Ohio and Switzerland counties are both fighting the vaccine culture war. One is winning.

Ko Lyn Cheang
Indianapolis Star

Nestled in the southeast corner of Indiana along the Kentucky border, Switzerland and Ohio counties share much in common: They are rural riverside communities with no major highways. They are overwhelmingly white — both about 96% — and not particularly wealthy, with median household incomes below $32,000.

But in one significant way, these two neighboring counties could not be more different. Ohio County has the state’s third-highest vaccination rate. Switzerland County has the fourth lowest.

To understand why is to uncover what is happening right now in rural Indiana — and across rural America — where a pandemic has become a strange yet entrenched battlefront in a politicized culture war. Where conspiracy theories spread in the local diner. Where vaccine hesitancy can easily morph into vaccine refusal. Where public health has become the curious enemy of a most patriotic American pursuit: freedom.

But this is also a more intimate story about how the smallest county in Indiana emerged as a leader in the fight against a deadly virus by embracing a love thy neighbor spirit. And it is a story — often repeated — of how in small-town America, all it takes to triumph over hardship is a few good neighbors doing the right thing at the right time to protect one another.

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Of Ohio County’s 5,875 residents, 66.4% had been fully vaccinated, as of July 11. Only Hamilton and Boone counties have a higher vaccination rate. For a period of time around March 29, Ohio County was No. 1 in the state for both first dose and complete vaccination rates.

Travel south across the county line and just 27.6% of Switzerland County is fully vaccinated. As of July 11, Ohio County had fully vaccinated 3,404 residents, which is 913 more than Switzerland County, despite being half its size.

The results show for it: Ohio County had two COVID-19 cases in the month of June; Switzerland County had 16.  As it becomes apparent that Indiana won’t achieve herd immunity against the virus soon, if ever, understanding why some rural counties succeeded at vaccinating most of their population where others have failed could be a critical clue in cracking the public health catastrophe that is the COVID-19 pandemic. 

So, what could explain the stark difference in vaccination rates between two neighboring, relatively similar counties? Part of the explanation may be that Ohio County has a slightly older population with just over 20% of its residents being 65 years and older, and so had plenty of people who were both concerned about the virus and able to get vaccinated, said Christopher Walcott, the county’s health officer.

But age alone does not explain the vaccination disparity. After all, 17% of Switzerland county is also of that age group. 

Ohio County’s high vaccination rate was not because people were forced to get vaccinated either: neither of the county’s two largest employers, Rising Star Casino and the local elementary and middle schools, made vaccinations mandatory for their employees.

Funding also does not explain the difference. Both county health departments have budgets that are roughly equal proportionate to their county's size — each receives about $23 per resident in county funding. Furthermore, Dr Scott Frede, the Switzerland County Health Officer, was paid $52,765.75 in 2020 for serving as both the health officer and the physician supervisor of the Nurse Managed Clinic (he told IndyStar about $15,000 of that amount is for the health officer stipend). Meanwhile, Ohio County's Dr Walcott said he is the lowest paid health officer in the state, earning just $4,920 last year in compensation for the role.

Fighting the virus as a community

Rising Sun is a golf-cart-friendly, no-stoplight town where everybody knows their neighbors by name. Walcott moved back to serve as a doctor and medical officer in 2014 because he wanted to work in a community “where I mattered to them as much as they mattered to me."

“There is an issue with health officers not really being a serious role for most people,” said Walcott, who filmed and posted Facebook videos on the Ohio County Facebook page providing COVID-19 updates, advocating safe distancing and debunking myths throughout the pandemic (the page has an impressive 1,428 followers).

Sunday, June 27, 2021, at the Ohio and Switzerland County line. The two counties are divided in their willingness to get vaccinated for COVID-19, with 65% of people in Ohio County getting theirs, while the rate drops to 27% in Switzerland County.

In one of them from Aug. 7, 2020, 39-year-old Walcott said, “I wanted to address a few concerns I’ve heard from the community recently. Number 1: COVID. It is not a hoax. It is very real. I realize that political powers that be have infiltrated the scientific community and caused a fair amount of distrust. My goal for these videos and through our work at the health department is to provide education and hope through proper understanding.”

The work is a labor of love for Walcott, who is the only doctor in the county. He cycles six blocks from his home to the clinic where he works every day. Having spent all his life in the county seat, Rising Sun, except a brief departure to attend medical school, Walcott is a recognizable and, many say, trusted figure in the community.

