AVONDALE, Ariz. — Under the bright lights of the Phoenix Raceway, as 100,000 people gathered to watch NASCAR drivers hurtle toward this year’s championship, a small battalion of nurses and trainees took on an even more daunting challenge: convincing attendees to get vaccinated against Covid-19.
At three tents, dotted around the sprawling raceway complex and a nearby campground, about a dozen nurses, paramedics, and student nurses handed out free sunscreen, hand sanitizer, and ear plugs — all the NASCAR essentials — while exhorting visitors to tack on a Covid vaccination. Armed with smiles and fliers about the updated booster, they approached attendees gently, stressing the convenience: The tent is right there, no wait, it’ll be over in a minute.
Over the three days they were there, they convinced 263 people to get flu shots and 250 people to get Covid-19 shots. Three people got their first-ever Covid-19 shot; three got their second primary dose, according to the Healthy Trucking of America, which coordinated the tents along with the Biden administration. Nurses and volunteers handed out 20,000 pamphlets about the updated vaccine and said they convinced some people to get the shots back home, after the party weekend — a respectable turnout, considering that at least one tent was competing for attention with neighboring booths, one advertising nicotine pouches and the other touting the world’s best bloody mary cocktails.
It’s a modest dent in stagnating vaccination rates as public health officials attempt to rally fatigued Americans before an expected winter surge, but among a key group of vaccine holdouts: rural, largely conservative Americans. The NASCAR tents are also a flagship test of federal health officials’ now yearslong strategy to build Covid-19 vaccine confidence by enlisting people, from religious leaders to local organizers, in their trusted communities, to take on the challenge that has eluded public health officials for nearly two years now.
“I love being out and being able to talk to people and see people … in something that’s more of their element,” said Sonia Paredes, a student nurse who worked the Friday shift at a tent that neighbored the Idahoan brand booth, where visitors waited in line for free mashed potatoes. “They’re NASCAR fans, that’s why they’re here; you’re not invading their space.”
But as dozens of people happily sought boosters and applauded the convenience of the tents sprinkled around the raceway, many others did not approach them and told STAT they never would.
Keith, who asked to be identified only by his first name, is a former police officer in his 50s who lost his job when the Tucson, Ariz., sheriff’s office required vaccination. He refused and was fired. He and his wife, a nurse who also remains unvaccinated despite getting Covid-19 twice, have since moved from Arizona to Texas, where there are few vaccine requirements or other pandemic-related measures.
“I believe in vaccinations,” the nurse, who also declined to give her name because of her occupation, insisted. Just not these ones. “If you have to get vaccinated every four months, it doesn’t f—ing work.”
Keith’s own brother Dwyane, a retired New York police officer also in his 50s, got the vaccine and subsequent boosters as soon as he could. He pushed back on some of Keith’s assertions as they talked at the Mike’s Hard Lemonade patio in the raceway infield, particularly about supposed risks of the shots. But he also was resigned to his brother and sister-in-law’s stance, telling STAT that his 38-year-old son felt the same way.
“I won’t convince him, he won’t convince me. Unfortunately, it’s a personal decision. Like smoking,” said Dwayne.
The brotherly impasse over vaccine safety reflects a larger national divide on trust in science and health institutions that has turned sharply political in the wake of the Trump administration and amid 2022 midterms campaigns.
Roughly the same share of both Democrats and Republicans — 57% and 58%, respectively — think misinformation about the virus and vaccines has fed problems in the national response to the pandemic, according to an October survey by Pew Research Center. The survey didn’t delve into examples, but they were likely vastly different.
In the same survey, nearly 64% of Democrats think public health officials have done a good or excellent job communicating about the pandemic, while the same number of Republicans rated the officials just fair or poor.
Meanwhile, the vaccination gap between urban and rural areas began early and more than doubled to a nearly 17% difference by April 2022, according to data from the Centers for Disease Control and Prevention. In its report, the agency noted a few potential reasons: difficulty getting to clinics and doctors in rural settings, “historically higher” vaccine hesitancy in these areas, and differing views about the severity of Covid-19 and the need for measures like masking and lockdowns.
