Vashon Island isn't avoiding vaccines this time around

Once known for having some of the lowest vaccine rates among local public school districts, it now has among the highest COVID vaccine rates in King County.

Lydia Aguilar draws a COVID-19 vaccine into syringes for upcoming vaccination appointments, March 11, 2021. Dozens of volunteers are involved in the effort to vaccinate Vashon Island. (Ravenna Koenig for Crosscut)

For years, Vashon Island has made local, national and international news for being a bastion of vaccine hesitancy, a place where parents have, in big percentages, opted out of giving their kids the state’s required vaccines.

Which is why it may seem surprising that, when King County began publishing data earlier this year on the proportion of seniors around the county who had received at least one dose of the coronavirus vaccine, Vashon was in the lead — sometimes by a whopping amount. The exact numbers fluctuate day by day — and some people  dispute the county’s math — but on March 10, for example, the percentage of vaccinated seniors on Vashon was higher than some other parts of King County by as much as 41.4%. 

Medical professionals, vaccination volunteers, residents, and public health officials reconcile this seemingly conflicted picture a number of ways. They point to a vaccination rate that had already been rising on Vashon during the past six years; possible differences in how vaccines are viewed by young parents versus the older generation currently making up the majority of those who have received the COVID-19 vaccine; and a situation in which outbreaks of contagious diseases — especially one as disruptive as the coronavirus — tend to prompt high immunization rates in response.

Others have pointed out that Vashon is a small, isolated, increasingly wealthy, mostly white community, where people could get the vaccine without facing some of the health equity hurdles that have been present elsewhere in King County.

On a recent sunny morning, a handful of volunteers in face masks and brightly colored vests stood in a gravel parking lot behind the Vashon Pharmacy. A Honda sedan pulled up, and in the passenger and driver’s seats James Griswold, 78, and Charlene Griswold, 81, rolled up their sleeves for their second doses of the COVID-19 vaccine, which was administered through their windows.

“I like living, so that’s why I’m here,” said James Griswold when asked about his attitude toward the vaccine he’d just recieved. “Just wanted to survive.” He added, “I just hope everything gets back to what used to be normal.”

According to data from King County’s vaccine data dashboard, Griswold is one of more than 2,500 people age 65 or over on Vashon who’ve gotten at least one dose of the COVID-19 vaccine. That’s over 114% of people over the age of 65 estimated to live on the island — an (obviously inaccurate) estimate that Public Health — Seattle & King County said is based on 2010 census data, which was all they had to work with until the 2020 census data is made available.

James and Charlene Griswold receive their COVID-19 vaccine at a drive-through vaccination clinic from members of Vashon’s Medical Reserve Corps, March 11, 2021. (Ravenna Koenig for Crosscut)

James and Charlene Griswold receive their COVID-19 vaccine at a drive-through vaccination clinic from members of Vashon’s Medical Reserve Corps, March 11, 2021. (Ravenna Koenig for Crosscut)

However, members of the Vashon team coordinating the vaccine rollout are questioning the county’s estimate. They point to the 2019 population estimate from the U.S. Census Bureau’s American Community Survey, which approximates Vashon’s 65-and-older population to be 2,942, instead of the 2,271 the county uses. In that case, Vashon’s percentage of vaccinated seniors would currently be 88% instead of the 114% shown in the county’s data dashboard.

A spokeswoman for King County Public Health said the county uses the WA State Office of Financial Management population estimates, which they said is based off the US 2010 Census. They did not provide more details as to why that would cause the population estimate to vary.

The 2010 census data shows a similar picture to the ACS population  estimates, with those 65 and older making up 28.6% of Vashon's total population of 10,624 — or 3,038 people — which would make the proportion of vaccinated seniors 86%. By those estimates, the seniors would be among the most vaccinated in the county, along with those in East King County and in North Seattle and Shoreline, but no longer head and shoulders above those other places.

While some people who don’t live on the island have been taking the ferry to get their vaccine (a couple from Snohomish went through the pharmacy’s drive-thru clinic soon after the Griswolds), each vaccination should be credited to the home ZIP code of the person getting it, so visitors would not be part of the Vashon numbers.

What seems clear, in any case, is that the island — whose reputation for vaccine skepticism precedes it — has a high proportion of older people who have made the choice to get this vaccine.

Vashon is a small town with just two places to get vaccinated: the locally owned Vashon Pharmacy and a Sea Mar medical clinic. And one thing that may explain Vashon’s rapid and widespread vaccination success is the simplicity of the vaccination options and Vashon’s sheer size. It takes a lot less time to vaccinate a high percentage of senior residents when there are only a few thousand of them than when there are 18,678 — as is the case in East King County, the next smallest area of King County after Vashon.

But some features of how the Pfizer vaccine has been stored and distributed also seem to have worked in Vashon’s favor. Until Feb. 25, when new guidance was issued that said the Pfizer vaccine could be stored for up to two weeks at conventional freezer temperatures, those who wanted to distribute the vaccine needed to have some way to keep it ultracold.