Part of the secret behind Ohio County’s vaccination success lies within the inconspicuous one-story brick building tucked off Main Street that is the county health department. Here, Walcott and a three-person team of women, all of whom are longtime Rising Sun residents, became the town’s vanguard against the coronavirus.

“Most people know us personally,” said Michelle Otter, the county’s sanitarian of 17 years. Otter is a gregarious woman with a deep-bellied laugh who keeps an otter-shaped tape dispenser on her desk. “My phone would go off at 2 a.m. with text messages,” she said, as county residents constantly reached out with COVID-related questions.

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The work did not stop when they left the office, said Regina Crouch, a self-described “control freak” who has been the health department nurse since 2004. Most days, they spent more than 12 hours at the office. When Crouch and Otter tested positive for COVID-19 during Thanksgiving week, they continued to work from home throughout their quarantine: taking calls, monitoring cases, doing contact tracing.

“It was a once, I hope, in a lifetime experience,” Crouch said. “It was demanding. It was exhausting. At times, it was overwhelming. But so much of that was rooted in the fact that we do truly care about our jobs and our community and always wanted to do the right thing.”

The team was quick to dismiss the suggestion that their health department was exceptional.

“Every health department was like that," Otter said. "We’re not special in that way.” 

But the results suggest that regardless of whether the team was exceptional, the Ohio County health department did what no other department in Southern Indiana could.

The church that became a vaccination clinic

To run a successful vaccine clinic, the health department needed volunteers — lots of them. Even before vaccines became available to Indiana residents in early January, Otter and Crouch began reaching out to their network of fellow Ohio county residents. Former nurses, teachers, and anyone who was good with a computer, they asked. Otter recruited two volunteers from her street alone, approaching a Red Cross volunteer who she knew had workedon-the-ground at Hurricane Katrina one daywhile the neighbor was shoveling snow.

Michelle Otter laughs as she recounts the contents of the box in front of her, containing loads of COVID-19 advisories dating back to early 2020, on Sunday, June 27, 2021, in Ohio County. Otter's work with the Ohio County Health Department, where she is standing, helped give her county the third highest COVID-19 vaccination rate in Indiana.

“I asked, Lynn, would you want to help us with our vaccination clinics?” Otter recounted. “She was like ‘You don’t have to say anything else, I’ll just be there.’ That’s how people are around here. That’s just the heart of people in this community. When there’s a need, or something going on, people are quick to step up.”

The army of 23 volunteers — which included six retired nurses, nine nurses who volunteered on their days off, and four retired teachers — vaccinated as many as 250 people during each 4-hour clinic during their busiest period.

Trudy Warren, 72, was one of them. A retired nurse, she had kept her nursing license active for many years, anticipating that if her town ever faced a terrorist attack, she would want to serve. Never had she imagined that it would be a devastating virus that brought her back into nursing.

“I wanted to be a part of the solution to this problem,” she said.

A local church, the Rising Sun Church of Christ, became the county’s makeshift vaccine clinic. It was one of the few buildings large enough to ensure safe social distancing. Along a sunlit hallway, flanked on one side by picture windows, the volunteer nurses vaccinated everybody who wanted a shot, twice and sometimes three times a week.

Wait times were less than five minutes. At a time when newspapers were reporting about Florida senior citizens who spent hours queuing outdoors in the chilly night to get vaccinated, the smooth, swift clinic experience in Rising Sun was a welcome surprise for many there, said Crouch.

Another strategy the health department used to get as many people vaccinated as possible was to give leftover shots — ones that had to be used at the end of the day or go wasted — to local teachers. The school superintendent Branden Roeder kept a spreadsheet of every teacher who wanted a shot in birthday order.

“We would call the superintendent and say, we have seven shots and they will go to waste in about 30 minutes and he would get teachers here,” said Crouch. The school principal would substitute for the lucky teacher while they raced from the classroom to the vaccine clinic to get vaccinated. “That was another front line of defense. We wanted to keep our schools open. That was very important."

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Warren recalls that people were very upbeat.

"We laugh because we thought, ‘This was a pandemic for heaven’s sakes,’” Warren said. "It was like social hour.”

The church’s lead minister let the department use the church without charge. Other members of the community chipped in to ensure the vaccine clinics ran smoothly: three high school boys — Brad Works, Payton Creech, and Peyton Merica — did the “heavy lifting,” setting up and packing away the medical carts, chairs, tables, trash cans, and all each day to make way for the church’s regular service.

