What’s Behind Rural Presidio County's Vaccine Success Story?
Presidio County in Far West Texas is hours away from major hospitals and lacks some basic health care services, but the county’s vaccination rate has far outpaced most of Texas.
By Travis Bubenik
On a recent night in the tiny West Texas town of Marfa, the pandemic felt almost like a memory.
Locals and tourists gathered around picnic tables outside a hip hotel, sipping Lone Star as a singer’s quiet melodies and guitar strumming wafted through the cool desert air.
Refreshing as it was, the scene was in some ways a mirage, as health workers across the nation are still rushing to get people vaccinated in their race against new COVID-19 variants.
Though more than half of U.S. adults have now received at least one shot of a vaccine, experts and the Biden administration are raising concerns about not enough rural Americans getting vaccinated. In Texas, where the statewide numbers generally mirror the national trend, vaccinations are still lagging in many rural areas.
Still, in Marfa and the surrounding Presidio County, health workers have done a remarkable job getting people vaccinated, especially for a typically underserved borderland region hours away from major hospitals and lacking in some basic health services.
As of April 23, more than 85% of the 7,000-or-so adults in the county have gotten at least one vaccine shot — well above the statewide percentage.
So, naturally, locals are loosening up.
“I am hugging friends when I see them now if they’re fully vaccinated, grandkids are coming over and visiting and spending the night,” said Marfa resident Pat Meckfessel.
Meckfessel said she’s been “pretty rigid” with health precautions throughout the pandemic, and even now she’s still following the Centers for Disease Control’s continued guidance and wearing a mask when she’s in public spaces.
Still, she described a kind of new world she’s now living in after getting both shots.
“I would think about going out to eat and sitting outside when I was in Marfa and then I’d think, well, I really don’t have to do that, it’s safer for me to stay home,” she said. “But now, I’m quite willing to go to Al Campo and sit on the patio and meet friends, and it feels nice.”
Health workers say this rural county’s impressive vaccination numbers are largely thanks to an aggressive push from the beginning.
“We have a habit of complaining and yelling really loud when we don’t get anything,” said Don Culbertson, a physician assistant at the Marfa Country Clinic who’s been a driving force behind the local vaccine rollout.
Culbertson said local officials were quick to ask the state for help when vaccine supplies first arrived in Texas, knowing the region might get left in the dust otherwise.
“I think our voices were raised ahead of time saying, ‘Hi, we need vaccines down here,’” he said.
Addressing the obvious, Culbertson said it’s probably easier in general to vaccinate thousands of people than it is to vaccinate millions in a place like Houston. Still, he said, Presidio County’s remoteness did make it hard to reach some older people who don’t have reliable internet or aren’t that computer literate.
On the flip side, the everyone-knows-everyone nature of the county’s small towns made his job easier. His staff could simply sit down and say: “Who do we know that needs a shot?”
“In rural communities, there are often much stronger social ties,” said Valerie Smith, a physician in East Texas who sits on a COVID-19 Task Force for the trade group Texas Medical Association.
“What we’ve seen are some communities where you can literally go to the mayor or to the person who directs the public health district, and they could tell you immediately, ‘Oh, these are the high-risk people in our community,’” she said.
Various other cultural factors have likely played in Presidio County’s high vaccination rate as well. In a place where people are used to driving long distances for simple errands, many, including Pat Meckfessel in Marfa, had no problem driving two or three hours to get a shot.
“Didn’t mind the drive and I just, you know, wanted to get this thing rolling,” Meckfesel said.
For months now, hospitals in the bigger cities of West Texas like Midland and Odessa have served as de-facto vaccine hubs for the entire region, making the shots more accessible than they would otherwise be to far-flung towns like Marfa and Presidio. Those hospitals have even given away some of their own supply to smaller hospitals and clinics scattered across the region.
Plus, according to Culbertson, Presidio County frankly just got lucky when it comes to people actually wanting the shots.
“We didn’t do any work about promotion or any evangelical work about how important it is,” he said. “We were extremely fortunate with that.”
Still, that experience has not been the case across the entirety of West Texas, in large part just because of how different the region’s politics and cultures are from community to community, factors that affect how people view vaccines.
“El Paso is definitely a more vaccine friendly, or ready, community than the Permian Basin,” said Rachel Sonne, Regional Medical Director for the Texas health department’s West Texas office.
Sonne said even with Presidio County’s success so far, there are still challenges ahead. The entire West Texas region, even Presidio County, is seeing the same kind of drop in vaccine demand that’s happening nationwide, she said.
Sonne and her colleagues are now focused on working with communities at the hyper-local level to convince people to get the shots.
“The idea is we’ll get some people vaccinated, and then those people are going to go home and not grow a third ear, not become sterile,” she said. “It takes time, and it takes the components of community.”
President Biden, meanwhile, has committed billions of dollars to ramping up vaccine availability in rural areas, along with low-income areas and in communities of color, part of the administration’s broader outreach strategy in rural America.
Editor's Note: An earlier version of this story referred to Presidio County's vaccination rate as second only to Cochran County in the Texas Panhandle. Days after this story was published, the Texas health department revealed Cochran County's vaccination numbers were based on erroneous data, so that reference has been removed.
Additionally, an earlier version of this story said Don Culberston is a doctor. That is incorrect. His title is physician assistant.