WASHINGTON -- Five areas with low rates of vaccinations -- including two that cover parts of Arkansas -- could put the entire country at risk of spreading new variants of covid-19, according to an analysis from Georgetown University.
The areas with concentrations of unvaccinated residents age 12 and older encompass the northern border with Missouri and the southwestern part of the state near Texas and Louisiana. They are a major cause for concern for health experts.
Georgetown researchers, who have been tracking vaccination rates since December, found that there are about 30 clusters across the U.S. that have lower rates than the national average of 47.8%. The five they have identified as most vulnerable are scattered across eight states and concentrated in the southeastern part of the country, touching Alabama, Arkansas, Georgia, Louisiana, Mississippi, Oklahoma, Tennessee and Texas.
The two clusters in Texas encompass about 140 counties out of 254, said Dr. Shweta Bansal, an associate professor of biology at Georgetown who led the project. Although that's a significant portion of the state, the clusters do not include many of the highest-density cities, which have had greater success with vaccination.
Texas' overall vaccination rate does not paint an accurate picture of the state's danger level, Bansal said. From a glance, Texas appears to be in good shape, with 50.4% of the population age 12 and older -- or 12 million people -- reported as fully vaccinated, according to data provided by the Texas Department of State Health Services. And nearly 14 million people in Texas, or 58%, have received at least one dose of a coronavirus vaccine.
More broadly, the Georgetown analysis raises a number of concerns. For one, nearly all covid-19 deaths in the country were people who weren't vaccinated, according to The Associated Press.
And clusters with lower vaccination rates pose greater threats because each interaction with an unvaccinated person risks a new transmission of covid-19, Bansal said. With every new case of the virus, there is another chance for a variant to emerge. Already, the highly contagious delta variant that was first found in India in December has become the dominant strain in newly identified cases of the coronavirus in the U.S.
In other words, it's no time to let precautions slip, she cautioned.
If a new variant surfaces that is resistant to current vaccines, "it would mean rewinding the clock back to 2020 for all of us, even those of us that are vaccinated," Bansal said.
She noted that certain counties have been doing better than others. For example, Dallas County, Texas, has a 41.2% vaccination rate, while Harris County's rate is 42.5%.
Yet in other counties, especially those in the clusters, some vaccination rates still hover in the low 20s.
"We can decide that we're happy with having two Americas, two Texases, with a line between vaccinated and unvaccinated counties," Bansal said. "But I'm pretty sure we don't want to do that. Interactions are going to continue, and if they do, we'll continue to be at risk."
The repercussions of unchecked transmission in the state would reach nationwide, experts say. The U.S. is not going to be in a stable position until each of these low-vaccination areas is brought up to at least a national average, said Dr. Ben Neuman, a virology professor at Texas A&M University.
"These are the places where the virus is going to have the easiest time to grow and flourish, essentially," Neuman said. "And the variants that come out of these hot spots are going to be problems that the rest of the country and ultimately the world are going to have to deal with."
Public health officials have mounted campaigns to combat vaccine hesitancy, which remains high in Texas. A recently released poll by The Dallas Morning News and the University of Texas at Tyler showed that 1 in 5 unvaccinated Texans have so far resisted making appointments to get vaccinated, with many citing concerns about potential side effects.
Neuman said the Georgetown research is an important move in the right direction. Once public health officials have a clearer sense of where vaccine-resistant areas are, they can better target their messaging and outreach efforts.
"Change has got to come through those communities, and this is a step forward in identifying how to do that," Neuman said.
In Tennessee, health officials have linked a small coronavirus outbreak to last month's meeting of the Southern Baptist Convention, Nashville's first large-scale conference after lifting restrictions on gatherings, The Tennessean reported.
Metro Public Health Department epidemiologist Leslie Waller said eight to 10 infections have been detected among the more than 18,000 attendees, but the cluster is almost certainly larger. It is difficult to know how many other cases there might be because most attendees live outside the state, Waller said. The Centers for Disease Control and Prevention has issued an alert asking health officials in other states to contact Metro Health if they discover more infections that trace back to the event.
Jonathan Howe, a spokesman for the Southern Baptist Convention Executive Committee, said the organization had not alerted attendees about the cluster and that it is working with city and state health officials to identify its next steps.
Nashville lifted its mask mandate and gathering restrictions a month before the two-day annual meeting of the nation's largest Protestant denomination in mid-June. Attendees packed tightly into an 18,000-seat convention hall that included only a small section designated for people who wanted to wear masks.
The gathering may also have attracted a crowd with a low rate of vaccination. In a March poll by The Associated Press-NORC Center for Public Affairs Research, 40% of white evangelical Protestants said they likely won't get vaccinated, compared with 25% of all Americans, 28% of white mainline Protestants and 27% of nonwhite Protestants.
The Baptist event was a long-awaited revival of Nashville's lucrative convention industry. Before the pandemic, conferences accounted for 40% of Nashville's tourism businesses, according to the Nashville Convention and Visitor's Corp.
As the push to get more Americans vaccinated continues, health experts have said they are concerned about people who received their first dose of two-dose courses from Pfizer or Moderna but not the second.
The latest concern centers on the delta variant of the virus, which has spread from India to England and, now, the United States. The highly contagious variant recently became dominant in the U.S., accounting for 51.7% of new cases, according to the CDC.
"Part of the reason we want people to have the full vaccine series is we need protection against these variants. And delta won't be the last variant," said Dr. Richard Zimmerman, a vaccine policy expert at the University of Pittsburgh.
Dr. Amy Crawford-Faucher, vice chairman of Family Medicine at Allegheny Health Network, said she wasn't sure how accurate the data is involving the gap between first and second shots. She mentioned that in May, Allegheny Health Network gave many first doses to college students in Pittsburgh who then traveled back home, potentially out of state, before they were eligible to get their second shot.
"They may well have gotten it, but we don't have access to that data," Crawford-Faucher said.
Even so, doctors are pushing for people to finish their vaccine courses. They emphasize that a single dose -- when two doses are recommended -- may not be enough protection for future variants of the virus.
In Britain, Zimmerman said, health care providers increased the time between the first and second vaccine shots and discovered that one dose was only about as third as effective at protecting individuals from the fast-spreading delta variant than a full course.
A new study by a team of French researchers published Thursday found that receiving just one dose of Pfizer or AstraZeneca vaccine "barely inhibited" the delta variant. However, receiving both doses created a "neutralizing response" in 95% of individuals against the variant, the study found.
As the number of variants increases, Zimmerman said, "you're really going to need the two doses to have enough protection."
During the time between the first and second shots of the Pfizer vaccine, Crawford-Faucher said, a person's immunity increases from only around 20% to about 80% right before their second shot.
If a person were four weeks out from receiving the first shot, Crawford-Faucher added, immunity would still be around 80%. This means that while 80% of individuals in this situation would have "pretty darn good" immunity, 20% would not.
And "you don't know which group you're in," Crawford-Faucher added.
Information for this article was contributed by Raga Justin of The Dallas Morning News (TNS) and by Boyce Buchanan of the Pittsburgh Post-Gazette (TNS)