On snow days, Crouch's husband would arrive by 5.30 a.m. to shovel, salt and scrape the church parking lot before work. Town residents would take turns providing pizza, subway sandwiches, fried chicken, pulled pork and other food for the volunteers’ lunches.

The volunteers who staffed Ohio county’s vaccine clinic were all “friendly faces in the community,” Walcott said. “So when (people) see their neighbor or grandmother or someone who used to work in the doctor’s office participating, then they feel much more comfortable about (getting vaccinated). And as people have positive experiences, in small communities like this, word of mouth spreads very quickly.”

For retired Ohio County volleyball coach Shelia Wilson, getting vaccinated was not just a personal choice, but also a social responsibility. She experienced first-hand the damage caused by the coronavirus when her husband of 46 years, Michael Wilson, died of COVID-19 on Nov. 3, 2020. 

“I was not in control at all while Mike was ill,” said Wilson. “Getting a vaccine was something that I could do to make a difference in my own personal health and so that I didn’t spread it to someone else.”

Wilson's husband was one of 11 people who lost their lives to COVID-19 in Ohio County. As a beloved, longtime Rising Sun schoolteacher who was made a widow by the pandemic, she believed her experiences would make her a persuasive advocate for vaccination. On the day she was immunized, the health department posted a photograph of her at the vaccine clinic on their Facebook page.

She added, “I think there is a lot that is unknown obviously, but personally I really don’t understand why everyone doesn’t get vaccinated.”

Vaccine skepticism: 'I just don’t trust it'

Belief in COVID-19 vaccine conspiracies and myths are almost as prevalent in some communities as the virus itself and rural towns in Southern Indiana are no exception. Despite Ohio county’s best and generally successful vaccination efforts, not everyone is convinced.

Sandy Ochs and James Michael “Mike” Sheroan are among them. The couple has owned and operated the popular Main Street Diner in the one-street downtown of Rising Sun since 2010.Inside, along wood-paneled walls, smiling care bears share shelf space with a pair of antique collectible roller skates, and a map of the United States tacked on the wall is scrawled with the names of all 60 countries whose citizens have visited the diner. 

Sandy Ochs and her boyfriend Mike Sheroan own Main Street Diner in Rising Sun, on Sunday, June 27, 2021, in Ohio County. While neither have gotten the COVID-19 vaccine, they live in a county where 65% of people are vaccinated, the third highest rate in Indiana.

A Vietnam war veteran baseball cap hangs on the wall, placed there by Sheroan. He said that when he served in the war, he refused to take the malaria pill, just as he now refuses to get the COVID-19 vaccine.

“I don’t have an attitude about it,” said Sheroan. “If there were cases around here, and it was prevalent and all that, I’d protect myself to protect my customers. I’ve always had this thought: Don’t give it to me so I don’t get it.”

Ochs is a former casino dealer who wears thick mascara and has a trinity knot tattooed on her neck. Her name is like “Ouch without the ‘U' cus I divorced him!” she quipped. She kept her diner open through the whole pandemic by doing takeout — “my saying is “I’m curbside, rain, sleet or shine. No man ain’t got nothing on me,” she said. The diner, where they serve homemade burgers, hash browns, fries and omelets with pepper relish and other special recipes, is their utopia, she said.

“I’m safe in here, nothing can touch me,” she said. “It’s all good, no bad. I think COVID is just going to go away and it’s nothing to talk about. I really do. It was here. It was a pandemic, and how it got so blown out of proportion…”

Because of a blood clotting disorder that gave Ochs a major heart attack in December, the second in her life, she cannot receive the COVID-19 vaccine. But even if she could, she said she would not get it.

“I feel like we’re being forced to do something,” she said. “This is my body. God gave it to me, and I’m just trying to take care of it best as I can. Don’t give me something — I don’t understand it, but I’m not a doctor.”

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Although her doctor and nurses have told her that the vaccine is safe, she said, “I don’t think I’ll ever in my lifetime see the effects of it. I feel like, OK, just like the Holocaust when the Jews were stamped, I feel like that’s what you’re shoving down my throat. Who’s to say you’re not going to turn me into a Zombie. I just don’t trust it and I don’t trust where America is going right now.”

Despite her skepticism about the vaccines, she agrees that the health department, led by Walcott, Crouch and Otter, had done a good job handling the pandemic and vaccinations, although she expressed annoyance that the health department team never came to check the temperature logs where Ochs took and recorded the temperatures of her staff religiously.