The Vashon Pharmacy got its first Pfizer shipment at the end of January. Libby Page, the immunization program director at Public Health, said the agency understood Vashon Pharmacy to be “one of the few providers in King County willing to accept the Pfizer vaccine at that time.” Since the minimum order of the Pfizer vaccine is 1,170 doses, the four Pfizer shipments the Vashon Pharmacy eventually got went a long way. “This resulted in more vaccine available on Vashon per capita compared with other geographic regions of the county,” Page said by email.

The Vashon Pharmacy doesn’t actually have an ultracold storage unit. Tyler Young, a Vashon resident who has owned the pharmacy since 2017, said he’s been using the thermal boxes the vaccine comes in and dry ice it comes packed with to keep it cold. Pfizer delivers a replenishment of dry ice the day after the vaccine arrives, and after that it recommends replenishing it every five days. Meanwhile, the temperature of the box is monitored by a company that lets Young know if it’s getting too warm. 

The Vashon Theater has provided its parking lot a staging area and check-in spot for the Vashon Pharmacy’s drive-through vaccination clinic. (Ravenna Koenig for Crosscut)

The Vashon Theater has provided its parking lot a staging area and check-in spot for the Vashon Pharmacy’s drive-through vaccination clinic. (Ravenna Koenig for Crosscut)

Young thinks the hassles and risks of handling dry ice might explain why this method isn’t being used more broadly. “The handling of dry ice presents, to a corporation, a risk to the employees that they would … mishandle it, freezer burn themselves, expose themselves to the carbon dioide that dissipates from the box,” he said. “I suppose I have a benefit there that as the owner of a business, I can do as I please.” Young said he’s the only one who handles the dry ice, so he’s the only one taking those risks.

In addition to being able to store the Pfizer vaccine, Young believes Vashon’s high vaccination rate results largely from the island’s volunteer power.

The Sea Mar clinic has administered roughly 1,000 doses of vaccine using its medical staff, but the 5,500+ doses of the vaccine that have been given out through the pharmacy’s drive-thru clinic were only possible with dozens of volunteers, people to get out the word about how residents could get vaccinated, trained medical professionals to put shots in arms and other volunteers to check people in for their appointments and guide cars where they needed to go. Additional volunteers helped 250 older people, for whom the online system was a real barrier, get signed up for their  appointments.

This cadre of volunteers and the emergency structure to organize them had been in place since well before the pandemic. The prospect of a catastrophic earthquake that isolates Vashon from the mainland has prompted many residents to be proactive about disaster preparedness. As a result, many volunteers actively participate in a handful of emergency organizations. Their actions are coordinated with state and county officials, and other local organizations, by an emergency operations center.

“There’s not many towns that have that degree of concern,” said Dr. Ina Oppliger, co-coordinator of Vashon’s Medical Reserve Corps, one of the disaster preparedness groups, “We realize that we’re at risk of a major disaster … and we don’t have the infrastructure. It’s possible that we could be cut off completely from help.”

When COVID hit last year, this coalition of groups was quick to respond, launching a testing site on the island, getting public health and other pandemic-related information out to the community in regular situation reports and opening a relief fund where islanders could donate to support local social service organizations, like the food bank. (Full disclosure: I volunteer for a mental health help line that falls under this COVID-response effort).

Several people I spoke with for this story acknowledged that these resources might not be available everywhere, or might not go as far in a bigger town or city. “We’ve done a great job,” said Sarah Day, the district nurse with the Vashon Island School District and a member of the island’s Medical Reserve Corps, “but I think the first thing we need to recognize here is a lot of privilege.”

She noted that Vashon is overwhelmingly white, fairly affluent and older (the median age is 54.2), with many retired people who have the time to devote to emergency volunteer work. “We’ve got some incredibly gifted, knowledgeable people here who have really set up a really robust testing and vaccination program here on the island,” she said. “So people who live here were able to take advantage of that.”

According to recent reporting on vaccination disparities between people of different races in the United States, white people are more likely to have reliable internet access, flexible work schedules, and access to transportation than Black and Hispanic people – all of which can play a role in successfully getting a vaccine.

None of this explains, however, why so many people in a place so seemingly resistant to vaccines have not shown resistance to this one. 

One big factor could be the demographics of who’s currently getting the majority of Vashon’s vaccines: older people. Their willingness may reflect that they’re more at risk from the virus, but also — as many pointed out — of a different generational attitude toward vaccines than that of the younger parents, whose hesitation to vaccinate their kids has kept Vashon, for many years, as one of the least-vaccinated school districts in King County.

The locally-owned Vashon Pharmacy has played a huge role in the vaccination effort on Vashon, storing the Pfizer vaccine and administering around 5,000 doses with the help of volunteers. (Ravenna Koenig for Crosscut)

The locally-owned Vashon Pharmacy has played a huge role in the vaccination effort on Vashon, storing the Pfizer vaccine and administering around 5,000 doses with the help of volunteers. (Ravenna Koenig for Crosscut)

Vashon Pharmacy owner Young — who’s 33 and has three young daughters — said that he hears more hesitation among his peer group about getting the vaccine than from the older population.

