BATON ROUGE, La. (AP) - Brass bands playing at a 24 hour drive thru coron avirus vaccine event. Doses delivered to commercial fish ermen minutes from the docks. Pop up immunization clinics at a Buddhist temple, homeless shelters, truck stops and casinos, with shots available at night or on week ends. And now, door to door outreach getting underway in neighborhoods where few people have gotten vaccinat ed. Louisiana is making a full court press to get shots in arms, with aggressive - and sometimes creative - out reach to make it as easy as possible to get vaccinated. The effort comes as vaccine supplies are surging but demand is not. The state has enlisted health care workers, colleges, community groups and church pastors to help cajole the hesitant and set up vacci nation events. Democratic Gov. John Bel Edwards has thrown open vaccine access to anyone age 16 or older. The health department has launched a call center to answer vaccine questions and set up appointments for those without internet access or limited tech skills. Civic organizations and faith based groups working with the state have started using get out the vote tac tics, knocking on doors and making phone calls, to pitch the vaccine. But even with widespread ease of access, Louisiana offi cials struggle with a problem almost as vexing as COVID 19 itself: How to persuade those who are iffy about the shot to roll up their sleeves. "I, quite frankly, don't know what folks are waiting for. It just doesn't make sense to me, but I'm going to con tinue to appeal to them," Edwards said. Health officials anticipate a difficult time reaching the threshold scientists believe is needed to stop uncontrolled spread of COVID 19, a bench mark of 70% or higher of the population having immunity either through vaccination or past infection. The problem has taken on particular urgency as more virulent and contagious virus strains reach the United States. State surveys indicate 40% or more of Louisiana residents are hesitant about getting the vaccine or entire ly unwilling to do so. And while Louisiana is adminis tering doses at rates greater than some other Southern states, it remains among the bottom six in vaccinating adults 18 and older, accord ing to the U.S. Centers for Disease Control and Prevention. Other states also are try ing novel approaches, either because they've seen notice able dips in vaccine interest or have concerns about equi table access. Even with the resistance, the United States has shown remarkable progress: As of Friday, more than 200 million doses have been administered to Americans, and nearly half of American adults have received at least one dose. Alaska's health depart ment is weighing creating vaccine clinics in airports. Ohio's health agency asked vaccine providers to develop sites near bus stops and to consider offering mobile immunization services. In Connecticut, the health department launched an effort to call residents direct ly to schedule appointments. Mississippi is working with local organizations to bring vaccinations directly to homebound elderly people. Alabama's health agency sur veyed vaccine reluctance to determine how it should craft messaging to appeal to the hesitant. Dr. Catherine O'Neal, chief medical officer of Our Lady of the Lake Regional Medical Center in Louisiana's capital, Baton Rouge, said she's hear ing from people who believe vaccine misinformation from social media, but also from those who simply don't have a sense of urgency about get ting a shot. Others worry about side effects. "We have enough vaccine. ... If you want an appoint ment, you can get it within a week," O'Neal said.

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Qween Amor of the New Orleans EMS gives the COVID-19 vaccine to Kayla Moran as she holds onto Brandon Smith during the shot for a shot event at the Dragon's Den in New Orleans April 9.

