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This rural, red southern county was a vaccine success story

MEIGS COUNTY, Tenn. — At a glance, it looked like a Southern pandemic success story in the most unlikely place.

A small county to the northeast of Chattanooga, along the twisted shores of Lake Chickamauga, has reported one of the highest COVID-19 vaccination rates in Tennessee for the past year and one of the highest in the South.

Meigs County, which is highly white, rural and conservative – three demographics that correlate strongly with low vaccination rates – has broken a pattern of hesitation and mistrust that has stymied vaccination efforts across America.

“They’re a rural county, and they have the highest vaccination rates in the state,” Tennessee Gov. Bill Lee said in September.

If only it were true.

According to a KHN review of Tennessee’s vaccination data, the rate in Meigs County was artificially inflated by a data error that attributed much of Tennessee’s county-level vaccination rates to tens of thousands of doses in the wrong counties. . When the Tennessee Department of Health quietly corrected the error last month, county rates shifted overnight, and Meigs County’s rate of fully vaccinated people fell from 65% to 43%, well below the state average and Rural is moderate in the south.

A building displays a mural with text that reads, "Decatur," In bright colours.
A mural welcomes visitors in Decatur, a town in Meigs County, Tennessee. Meigs County reported the highest COVID-19 vaccination rate in the state over the past year, but the rate was pushed up due to a data error.(Brett Kellman for KHN)

The Department of Health blamed the error for the software of STCHealth, an Arizona company paid $900,000 a year to host and maintain Tennessee’s vaccination information system. STCHealth offers similar services to at least eight other states, and officials in West Virginia and Montana said zip code errors affected their county-level vaccination data as well.

The data error misplaced vaccinations of Tennessee residents who live in zip codes who live in more than one county and incorrectly attributed all vaccinations to areas that include most zip codes. Meigs, with a population of 13,000, was credited with about 2,900 additional vaccinations, mainly from neighboring Ronne County.

The reverse occurred in Moore County, which was labeled the least-vaccinated area of ​​Tennessee. Many of Moore County’s vaccinations were incorrectly administered in surrounding counties, and once the error was corrected, the rate nearly doubled—from 21% to 40%.

An infectious disease specialist at Vanderbilt University Medical Center in Nashville, Dr. William Schaffner said the zip code error is a symbol of the country’s crumbling public health infrastructure. Reports of diseases and vaccinations from local hospitals and clinics through county and state governments and eventually the federal Centers for Disease Control and Prevention, “all with different computer systems and levels of training along the way,” he said.

Schaffner wondered: What if Meigs County gave Tennessee leaders false confidence in rural vaccination efforts?

“Good data doesn’t guarantee good decisions,” Schaffner said. “But the faulty data – ah! – you can be sure they make the wrong decisions.”

In Meigs County, residents said they had long suspected such high vaccination figures in an area where many openly distrusted vaccines. When told of the data error, some lamented the county’s once-envy rate. Some got up. Some were surprised.

“If I had a million dollars and I could make a bet, I’d bet this place isn’t the tallest,” said Meigs County hemp shop owner Steven Voisin.

Betty Pillian, a longtime resident working in the county mayor’s office, insists that the data error should not overshadow the county’s arduous effort to vaccinate every interested resident — even if the total is ultimately less than half.

“To be from this county and to know that we worked hard enough to get to 44%, we will take it,” Pillian said. “It’s better than 10%. Or 0%.”

Tennessee Department of Health spokeswoman Sarah Tunksley first confirmed the ZIP code problem in February and said a software update from STHealth is expected to fix it. The Department of Health stopped waiting for that software update on April 1 and assigned its employees to the correct counties with geocoding vaccination data.

The fix reshuffled the rates and rankings of counties on Tennessee’s COVID-19 website, with the most dramatic changes occurring between smaller and narrower counties with more partial zip codes. The CDC still publishes inaccurate statistics daily.

Two people walk past a building on a sunny day in Decatur, Tennessee.
For most of the past year, Meigs County reported the highest COVID-19 vaccination rate in Tennessee and one of all counties in the South. But the rate was increased due to data error.(Brett Kellman for KHN)

The health department declined to make the data available to any officials to discuss the error in detail or answer further questions. STHealth initially agreed to an interview with KHN, but canceled after more details were provided about the focus of this article. The company did not respond to additional requests for comment.

There are indications that Tennessee Data knew about the problem long before it was confirmed or fixed.

Dr. Michelle Fiscus, who was removed from her position as Tennessee’s top vaccine official in July amid anti-vaccine political pressure from state lawmakers, told KHN that the health department knew as of last year that county-level data was skewed was because it was drawn. The CDC and the public are to be notified from the state’s Immunization Information System, known as TennIIS.

Fiscus said TennIIS was designed long before the pandemic to track routine vaccinations across the state and was not used to calculate county rates.

,[TennIIS] Pre-Covid has never been used to generate county level reports on vaccination rates, as the data has always been incomplete,” Fiscus said. “When the data was extracted, each zip code had to be specified as a county because there was no other good way to do this.”

Alison Adler, a spokeswoman for the West Virginia Department of Health, said the state records vaccinations from zip codes that cross county lines just like Tennessee “most of the time.” But, Adler said, the state takes steps to make the data more accurate once it is received from stealth.

Megan Grotzke, a spokeswoman for the Montana Department of Health, confirmed that the state has faced similar issues in “isolated instances” where zip codes straddle county lines and said the agency has “attempted to fix these.” “

Other states seem to have avoided the issue of zip codes before skewing their public vaccination data. Health department officials in Arizona, Louisiana and Ohio — all of whom employ the same services of STHealth as Tennessee — said COVID vaccination data is geocoded by the agency to ensure vaccinations are delivered to the appropriate county or parish. is responsible for.

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