MEIGS County, Tenn. – At first glance, it seemed like a southern epidemic success story in one of the most unlikely places.
Chattanooga, a small county in the northeast, along the twisting shores of Lake Chicamauga, reported the highest Covid-19 vaccination rate in Tennessee for most of last year and the highest in the south.
Maggie County, which is extremely white, rural and conservative – three populations strongly associated with low vaccination rates – has broken a pattern of hesitation and mistrust that has hampered vaccination efforts across the United States.
“They’re a rural county, and their state has one of the highest vaccination rates,” Tennessee Governor Bill Lee said in September.
If it were true.
Megus County rates were artificially inflated by a data error that distorted most of Tennessee’s county-level tick rates, blaming thousands of doses in the wrong counties, according to a Tennessee vaccination data KHN review. Last month when the Tennessee Department of Health silently corrected the error, the county’s rate shifted overnight, and the rate of fully vaccinated people in Megus County dropped from 65% to 43%, lower than the state average and moderate in rural South.
The Department of Health has blamed STChealth’s software for the error, with an Arizona company paying $ 900,000 a year to host and maintain Tennessee’s immunization information system. STChealth provides similar services in at least eight other states, and officials in West Virginia and Montana say zip code errors have also affected their county-level vaccination data.
Due to a data error, the vaccination of Tennessee residents who live in a zip code that is located in more than one county is incorrect, and incorrectly blames all vaccines in those areas that contain the majority of the zip code in any county. Meigs, a population of 13,000, received credit for approximately 2,900 additional vaccinations, primarily from neighboring Roane County.
The opposite happened in Moore County, which has been identified as the least vaccinated area in Tennessee. Many Moore County vaccines were given incorrectly in nearby counties, and once the error was corrected, the rate nearly doubled – from 21% to 40%.
Dr William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, said the flaw in the zip code was a sign of the country’s fragmented public health infrastructure. Disease and vaccination reports from local hospitals and clinics go up through county and state governments, and eventually to the Federal Center for Disease Control and Prevention, “which has different computer systems and training levels along the way,” he said.
Schaffner wondered: What if Megus County gave Tennessee leaders the wrong confidence in rural immunization efforts?
“Good data does not guarantee good decisions,” Schaffner said. “But the faulty information – aha! – you can be sure that they lead to bad decisions.”
In Megus County, residents say they have long been skeptical of high vaccination statistics in an area where many people publicly distrust vaccines. Speaking of data errors, some regretted the once enviable rate in the county. Some shook their heads. A few were surprised.
“If I had a million dollars and I could make a bet, I’d bet this place isn’t the highest,” said Steven Weissin, owner of a Magus County hemp shop, who said he had caught covid twice and had not been vaccinated.
Betty Pelion, a longtime resident who works in the county mayor’s office, insisted that the data error would not overwhelm the county’s efforts to vaccinate every willing resident – even less than half the total number in the end.
“To be from this county and to know that we’ve worked hard enough to get 44%, we’ll take it,” Pelion said. “It’s better than 10%. Or 0%.”
Sarah Tanksley, a spokeswoman for the Tennessee Department of Health, confirmed the zip code issue in February and said a software update from STchealth was expected to fix it. The Department of Health stopped waiting for that software update on April 1 and assigned its staff with geocoding vaccination data in the right counties.
The fix changes county rates and rankings 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 every day.
The Department of Health has refused to provide an official to discuss the information error in detail or to answer further questions. STChealth initially agreed in an interview with KHN but was canceled after providing more details about the focus of this article. The company did not respond to additional requests for comment.
There are indications that Tennessee knew about the data problem long before it was confirmed or corrected.
Dr. Michelle Fiskas, who was fired from her position as Tennessee’s top vaccine officer in July amid political pressure from state lawmakers against anti-vaccine, told KHN that the Department of Health knew last year that state immunizations had been slashed with the withdrawal of county-level data. Reporting to the CDC and the public from the information system, known as TenIIS.
It was designed to track routine vaccinations across the state long before the TenIIS epidemic and was not used for the purpose of calculating county rates, Fiskas said.
“[TennIIS] To create a county-level report on vaccination rates, pre-covid was never used because the data was always incomplete, ”Fiskas said. “When the data was extracted, each zip code had to be marked as a county because there was no other good way to do it.”
West Virginia Health Department spokeswoman Alison Adler said the state records vaccines from zip codes that cross county lines in a similar way to Tennessee “most of the time.” But, Adler added, the state took steps to make it more accurate after receiving data from STChealth.
Montana Health Department spokeswoman Megan Gretz confirmed that the state had faced similar problems in “isolated situations” where zip codes stuck to county lines and said the agency had “tried to fix them.”
Other states seem to have avoided the zip code issue before reprimanding their public vaccination data. Health department officials in Arizona, Louisiana and Ohio – all of whom employ STChealth services like Tennessee – say the covid vaccination data is geocoded by the agency so that the vaccines are accountable for the appropriate counties or parishes.
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