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ELKHART (AP) - The local Amish popu lation faces barriers to getting vaccinated for COVID 19 that other groups do not, as Hoosiers generally need to make vaccination appointments online or by phone and clinics are located in towns and cities. About 26,000 Amish residents live in Elkhart and LaGrange counties, according to the Young Center for Anabaptist and Pietist Studies at Elizabethtown College. In Elkhart County, a direct effort to get shots to the Amish has yet to launch, according to county Health Officer Dr. Bethany Wait. First, she said, the county and state are reaching out with information. "We are at the point where they are not ready to choose vaccines. I think we are at the point where they want more information about vaccines. At least that's the feedback that we're getting," she said. Wait believes the Elkhart County Health Department, not the state, should be in charge of getting doses to the Amish commu nity when that time comes. "We're going to have to do that. I think we have the closest relationship, in general, with the Amish population," she said. But for now - even if members of the Amish community wish to get vaccinated it isn't easy, according to Wait. "I don't think you can target the Amish population if you're requiring online regis tration," she said. Sociologist Cory Anderson, a postdoctoral scholar at Penn State University and editor of the Journal of Amish and Plain Anabaptist Studies, said the Amish have ways of getting around the barriers, but the fact that barriers exist is likely to mean fewer get vaccinated. "Even though the Amish and the conser vative Mennonites are going to have restric tions of one nature or another on the inter net and telephone access, they've lived with these restrictions so long that they know full well what are workarounds to getting to what they need to get access to," Anderson said. "If the desire is there among Amish indi viduals to seek out a vaccine, I don't think registering for them through the telephone or even through the internet is going to be an issue for most Amish." Another issue is transportation. According to the Indiana State Department of Health, the vaccination sites nearest to the local Amish communities are in Goshen and Topeka. LaGrange County only has one other site, which is in Howe, and the nearest site in Kosciusko County is in Warsaw. "While arranging long distance trans portation in a motor vehicle can be a little bit of a hassle for the Amish, they coordinate their transportation together; they've got ways to get places where they need to go. But it is going to be a little more hassle than for those of us that can just hop in a personally owned automobile and go where we need to," Anderson said. "But I wouldn't say that the obstacle is a great struggle or insur mountable." Still, it could be the barrier that keeps some from getting immunized, he said. "The Amish are very busy people, so it's going to be a little extra hassle, and that might be a little bit of a reason why they might not seek out the vaccine as readily," he said. Anderson praised Indiana health officials for their outreach to Amish communities during the pandemic. "In my observations of the northern Indiana Amish community, and especially in Elkhart County, the health department has been fairly proactive throughout the entire coronavirus pandemic to communicate with the Amish and Mennonite population local ly," Anderson said. One example of that is the state running advertisements in Amish newspapers, encouraging vaccination and providing the 211 phone number that can be used to book appointments. In the past few months, Anderson has been researching what might explain Amish and Mennonite hesitance toward getting vac cinated for COVID 19. Those groups are gen erally more hesitant than the population at large, though some other groups tend to skeptical as well. One of the reasons for the hesitancy is a strong sense of identity as Amish and Mennonite people, Anderson said. "That translates into a desire to be in con trol of and have ownership of their own affairs," he said. "So they are going to be sus picious of a program that comes pushing into the setting without first gauging their opin ion or getting their reactions or giving them time to own that particular program as theirs." The Amish have a strong collective memo ry of persecution in Europe. Even if today's Amish population has not lived through the same persecution, that collective memory causes a stronger distrust of government and science than many others have, according to Anderson. A final reason for Amish hesitancy is their strong opposition to abortion, Anderson said. Though the available COVID 19 vac cines do not contain aborted fetal cells, Pfizer and Moderna tested their vaccines using fetal cell lines that descend from cells taken from elective abortions in the 1970s and 1980s, and Johnson & Johnson use fetal cell lines in testing and now in production, according to infectious diseases expert Dr. James Lawler. "Even that is enough to make them very nervous," Anderson said. "The facts about that particular issue maybe muddy people's understanding so they don't even really know what's true." And the issue isn't just with COVID 19 vaccines. Anderson said a study completed before the coronavirus pandemic showed that acceptance of vaccines declined in one Amish community in Ohio in the last decade. But there are no rules against vaccines, so those who want a shot and can get around the barriers can get vaccinated. In LaGrange County, about one third of the county's roughly 40,000 residents are Amish, according to AmishAmerica.com. Because of the large Amish population, the state is working with Topeka Pharmacy, which owner Trevor Thain said has had some success getting shots to those communities, even though difficulties persist. "I am starting to see more and more peo ple come in and get their vaccines, including some Amish," Thain said. Many Amish are skeptical, he said, but that is also the case for other parts of the population. LaGrange County was the least successful in the state at getting residents older than 16 vaccinated until late March, but, with its 13.4%, it has overtaken Newton County, according to the Indiana State Department of Health. Elkhart and Daviess counties, at 18.4 and 17.9%, respectively, are also lagging the state as a whole, which is now at 21.4% It is worth noting, Anderson said, that counties with large Amish populations tend to have a large percentage of young residents, who haven't been able to get vaccinated for as long older residents. Thain hopes that, as elders and well respected members of Amish communities are getting their second doses of the Moderna vaccine without significant side effects, others will be persuaded to get their shots as well. According to Anderson, Amish communities value internally produced knowledge highly, so those sorts of experi ences could be effective. Since doses stay good for only six hours after being removed from refrigeration, Topeka Pharmacy generally requires people to sign up by calling or visiting the pharmacy website. But some walk ups have been allowed, especially for the Amish. "As far as our Amish patients are con cerned, we've tried to do a lot of on the spot education, and we try to make it work to get them in that day if they're interested," Thain said. The pharmacy recently set up a one day clinic at a local school in order to reach local school employees, and more clinics at large employers are coming up. Thain said the pharmacy is also working on other partner ships that would hopefully break down some of the barriers to getting the Amish vaccina tion, which could mean setting up clinics that would allow them to not travel as far. Wait said it may be necessary to go out to the Amish communities and do walk up appointments, most likely with the one dose Johnson & Johnson vaccine. No such clinics are planned for Elkhart County, though a spokesperson for the Indiana State Department of Health said they sent a mobile unit to Daviess County, which also has a large Amish population. The spokesperson did not answer whether registration via phone or the internet is required, but it was when one of the state's units came to Elkhart in late March. In Elkhart County, many Amish residents have ties to Clinton Frame Mennonite Church, where the county Health Department provides childhood vaccina tions. For that reason, the church - which could not be reached for comment - will like ly be among the sites that the county will use for the coronavirus vaccination effort, Wait said. As for other locations, the county at least needs to be able to refrigerate vaccines, so some source of electricity is necessary. Though there isn't a specific plan yet, Wait said the county is committed to reaching everyone, including the Amish. "Our goal is to vaccinate anybody who wants to be vaccinated," she said. Megan Wade Taxter with the Indiana State Department of Health said the depart ment is working with local health depart ments, federally qualified health centers, and their own mobile units to "ensure that vac cine is deployed to areas that have difficulty accessing it." She did not provide further details.

Northern Indiana Amish See Hurdles To COVID-19 Vaccines

Louisiana Gets Creative With Vaccine Outreach