CRISFIELD — At the Crisfield City Dock near the southernmost tip of Maryland, within view of the wastewater treatment plant’s towering, crab-emblazoned wind turbine, David Brown and his wife lowered chicken legs into the water — one in a crab pot, another on a fishing line. They caught their first crab within about 20 minutes.
A 68-year-old former septic truck driver, Brown lit a Virginia-purchased Marlboro Gold cigarette, which he called “my pleasure in life,” despite his doctor advising against smoking because of his emphysema, high blood sugar and high blood pressure. He also has no plans to get the COVID-19 vaccine.
“It’s just not for me,” he said. “I take enough meds now. … I live every day for what I can.”
Rural Somerset County has struggled to reach — and then persuade — its fewer than 26,000 residents to take the coronavirus vaccine, county health officials say. As a result, the vaccination rate in Maryland’s second-least-populated county has stubbornly remained the state’s lowest.
On the bayside, bordering Virginia, Somerset is home to just over 8,500 households and includes the University of Maryland Eastern Shore, Princess Anne, Crisfield and Smith Island. It is fairly conservative politically and went more for Donald Trump in the 2020 presidential election than in 2016. It’s also the state’s poorest county, with a higher proportion of its people living in poverty than anywhere else.
Brown, who moved to the area from Edgewood about four years ago, said his neighbors typically wave to one another but don’t know one another’s names. Many in the remote county feel a sense of isolation, and therefore insulation, from the pandemic and other problems, he said.
“There’s nothing down here but farms and watermen,” he said. “They’re not worried about all that. They’re just trying to get through the day.”
County Health Officer Danielle Weber scheduled 19 pop-up vaccination clinics in June, but that mindset is one reason some clinics have seen as few as just a person or two show up for shots.
It hasn’t always been that slow. Somerset took just under 90 days to reach 10% of its population being fully vaccinated, the same pace as Baltimore City and more than a week faster than both Charles and Prince George’s counties.
But vaccinations leveled off more quickly than in other jurisdictions: It was the fourth-slowest jurisdiction to reach 20%, and has since lagged all other state jurisdictions. Nearly two-thirds of Howard County’s residents are now fully vaccinated, leading the state; meanwhile, Somerset has not yet reached 40%.
Weber said the county’s geographic isolation is exacerbated by a lack of adequate public transportation and spotty internet connectivity in many homes that makes reaching people difficult.
She is exploring Somerset-specific solutions, including gas cards and other incentives, she said. Partnerships with the state and organizations in the county have provided staff and space for testing and vaccinations.
Rural areas are typically less health literate than urban ones, but politicization of the vaccine and hesitancy among the county’s significant African American population have combined to keep the COVID-19 vaccination rate low, said Richard DeBenedetto, assistant professor in the University of Maryland Eastern Shore’s School of Pharmacy.
It isn’t as simple as planning a clinic: The county’s main population centers, Princess Anne and Crisfield, are “two separate areas that are worlds apart,” he said, “and most people don’t live in either of them.”
Even the lack of local news outlets based in the county hurts the effort, DeBenedetto said, because those seen encouraging vaccinations on TV and in other news outlets are perceived as outsiders.
“You’ve got to change people’s attitudes and get the key influencers in the community on your side,” he said. “That’s really what’s needed. ... I believe we’ve done some work with that, but it hasn’t been everything we need, by any means.”
Craig N. Mathies Sr., president of the county board of commissioners and a pastor at Zion Baptist Church in Cambridge, promoted vaccines in a county health department Facebook video and enlisted other pastors to urge their congregations to get the shots, the county health officer said.
“What’s going to be powerful for us now, in this stage of trying to get people vaccinated,” Weber said, “is word-of-mouth.”
No shot, no ‘Bat Cave,’ no beer
John Brittingham’s girlfriend and sisters got vaccinated, but he initially resisted when they pressed him to get his shot, too. The 58-year-old Westover man was far from the only one in Somerset County who wanted to “wait to see what happens.”
The final straw for the former wastewater management worker with a disability came when his friend declared that the “Bat Cave,” as they fondly refer to their favorite hangout area in the house, was off-limits to unvaccinated visitors — along with the Michelob Ultra in the fridge.
“‘I don’t want you in the Bat Cave if you ain’t got a shot,’” Brittingham said his friend told him. “‘And don’t touch my damn refrigerator.’”
Nearly three dozen people showed up to a June 23 clinic at the Somerset County MAC Center, mostly for second doses. Before the door opened at 12:30 p.m., Brittingham and six others lined up outside, near a sign advertising Somerset’s “Trails, Streams & Breathtaking Scenes” and a set of solar panels.