In the CDC’s analysis there was just one state where rural areas actually had higher first-dose rates than urban areas: Arizona. However both dropped off significantly when the agency analyzed second doses and boosters. Today, though 80% of Americans have received at least one Covid-19 vaccine, just over 8% have gotten one of the updated boosters from Moderna or Pfizer and BioNTech.
Other NASCAR attendees who spoke to STAT echoed Keith and his wife’s skepticism over how well the shots worked, their side effects, and the pharmaceutical industry. Several aimed their derision at federal health officials such as National Institutes of Allergy and Infectious Diseases Director Anthony Fauci, who has become a national lightning rod in the coronavirus response.
One man, a retiree named Lance R., said he was moving from Mexico to Florida because the state has bucked vaccine requirements and Covid-19 measures under Republican Gov. Ron DeSantis. Lance, who asked only to be identified by his last initial, said he would consider getting a vaccine if 10% of the world’s population died from the virus — a scenario in which he assumed he would not be one of those people.
Of more than 20 people STAT spoke with outside of the vaccination tents, seven had been vaccinated and four — two Germans and two Canadians — had been boosted. The Canadians noted that they had to be vaccinated to get in the U.S.
NASCAR itself has resisted vaccine requirements for its drivers and swerved questions about its stance, though vaccinated drivers who are Covid-19-exposed can return to racing sooner than unvaccinated peers. But if racing officials and drivers were to speak publicly about vaccine safety, they could reach what NASCAR claims are 75 million fans worldwide. Besides the more than 4 million people attending races each year, tens of millions more make it one of the most-watched sports in America, rivaling football.
Biden officials had touted the NASCAR effort in the weeks leading up to the effort, heralding it as an example of meeting people where they are.
“We’re reaching out to folks through trusted messengers — doctors, community leaders, faith leaders; meeting folks where they are with information; and setting up locations where people are — from Head Start locations, to nursing homes, community health centers, even the NASCAR Cup Series Championship at the Phoenix Raceway in Avondale, Arizona, in a couple of weeks,” White House press secretary Karine Jean-Pierre said at a briefing last month.
The Health and Human Services Department is taking an extra-targeted approach in part because of limited funding that is drying up without new allotments from Congress, said one HHS official. An influx of cash is increasingly unlikely, as Republicans who have opposed new spending are poised to take at least one chamber of Congress after the midterms.
“The number of people we get vaccinated at these events doesn’t tell the full story of our impact. We’re here to engage and answer questions, to listen and learn,” said Hannah Kim, an HHS official who attended the championship and spoke to vaccine recipients at the tents. “We’re here to show that we care about their health, and to make it as easy and accessible to get their shots — when they’re ready, where they already are.”
Several people were. Two Air Force veterans who stopped by said they’d been meaning to get the new booster — why not now. A dog groomer named Jessica Trausch went to get her mother and son from their campsite and bring them back for a multi-generational boost. A retiree who called himself Bub admitted to his wife, upon seeing the tent, that after some confusion at the pharmacy last week, he’d only gotten his flu shot then — he’d get the Covid-19 booster now.
“I want to live my life,” he said about his reason for getting boosted.
Jenny Williams, a 35-year-old real estate agent, stopped by a tent after buying one of the world’s best bloody marys, and asked about the safety of vaccinating her 2-year-old. She told STAT she would do it next week.
Amy, a 60-year-old customer service agent who works remotely, is not physically mobile enough to reach or even notice the tents, but saw nurses wandering through the campgrounds and approaching people about vaccinations. After some questions, they brought a booster shot from the tent to her RV.
Amy, who declined to give her last name, wasn’t required to get a vaccine for work, though her husband, a service tech for long-haul trucks, was. “We’d never had the flu shots or anything,” said Amy. “This Covid thing kind of threw us for a loop, like everybody else.”
As the sun set on Friday, the first day of the major races, nurses and paramedics packed up the extra vaccines, pamphlets, and freebies. They were tired and sore, but optimistic.
“I was pleasantly surprised,” said one student nurse, Amber. “Only one person was mean to me today.”