Walcott, who was trained as a cell biologist, said the biggest challenge faced by the health department in their vaccination efforts was dealing with misinformation. “Mostly generated from the political sphere,” he added, “with people thinking they’re putting trackers in there, or it changes your DNA or it affects your fertility in the future. Just some really strange, paranoia-type conspiracy theories.”

When consulting with patients who are anxious or skeptical about the safety and effectiveness of vaccines, Walcott uses what he calls “the Socratic method."

“I’m a health educator all day every day,” he said. “You first want to start asking questions. You want to ask, why did you think that? Where did you hear that from? How did you come to that conclusion? So you can understand what their starting point is.”

A stark contrast

Drive along the Ohio River scenic byway, travel 20 miles southwest along winding hillside roads and straight-rowed cornfields and you will arrive at Cuzzs Bar in Vevay, the seat of Switzerland County, where almost three quarters of adults have not opted to receive a COVID-19 vaccine. The largely blue-collar community is home to a large number of farmers and factory workers, many of whom work across the Ohio river in Kentucky steel mills.

The smell of tobacco smoke dominates in the dimly-lit Main Street bar, where an impressive library of whiskey, rum, bourbon and other options perch on the shelf. Not one of the four county residents interviewed in the bar had received a COVID-19 shot. The trend continues down the historic street, where only 15-20 of the roughly 40 employees who work in these downtown businesses have been vaccinated, according to estimates Dr. Frede, by the county health officer.

“I just don’t see the need for it,” said Rhonda Brooks, a 51-year-old who is in the process of buying the bar. “I hadn’t been around anyone sick. I don’t know anyone personally that’s had the COVID. I just don’t feel the need for the vaccine. I have enough health problems. I don’t need to add to them.”

“I think let your immune system fight it itself,” said Lee Edwards, Brooks’ boyfriend. “Build your immune system. I think the vaccine may break immune system down. It’s the way I see it. That’s just my opinion.”

The claim that the COVID-19 vaccine will cause autoimmune disease has been disproven by multiple sources, who say there is no evidence it will do so.

Ultimately, like many people interviewed who did not want to get the vaccine, Brooks emphasized the personal freedom of individuals to decide. “We’re allowed our own opinion, aren’t we?” she asked.

Forty-year-old Ryan Brown, who works down the street in the town’s liquor store, said it is unsurprising most people here refuse to get vaccinated.

“There’s a lot of stubborn people in this county,” he said. “This county is very Republican and they don’t agree (with getting vaccinated).” He has stopped showing the news on the television above the liquor store cashier counter, opting instead for a neutral USA Network drama series because “people get real upset” when they see the news. President Biden, MSNBC, and CNN are some of the triggers that cause people to “flip out,” Brown said.

“A lot of people don’t watch the news anymore around here and if they do, it’s Fox News,” Brown said. Fox News television host Tucker Carlson went under fire from his colleagues in May for spouting anti-vaccination rhetoric and speculating, without evidence, about possible dangers of the vaccine.

Afraid about the risk of blood clots from the vaccine, Brown has received one dose of the vaccine instead of the recommended two doses. He had previously battled a serious blood clot in his leg and spent 41 days in hospital after getting injured in a RZR motorsport accident last year. (Of the three vaccines authorized in the U.S., only the Johnson & Johnson been linked to blood clots, and even then, the risk is about one in a million.)

Brown said he, like many others in his community, used to consider COVID-19 a “hoax.” But his mind was changed during his extended hospital stay when he heard "first-hand" about nurses whose lives were upended by the virus. A male nurse shared about how he lost his sister and brother-in-law to COVID-19.

"He goes, Ryan, the COVID, it's nothing to joke with 'cus it's real," Brown said. "I could trust him. I mean, he was my doctor putting IVs in my arm. That is what did it for me." 

He knew then that he wanted to get vaccinated “to feel safer, and make other people feel safer because I work in a public place,” he said.

Switzerland County: 'A lack of urgency to get vaccinated'

Dr. Frede is a Cincinnati native who took up work as a doctor in the area 20 years ago because he wanted to provide care to a medically underserved community. Switzerland County has poor health access compared to the rest of the state, with only 0.3 primary care doctors per 100,000 people. The state average is 1.5. 

When asked why vaccination rates in his county remain so low, he said, “I don’t believe it is a matter of education. Our community is well-educated and they’re very knowledgeable about the vaccines and the virus itself.”

Shelia Wilson (with her dog Gus) who lost her husband Mike Wilson to COVID-19 last fall, talks about their lives on Sunday, June 27, 2021, in Ohio County. She said that she has had her inoculations. Next door Switzerland County has the fourth lowest county rate of COVID-19 vaccinations in Indiana, while Ohio has the third highest.