“I’d rather be safe than sorry,” he said. “It’s not like they’re charging you for it.”
Douglas Kidd also got his vaccine at the center that day. The 59-year-old mechanic said it was a fitting place to get vaccinated, since his two daughters went there when it was an elementary school and now both work as nurses. He lives about a half-mile from the site, which now houses the county health department and a senior center.
“I’m all for vaccination,” he said. “It’s the way to go. I’m tired of wearing a mask.”
Carmela Singer’s desire to spend time with her grandchildren motivated her to get the shot, she said. But she has friends who are “afraid of what’s going to happen in the future,” she said, referring to fears about the rapid development and approval of the vaccines and lack of long-term testing.
“They’ve made up their mind,” she said. “There’s nothing I can say.”
The retired dental technician and her husband, Robert, enjoyed lunch in the sunshine at the Crisfield dock, near where the Browns were crabbing, with their grandson John Boncore, 19, a rising University of Maryland, Baltimore County sophomore who lives in Ellicott City.
Singer agreed with Brown about many living in such a small, spread-out county: “It’s so isolated here, they don’t care,” she said. “They feel like, ‘You’re not going to get us.’”
‘This is serious’
Getting to them is Wanda Mumford’s job. Every day takes her someplace new — fast-food restaurants, libraries, apartment complexes, hotels, even a landfill. She pleads with people wherever she can find them.
Mumford’s brother died of COVID-19 six months ago, not long before she joined the Somerset County Health Department in February. After contracting the virus herself, the 62-year-old retired Perdue Farms recruiter said, she inadvertently infected other family members.
“Look, this is serious out here,” she tells vaccine skeptics about the pandemic. “I lost a brother to it. I personally had it, and I infected my whole family.”
Mumford is one of just three outreach workers at the forefront of the county’s effort to boost its vaccination rate. She estimated about 1 in 10 people reject her entreaties to even talk about the vaccines. But her job is rewarding when others tell her they’ve gotten their shots or promise to attend one of the health department’s upcoming clinics, she said.
The Maryland Department of Health has taken note of Somerset County’s lagging vaccination rate and has been targeting the county with efforts to improve it since March, said Charlie Gischlar, a state health department spokesman.
The state’s Vaccine Equity Task Force launched its mobile clinics in Somerset County and opened one of the state’s first independent pharmacy clinics at Marion Pharmacy in Crisfield, he said.
“We have sought to innovate and provide as many different options as possible for county residents to get vaccinated,” Gischlar said.
After only one resident agreed to get a shot at a pop-up clinic at the Princess Anne Townhouses, Mumford returned to the 120-unit affordable housing complex to make another pitch to residents, she said.
“I‘m going back to talk to them today to find out what happened,” she said, “and let them know that we do have another clinic this afternoon that’s not too far.”
‘Like we haven’t had enough deaths already’
Less than a mile from the townhouses, Nellie Yardim got into the car with her daughters after an afternoon run to the Princess Anne Food Lion.
The 34-year-old recently quit her job as a cleaner at Sysco Eastern Maryland, she said, because she wanted to find a different opportunity and spend more time with Nae, 13, and Khy, 4.
Yardim’s mother and grandmother got COVID-19 vaccines, she said. But she hasn’t yet, and neither has her older daughter. The CDC has authorized the Pfizer vaccine for minors 12 and older.
“I believe if God wants me to get [the vaccine], He will put me in a position where I have to get it,” Yardim said.
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Children will play a big role in persuading unwilling parents to get the vaccines, said Mamie Saunders, after helping her elderly mother into the passenger seat of her car in the grocery store parking lot.
But Saunders worries they won’t be persuaded in time to prevent the pandemic’s death toll from rising. At least 40 people in the county have been killed by COVID-19 and more than 2,600 people have contracted the virus, according to the state. Nearly all COVID-19 deaths now are among unvaccinated patients.
“You’re going to have to let people make up their minds,” she said, adding: “Like we haven’t had enough deaths already.”
Brandon Green saw the drop-off in vaccinations firsthand over the past few months.
The pharmacist at a Rite Aid in Pocomoke City, just over the county line from Somerset, said he sees just 10 to 20 people come each day for vaccinations, down from 30 to 40 per day earlier in the spring.
“For the most part, the adults who are going to get it have already gotten it,” Green said of the vaccine. “Now it’s kind of like pulling teeth.”
Baltimore Sun data journalist Steve Earley contributed to this article.