“Those discussions aren’t necessarily that they’re opposed to it,” he said. It’s more that they feel there’s some uncertainty about the long-term side effects of the vaccine, and they wonder if the risk of that unknown is worth it, given how unlikely they are to get really sick from COVID. Long-term side effects, according to the Mayo Clinic, are very rare in vaccines, but it is true that because the clinical trials for these vaccines started only in the summer of 2020, the picture of their long-term effects is not complete.

“I think there is a generational difference,” said Jessica Wesch, a primary care physician at Sea Mar’s Vashon clinic who has regular conversations with parents hesitant to get their kids vaccinated. “We have patients with post-polio syndrome,” she said. “The older generation remembers having mumps; they remember having measles. And they are much more likely to also remember being vaccinated and being so grateful to be protected.”

Even so, Vashon is home to some people in that older generation who are skeptical about vaccines. Roxy Hathaway, 72, is one. Hathaway has experienced the value of traditional doctors and medicine in her fight against cancer, but she said she still doesn’t put a lot of stock in the American Medical Association and the pharmaceutical industry, and she’s always followed naturopathic doctors. She said she still isn’t sure about the safety of the COVID-vaccines that are available; she wants to wait for more data about how people who’ve taken them are faring.

She was surprised by the number of Vashon seniors who got vaccinated against COVID. She thinks a big part of it has to do with how scary the disease is to people in her age group, and how much everyone wants life to go back to the way it was before the pandemic: “I feel like people are so burned out and so tired of isolation, and so fearful that as soon as something was offered everybody just fled with their hands in the air,” she said.

It remains to be seen what Vashon’s younger generations of adults will choose as they become eligible for COVID-19 vaccination under Washington’s vaccine rollout plan — and, even further down the line — what they will choose for their children whenever a vaccine is authorized for kids, likely not until at least this summer.

But Day, the district nurse, said Vashon’s deep vaccine hesitancy among parents has generally been getting better. Over the past few years, the vaccination numbers have “really come way up,” she said, with the percentage of kindergarteners in the Vashon Island School District who’d received all their state-required vaccines — hepatitis B, diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella and chickenpox — increasing by over 30 percentage points over the past six years, from 48.8% in the 2014-2015 school year to 80.55% in the 2019-2020 school year.

For super-contagious measles — which has seen outbreaks around the U.S. and even in Washington in recent years — the stats are even better. The number of kindergartners vaccinated against that disease on Vashon has risen from 80% in the 2016-2017 school year to 91.66% in 2019-2020, according to data the school district reported to the Department of Health in 2019. Herd immunity is different for different diseases, but Public Health said its goal for measles is 90% to 95% coverage. Day said it’s the first time in her nine-year tenure that the school district has reached that goal range.

It’s not clear whether that rising trend in vaccinations means that younger people on Vashon will be more likely to get vaccinated for the coronavirus or get their kids vaccinated. But the seriousness and disruptiveness of the pandemic seems to have been a huge incentive for older people.

“When the population is highly vaccinated and diseases aren’t happening very much or at all, it’s easy to forget the importance of vaccines or the fact that they’re why we have this reprieve from disease,” said Danielle Koenig (no relation to the author of this story), an immunization health promotion supervisor with the state Department of Health.

She said it’s expected and common for outbreaks to cause immunization rates to suddenly rise — even in a place like Vashon that has been resistant to it in the past. “When people are getting sick and dying so visibly, it is a harsh reminder of why we vaccinate against serious and deadly diseases,” she said. 

That speaks to the experience of 46-year-old Vashon resident Jessica Kennan. She wasn’t opposed to vaccines completely but did delay her two, now-teenage kids’ vaccinations — not starting until they were 2 years old — out of a host of concerns about vaccine safety, including some she had read about in Mothering, the natural/ alternative parenting magazine.

“I tend to be an anxious parent,” she said. “And so I think whatever I had read definitely heightened that and I felt like once they’re 2, they’re not going to die of SIDS and they’re stronger and bigger and their brains are more developed so I feel more comfortable.” The Centers for Disease Control and Prevention said studies on possible links between vaccines and sudden infant death syndrome  have found no evidence of a connection.

Kennan can’t wait to get the coronavirus vaccine when she’s eligible, and she plans to have her 16-year-old daughter vaccinated, too.

“This feels different,” she said, “because many, many people have died.” She explained that polio and the other diseases she was vaccinating her kids against over the years felt sort of unreal — even though she knows, intellectually, that the only reason it felt that way was because so many people were vaccinating.

The coronavirus, though, could not feel more real. “The only way forward is for everyone to get vaccinated,” Kennan said.

Corrects subhead to "some of lowest," deletes reference to health department not responding, trims throughout.

About the Authors & Contributors

Ravenna Koenig

Ravenna Koenig is a writer, reporter, and radio journalist based in the Seattle area. Her reporting has appeared on Weekend Edition, All Things Considered, Morning Edition, WBUR's Here & Now, and NPR's science podcast Short Wave. You can follow her here, and find more of her work here.