Lewis County, Kentucky, stretches across nearly 500 square miles of wooded hills and farmland — and is home to just 13,000 people. Despite its sparse and spread-out population, the community is close-knit.

“People here take care of each other,” said Pamela Elliott, Lewis County Health Department’s Finance Director. Having grown up in the county, Elliott knows almost everyone who comes to the health department to get vaccines, apply for programs like WIC, or request a copy of their birth certificate.

But the COVID-19 pandemic tested the close relationships between community members and health department staff. “People started viewing the health department as the enemy. We were doing contact tracing, and we had to tell people: ‘Hey, you have to quarantine. You can’t go to that wedding,’” Elliott said. “It was hard.”

So when Elliott and her colleagues started their COVID-19 vaccination efforts, they knew they had their work cut out for them. Trusting that their personal connections with residents would make a difference, they went into the community to talk to people directly. They set up booths at frequently visited locations — like grocery stores and churches — to talk to people about COVID-19 vaccines, address common misconceptions, and give a vaccine to those who wanted one.

Health department staff also talked about their own experiences with COVID-19 and shared their reasons for getting vaccinated. At first, few community members agreed to get a vaccine, Elliott said. “But by the third and fourth time we went, people started saying: ‘I want to do this. I want to protect my mom. I want to protect my new grandbaby.’”

Apart from leveraging personal relationships with community members — and a great deal of persistence — Elliott said the key to successful conversations about COVID-19 and vaccines is listening and keeping an open mind: “People want to tell their stories. Maybe someone they know got the vaccine and it made them feel sick. And it’s really, really important to listen and to validate people’s feelings.”

Elliott said that instead of brushing off people’s concerns, she was honest about COVID-19 vaccines’ possible side effects. “I told them how I, too, felt sick the day after my vaccine. But then I got better, and I felt more comfortable being around my children and going places because my family and I were vaccinated.”

Looking to the future, Elliott hopes that the lessons learned from the pandemic will lead to sustained support for local health departments. Recently, her health department was able to hire community health workers to fill a gap in vital services thanks to new state funding.

Her message to legislators and funding organizations? “We’re not just a spot on the map. We’re a tight community, and we don’t fit every box. The things that might work in bigger counties may not work for us. We know our community best.”

Learn more about Lewis County Health Department’s work at lewiscountykyhd.org, and read the profile here.

NACCHO’s COVID-19 Workforce Project supported Lewis County Health Department’s emergency response efforts.

This publication was supported by grant # 6NU38OT000306-03-06 awarded to the National Association of County and City Health Officials and funded by the Centers for Disease Control and Prevention. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services.