For a century, Cooperative Extension agents have helped Virginians identify garden pests, set up household budgets and raise 4-H livestock.
Now they’re trying on a new role: vaccine educators.
Virginia Cooperative Extension is part of EXCITE, a nearly $10 million national initiative that aims to harness the research and communications expertise of land-grant universities like Virginia Tech and the reach and reputation of Extension agents to spread accurate information about COVID-19 vaccines.
“There’s so much misinformation out there that it’s very easy for people to have concerns, especially when they maybe either don’t have access or are not sure where to go for credible, reliable information about these vaccines,” said Christy Gray, director of the Division of Immunization at the Virginia Department of Health, who has been consulting with the Virginia EXCITE team. “We’re really trying to empower messengers, trusted messengers, to get this information out.”
With more than 100 Extension offices across the state, and programming that ranges from 4-H to personal finance, agents are well known and tend to be trusted in their communities, said project leader Kathy Hosig, an associate professor and director of the Center for Public Health Practice and Research at Virginia Tech. Virginia State University, the commonwealth’s other land-grant university, also is a partner in the project.
“Extension is becoming more and more acknowledged as a really great way to get to local communities with scientific information,” Hosig said. “Which we’ve known all along, of course.”
Hosig’s team, which includes Virginia Tech faculty members and Extension agents, is interviewing residents, holding focus groups and fine-tuning its educational materials and presentations, which discuss vaccine facts and fictions and provide up-to-date local information about vaccination rates, cases and hospitalizations.
They’re targeting people who are hesitant about the shots, Hosig said, not those who are virulently anti-vaccine. “We’re trying to reach the people who actually are able to listen and are still thinking about it,” she said.
According to VDH data, 68.2% of the state’s population was fully vaccinated as of Jan. 13. But vaccination rates vary wildly by location and demographics. In Carroll County, for instance, just 39.3% of the population is fully vaccinated, while in Albemarle County it’s 75.5%.
Based on VDH data and what they heard in their communities, the EXCITE team decided this spring to focus on several groups that tended to have lower rates of vaccine acceptance: rural and Appalachian residents; agricultural workers, particularly migrant workers; Black and Latinx residents; and military personnel.
Geographically, they settled on 10 localities: Craig County, Martinsville/Henry County, Tazewell County, Grayson County, Patrick County, Portsmouth, Prince George County, Hopewell, Norfolk and Petersburg.
Gray said some things have changed in the months since the project proposal was written; service members, who once showed relatively low vaccine acceptance, are now required to be vaccinated, for instance, and vaccine uptake among Latino residents has increased.
But, she said, there’s still plenty of work to be done; there’s a need to educate military families, for example, on why the vaccine is safe and effective. And according to VDH data, less than half of fully vaccinated people in Virginia have received a third dose or booster.
And rates of infections and hospitalizations have recently hit new records in Virginia as both the delta and omicron variants continue to spread.
“Vaccines really work best at a population level,” Gray said. “If there’s still spread, then it allows the virus to create these variants.
“That’s why we want to make sure people realize the vaccine is safe, it’s effective, it’s important you get it,” she said. “It’s important that you follow these recommendations that are based off of these studies that are being done when natural waning immunity is happening, and getting things like the booster.”
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Extension agent Brian Hairston, who’s based in Martinsville and is part of the EXCITE team, thinks it makes sense to enlist fellow agents in the vaccine education effort.
“We are out in the field,” he said. “We are the go-to people for everything. Everyone in every community knows Extension.”
Residents come to his office with questions about insects and personal finance and 4-H projects.
And he hears plenty of questions about the vaccine, too: How was a vaccine developed so quickly when we still can’t cure cancer or AIDS? Why should we put this into our bodies when we know so little about it?
“It’s very important to hear the people in the community, what they have to say, how they feel about it, what can be done about it,” Hairston said. “You have some that are against it, and I want to know why.”
