Christina Simone (left) receives her COVID-19 booster shot from registered nurse Akinwumi Cecilia during a mobile vaccine clinic in Hillsville. Photo by Ralph Berrier.

We receive an embarrassing amount of fan mail here at Cardinal News.

Cardinal News is brilliant.

The Cardinal team is on [fire emoji] covering SW and Southside VA!

Great model for filling the legacy media gap.

Some people even send us money so they can see more reporting for and about Southwest and Southside. (You can, too!)

Not everyone sends fan mail (or money), though. One reader recently emailed to object to Ralph Berrier Jr.’s story about why Carroll County has the lowest vaccination rates in Virginia – and the public health nurses who have been trying to change that. The reader’s objection was that the story “seem[s] to ignore the evangelical influence in SW VA, that God will look after ‘us’.”

Let’s take a closer look at this.

It does seem true that white evangelicals have been unusually resistant to appeals to get vaccinated, whether for the good of themselves, their families or the community at large. Surveys have shown that between 31% (Public Religion Research Institute) and 40% (Pew Research) of white evangelicals have refused to get vaccinated – “the highest proportion among any religious group surveyed,” according to STAT, a website that covers health and medicine.

That would certainly help explain why some localities – typically rural localities – have such low vaccination rates, even as they have the highest death rates from the virus. It would also seem to be a better explanation than looking at whether a county voted for or against Donald Trump. After all, some of the vaccines were developed with help from the Trump administration (Pfizer is the exception; it was funded by the German government, so thank Angela Merkel if you got that one), and Trump himself has talked up vaccines – not as enthusiastically or as openly as he could have, of course. Indeed, I’ve written before that the political divide on vaccines isn’t as clear as some might make it sound. Roanoke County is a solidly Republican county, but 72.9% of the population there has had at least one dose, vs. 44.3% in Carroll County. Now, Roanoke County is a suburban county – higher education levels, higher income – and those may well be drivers. So let’s look at other rural counties that vote Republican (which is most of them). My go-to example: Lancaster County on the Northern Neck is a rural county that votes Republican, but the vaccination rate there has typically been one of the highest in the state (currently 75.6% of the population there has at least one dose, even higher than suburban Roanoke County and definitely higher than Carroll County).

So I’m disinclined to regard political preferences (Trump or no Trump) or residential preferences (rural or non-rural) as the driving factors on vaccinations. They may certainly play some role but they are clearly not the sole determinants – otherwise Roanoke County and Lancaster County would have much lower vaccination rates.

So is religion the driving factor on vaccinations?

Conveniently, PRRI – the aforementioned Public Religion Research Institute – has a handy map of religious preferences at the county level.

It shows that Carroll has one of the highest percentages of evangelicals of any county in Virginia – 51% – but not the highest percentage. That survey shows seven other counties in Virginia that have a higher percentage of evangelicals – with Scott County ranking highest at 57%, followed by Buchanan County and Dickenson County at 56%. Two more tie with Carroll at 51%.

If religion were the sole driver, then you’d expect Scott to have the state’s lowest vaccination rate, but it doesn’t. Scott is low – 51.6% – but not the lowest. Dickenson County has a vaccination rate of 55.6%, Buchanan County 54.9%. None of those are particularly good but they’re all distinctly higher than Carroll at 44.3%. Here are seven counties with a higher percentage of evangelicals – and two with the same percentage – that all have a higher vaccination rate than Carroll. I’d be naive if I discounted religion completely as a factor here, but whatever correlation we have isn’t exact.

Now, maybe I’m focusing too much on relatively small percentages, so the difference between the state’s highest percentage of evangelicals or the eighth-highest may not be particularly important. Let’s not quibble over minor differences and lose sight of the big picture. The point is, Carroll has a lot of evangelicals and not many vaccinations so there’s obviously a connection, right? Case closed!

Not so fast.

Do your own research, they say. Follow the science, they say. Well, by golly, let’s do both.

In theory, other counties with a similar percentage of evangelicals as Carroll should have about the same vaccination rate, right?

And yet … how do we explain Wheeler County, Georgia? Like Carroll, it’s 51% evangelical. However, in Wheeler County, only 29% are vaccinated.

Or how about Douglas County, Missouri? Same profile: 51% evangelical, but only 26% vaccinated.

By that score, we shouldn’t single out Carroll County for being the least vaccinated locality in Virginia, we should hold it up for praise for being far more vaccinated than some of these other counties.