He added, “It’s a well-educated, close community, but they're not, however, immune to the politicization of the virus and the vaccine. I do think a rural community has a sense of separation from more densely populated areas, that may lead to that sort of lack of urgency to getting vaccinated, but again I’m speculating.”

Vevay has three districts of Amish people who settled there in 1986 with an estimated population of 470 residents, about 4% of the overall population, according to an Elizabethtown College academic website, Amish Studies. Meanwhile, Ohio does not have an Amish population, according to the site. Frede said that vaccine hesitancy is more common in the Amish community and may explain their lower vaccination rates compared to Ohio county. The statistics offer modest support for this theory: The state's counties with the largest Amish population, Elkhart, LaGrange and Noble, have relatively low vaccination rates of about 39%, 22%, and 35%, respectively. But, again, the Amish represent only 4% of Switzerland's population.

The health department administrator, Carly Archer, defended the work done by the health department and the county's volunteers in vaccinating the population, saying that it was a "positive experience." The county held a vaccine clinic out of the local technology and education center four times a week in the beginning, scaling back to twice a week in May, after which they moved it back to the health department because they no longer had as high a volume of people getting vaccinated.

Frede added that it had been a trying year and the team visited the local jail, casino, nursing home and homebound elderly residents in the town's senior citizen housing apartments to administer vaccinations.

“I’m not here to argue with patients that don’t want to get it and people that don’t want to get it,” Archer said. “Obviously, we are supporters of vaccines and we let them know that. And more often than not people end up scheduling after some education.”

The efforts of the health department to educate their community on the vaccine do not seem to be reaching all those individuals most in need of persuasion.

Brooks, the bar owner, said she has not seen health department staff come to her business at any time to tell them where they could get vaccinated or when they would be eligible to receive immunization.

“We’ve never had anyone checking on us after we opened to make sure we were wearing masks,” she said. “I thought if it was that big of a deal, they’d be coming round and fining people who didn’t have a mask on.”

“You don’t hear the health department trying to get people to get vaccinated or anything. You don’t hear anything about it,” said Lorraine Brown, who is the mother of liquor store worker Ryan Brown. She has received both shots of the Moderna vaccine. “I don’t know what the role is. I hate to say it but I really don’t know what their role is in Vevay. I don’t think they’re too involved.”

Although she said Frede “does the best he can” and “is good at what he does,” she suggested that he needs to be more involved in public messaging about the COVID situation in Switzerland county by addressing the COVID infection rates in the county weekly instead of just once a month. 

When told that town residents said they did not see the health department active in encouraging vaccinations, Frede said, "That makes me sad to hear that but I know what our attempt was and I know we reached out early in the pandemic regarding the mask and I know we reached out regarding the vaccine."

Vaccinating as many people as possible against COVID-19 remains the most effective way to prevent the spread of the disease which claimed the life of 600,000 Americans.

When Shelia Wilson kissed her husband of 46 years goodbye in the emergency room of St. Elizabeth Dearborn Hospital she never dreamed it would be the last time she would see him in person. He was being admitted for a kidney stone procedure.

She had noticed Mike was flushed and feverish while they were watching a Cincinnati Bengals game on television in their Ohio County home the previous day. As a precaution, they went to the hospital. The emergency room nurse chalked it up to a urinary tract infection. Three days later, they found out he had COVID-19.

She had to be quarantined. By the time she was out, her husband was in the intensive care unit, on a ventilator, with pneumonia and impending respiratory failure. Wilson said the doctor could see “the writing on the wall,” and invited her into his ward to be with him — behind a glass window — in his final days. On Nov. 3, 2020, Michael Wilson, a legendary basketball coach who spent 19 years coaching the local Rising Sun High School team to 192 wins, died from COVID-19.

The last conversation Shelia Wilson had with her husband was about the fourth millennium grass he had carefully selected and ordered from Nebraska to plant in the yard just weeks before he fell ill. She told him the grass was growing.

Now, she hopes to plant it around his grave.

She also hopes that her husband's death will serve as a reminder of the need to take the virus seriously and to be vaccinated — regardless of where you live or your politics or the theories shared between bites of a burger at the local diner.

IndyStar visual journalist Robert Scheer contributed to this report.

Contact Ko Lyn Cheang at kcheang@indystar.com. Follow her on Twitter: @kolyn_cheang.