportunity for people.”

Nashville’s vaccination rate, with roughly 38% of residents having at least one dose, is higher than most other counties in the state. Still, the city will likely fall short of its goal to hit 50% by May 1.

Public health officials say the recent hesitancy can be attributed to a combination of factors: the news of the safety concerns about the Johnson & Johnson vaccine as well as the continued plateauing decline of new COVID cases in Tennessee.

Southern states are seeing a pretty sharp drop off in the pace of COVID vaccinations — and the slowness can’t be blamed on supply. In Tennessee, the vaccination numbers on Monday were less than half of the highest days in recent months, with plenty of shots on hand.

Neighboring states like Mississippi are seeing a similar trend, and this is likely the beginning of a slowdown that was expected, state health officials say. The people who really wanted a shot now have it, and convincing those who don’t is getting harder.

Clint Satterfield is the superintendent of schools in Trousdale County and was hoping to increase his vaccine numbers by offering teachers the one-shot Johnson & Johnson vaccine, which has now been pulled from use for an additional safety review.

“It just raises more skepticism with people, and that’s unfortunate,” he says.

At an event in Trousdale County last week, a company partnering with the schools, AdhereRx, offered Pfizer shots instead, but no teachers stopped by. Franklin-based Adhere Health has been piloting pop-up vaccination clinics in rural communities.

One of the company’s executives, Cyndi Alexander, says her telepharmacy company specializes in “motivational interviewing” to help patients take the medication they’re sent. Similarly with COVID, she says it seems like there are often barriers that could be overcome.

For instance, many think they could contract COVID from the shots, she says, which is easily demystified. They also are concerned about money. At the Trousdale County event, they added the word “free” to the sign because so many people asked about cost.

“There is missing information or there is misinformed information,” Alexander says. “Those are the two reasons they don’t come.”

Rural counties in Tennessee are seeing the slowest uptake. The state’s vaccine tracker shows Grundy County has just 17% of residents with at least one dose. By contrast in the Nashville area, Williamson County, which is also the state’s wealthiest, has topped 40%.

But even urban areas are seeing demand soften. Davidson County is now offering walk-up vaccines at Music City Center. Fewer than 150 people a day are showing up without appointments, though the city was planning for at least 500.

More than half of Tennesseans are still hesitant to get the COVID-19 vaccine, according to state-based surveying conducted this month by the Tennessee Department of Health. But the “why” is often more complicated than a multiple-choice survey can handle.

I know from my own on-the-ground reporting that people have their reasons. So to help us make our coverage more detailed and nuanced, we’re asking you to fill in the form below to tell WPLN News why you’re not getting the shot, at least not yet.