If religion is the deciding factor in vaccinations, then it’s obviously not a perfect method because here are two very big exceptions (and I’ve left out a lot of others in the 30% vaccination range for reasons of space). Still, all those examples, wherever they are on the vaccination continuum, do suggest that evangelicism depresses vaccation rates.

Hold on, though. There are also some notable exceptions the other way: Doddridge County, West Virginia, is 51% evangelical; its vaccination rate tops 64% – which puts it on a par with Portsmouth, Virginia, where the evangelical population is just 14%. And then there are localities that have a higher percentage of evangelicals than Carroll County does, yet also have a much higher vaccination rate (examples of that coming below). So maybe this connection between religion and vaccinations isn’t quite as strong as we thought?

Now let’s look at things another way: Are there non-evangelical counties where vaccinations are low? Oh yes there are. There are parts of the Deep South and Midwest, in particular, with exceptionally low vaccination rates. They also have very low percentages of white evangelicals (which is how all the surveys measure evangelicals).

Let’s just look at a few:

Billings County, North Dakota: 25.4% vaccinated, far, far lower than Carroll County. It’s also only 23% evangelical, again, far, far below Carroll’s rate.

King County, Texas: 25% vaccinated. It’s 38% evangelical, which puts it on a par with our own Augusta County, which is more than twice as vaccinated. Even Carroll County, with a much higher evangelical population, is nearly 20 percentage points higher when it comes to vaccinations.

Slope County, North Dakota: 15% vaccinated. It’s also 38% evangelical. Carroll, with a bigger evangelical population, is about three times as vaccinated.

If you look at these statistics deep enough, you do see some correlation with religion – counties with a high evangelical population do tend to be more vaccine resistant, but the connection is not absolute and conceivably could be related to other factors not being measured here, such as education and income. Black Americans are another group that’s often been hesitant to get vaccinated. That’s one reason a lot of counties in the Deep South show up as lightly vaccinated.

The point here is if we’re assigning blame for not getting vaccinated, we can’t apportion that blame solely on the basis of religion, just as we can’t apportion it solely on political preferences or residential preferences. All these things may make good talking points on some cable show or the echo chamber of social media, but the reality on the ground is far more complicated (as it usually is).

Here’s some of that reality: Virginia, for all its faults, has done a better job getting people vaccinated than many other states. Here Carroll stands as a good example. Yes, a good example. As low as Carroll’s rate is, it’s higher than the least-vaccinated county in many other states.

Of the 26 states east of the Mississippi, 11 have a least-vaccinated locality that’s more vaccinated than Carroll County. They are all to the north – Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York, New Jersey, Delaware and Maryland – with the exception of North Carolina (hold that thought). That means 15 states east of the Mississippi have counties that are less vaccinated than Carroll.

Some of those states are close to catching up: The least-vaccinated locality in Michigan is Oscoda County – 41.8% vaccinated (and only 28% evangelical.)

Some aren’t. The least-vaccinated locality in Ohio is Holmes County – 19.2% (and only 33% evangelical).

None of this excuses Carroll’s low vaccination rate but it does put it in context, and the more context I see the less it seems we can attribute the county’s low vaccination rate to religion. Another cultural factor – old-time Appalachian stubbornness – might play a part, too, you know? Except that we see other Appalachian counties with far better vaccination rates and lots of non-Appalachian counties with lower ones (just not in Virginia). North Carolina has one county with a higher evangelical population than any of ours — Wilkes County, with 60%. Wilkes is also classified as an Appalachian county by the Appalachian Regional Commission. Yet the vaccination rate in Wilkes County is almost 62%, which puts it in the same range as Fredericksburg and Richmond in Virginia, which are neither heavily evangelical (16% and 9% respectively) and most certainly not Appalachian. Wilkes County, North Carolina would seem to suggest that being evangelical and Appalachian is not necessarily what’s holding down vaccination rates in Carroll or other Virginia counties.