He doesn’t ask whether people are vaccinated; he doesn’t want to scare them off from having a conversation. “But if people want you to know that they’re vaccinated, they’ll say it,” he said. “If they want you to know they’re against it, it’ll come out when you’re interviewing.”
Later this month, he’ll interview members of a local rescue squad where some people are vaccinated and others aren’t. He’s also planning to set up in the lobby of the Henry County administration building. It’s personal property tax season, he said, so there will be a lot of people coming and going.
“I’m just going to sit over in the corner and have my video camera up and just pull random people out,” he said. “‘Hey, you want to talk about the vaccine? Come over here and talk to me.’”
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While Cooperative Extension might be best known for its work with 4-H and other agriculture-related outreach, health is a key part of its mission. For decades, the agency has offered programs that focus on topics such as nutrition and diabetes management; in recent years, it launched an opioid education effort as use and misuse of painkillers surged.
But most of what Extension agents do is noncontroversial and apolitical. So they’re having to figure out how to tread carefully through the highly charged vaccine landscape so that they don’t turn off the people they’re trying to reach.
They’ve been encouraged to rebrand the written materials and presentations provided by the CDC to make sure they resonate with their particular audiences. A brochure bearing a CDC logo might not play well with people who don’t trust the government, Hosig said; a Virginia Tech or Virginia State logo might be better received.
They’ve also done some editing as they’ve reviewed the materials. In a slide show meant to be shown at community events, for instance, they got rid of references to “common myths” about the vaccines, fearing that the language could alienate people.
“If they truly believe something – like that you’re being chipped with the vaccine, or that you’re going to be sterile with the vaccine, that kind of thing – if we lead with calling it a ‘myth,’ then they may just say, ‘Well, you don’t believe what I believe’ or ‘You don’t respect what I believe,’” Hosig said.
So they changed the language. “We call them ‘concerns,’” she said. “That way, it’s more of a validation that they’re concerned about it. But then we do provide the facts behind it.”
Another challenge discussed during the monthly calls with other project sites: What if the people tasked with taking the vaccination message into their communities aren’t actually comfortable talking about it?
Extension agents are Virginia Tech or Virginia State employees, so they fall under university vaccine mandates, Hosig said. But even if they believe that the vaccine is important, some of them might be reluctant to push that message out into a community that’s not receptive – and perhaps risk harming the relationships they’ve built.
“They don’t want to be seen as someone who’s talking about something that people don’t want to talk about,” she said. “It could affect their relationships for the other programming that they’re doing. That’s something we need to respect.”
The team is using some of its funding to hire local people to conduct community interviews, focus groups and surveys, both to help address that concern and to ease the workload of short-staffed Extension offices, Hosig said.
The $200,000 grant is intended to cover two years of the project. It’s barely enough to do what they want to do, Hosig acknowledged. They’ve been getting a lot of unofficial in-kind support from people who believe strongly in what they’re doing, she said.
“The whole point of Cooperative Extension is to get science-based information out to local communities,” she said.
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The EXCITE team’s role is educating residents, not providing vaccinations. But the information that is gathered could help the Health Department fine-tune how the shots are disseminated, Hosig said – if they discover, for instance, that transportation or clinic hours are barriers to getting vaccinated, more mobile clinics might be a solution.
While the immediate focus is on COVID-19 vaccinations, the work won’t end there. The goal is to build a framework for promoting all adult vaccinations: shingles, tetanus, diphtheria and the rest.
“Vaccines so often … are seen as just for kids, something you get when you’re younger,” Gray said.
For several years, the state has had an adult vaccination program that mirrors efforts to get kids vaccinated. It uses state and federal money to provide shots to adults who couldn’t otherwise afford them.
VDH will be working with EXCITE to set up an infrastructure to create what Gray hopes will be a “new normal” – an expectation that adults need to be vaccinated, too. And a more universal understanding of why.
“A lot of behavior and personal decisions you make really do stem from stories and from relating to other people, not just a series of facts,” she said. “Knowledge is not enough. Stats, facts are not enough. You need to be able to relate to it and understand the true impact.”