In fact, North Carolina has nine localities where the evangelical population is the same as Carroll’s or higher — all are officially classified as Appalachian and all have a significantly higher vaccination rate. The lowest is Alexander County, which is 56% evangelical and 57.15% vaccinated — 13 percentage points higher than Carroll. Caldwell County is 53% evangelical and 58.9% vaccinated. The other seven all have vaccination rates north of 60%, often well north. Avery County and Clay County are both at 69% vaccinated, better than Roanoke (63.9%), better than both Spotsylvania County (63.9%) and Stafford County (66.6%) in the urban crescent, better than Newport News (68.1%). The highest is Alleghany County, North Carolina, which is 54% evangelical but has a vaccination rate of 80.9%, which puts it slightly higher than Virginia’s Loudoun County (80.8%), which is definitely neither evangelical or Appalacahian. So is Carroll really Virginia’s least vaccinated county because it has a large evangelical population?

At the very least, this seems a lot like the relationship status that Facebook once had: “It’s complicated.”

Yes, yes it is.

And yet this isn’t: Gov. Glenn Youngkin, despite all the furor over mask mandates, has been very consistent and very vocal about urging vaccines. He’s made two trips to western Virginia – Roanoke and Abingdon – to speak directly about getting vaccinated. He’s put out a public service announcement. He was in Petersburg on Tuesday to talk up vaccines. He could surely do more – we all could – but he’s certainly no anti-vaxxer. I’m not sure he’s gotten enough credit for that. However, Youngkin also says he wants Virginia to do a better job of competing with neighboring states for jobs. Surely part of that equation is going to be how well vaccinated we are. What company wants to locate somewhere where their future employees are likely to miss work due to some sickness they might have been able to prevent?

With that in mind, here’s a curious comparison. Let’s compare each county along Virginia’s southern border with the counties just south of it. Because we cover Southwest and Southside, we’ll start in Lee County – where, as the locals like to say, Virginia doesn’t end, it begins. In a few instances, counties in neighboring states are repeated to make the visual comparison easier. And I might have missed a few cases where there’s just a few miles of border with a neighboring county, but these are the main neighbors.

Lee County: 48.7%

Claiborne County, Tenn.: 48.6%

Hancock County, Tenn.: 36.46%

* * *

Scott County: 51.6%

Hawkins County, Tenn.: 46.43%

Sullivan County, Tenn.: 57.12%

* * *

Washington County: 58.9%

Sullivan County, Tenn.: 57.12%

Johnson County, Tenn.: 41.5%

* * *

Bristol: 56.0%

Sullivan County, Tenn.: 57.12%

* * *

Grayson County: 50.5%

Ashe County, N.C.: 76.02%

Alleghany County, N.C.: 80.9%

* * *

Carroll County: 44.3%

Surry County, N.C.: 64.45%

* * *

Patrick County: 46.8%

Surry County, N.C.: 64.45%

Stokes County, N.C.: 59.77%

* * *

Henry County: 56.5%

Rockingham County, N.C.: 66.14%

* * *

Pittsylvania County: 55.7%

Rockingham County, N.C.: 66.14%

Caswell County, N.C.: 59.08%

* * *

Danville: 61.4%

Caswell County, N.C.: 59.08%

* * *

Halifax County: 61.7%

Person County, N.C.: 73.78%

Granville County, N.C.: 81.13%

* * *

Mecklenburg County: 61.0%

Granville County, N.C.: 81.13%

Warren County, N.C.: 68.74%

* * *

Greensville County: 57.4%

Warren County, N.C.: 68.74%

Northampton County, N.C: 56.28%

* * *

Southampton County: 61.4%

Northampton County, N.C.: 56.28%

Hertford County, N.C.: 60.23%

* * *

Suffolk: 66.9%

Gates County, N.C.: 62.48%

* * *

Chesapeake: 74.0%

Camden County, N.C.: 83.7%

Currituck County, N.C.: 84.0%

* * *

Virginia Beach: 75.0%

Currituck County, N.C.: 84.0%

* * *

Here’s the big picture: West of the Blue Ridge, from Lee County to Washington County, our localities are generally better vaccinated than their neighbors across the border in Tennessee. However, from Grayson County east to Virginia Beach, our Virginia localities are generally less vaccinated than their neighbors in North Carolina – and in some cases the differences are pretty stark, the biggest being that 30.4 percentage point gap between Grayson County and Alleghany County, North Carolina. The gap between Carroll County and Surry County, North Carolina, is 20.1 percentage points. The gap between Mecklenburg County and Granville County, North Carolina, is also 20.1 percentage points.

Are those counties really so different? Or perhaps we should ask: Why are they so different?

Dwayne Yancey

Yancey is editor of Cardinal News. His opinions are his own. You can reach him at dwayne@cardinalnews.org.