AUSTIN (Texas Tribune) — The coronavirus vaccines have been thoroughly tested and found to be safe and effective. More than 340 million doses have been given in the U.S., and side effects have been determined by the FDA and independent researchers to be extremely rare and far less substantial than the dangers of getting COVID-19, which has killed more than 52,000 Texans as of August 2.

But some vaccine hesitancy — or flat out rejection — remains.

Brad Offutt, a 53-year-old pain therapist in Marble Falls, said he wants to see the vaccines get full approval — rather than the current emergency authorization — by the Food and Drug Administration before he gets one. But even then, Offutt said that the chances of him doing so are slim since he “doesn’t feel threatened by COVID personally.”

Instead, he says he’s made the decision to “take the risk of getting COVID.”

Public health experts say getting as many people vaccinated as possible is the best and fastest way to end the pandemic — but Offutt’s hesitancy is common. He’s one of 14 million Texans as of August 1 who, about eight months after the first batch of vaccines first rolled out, remain unvaccinated.

Many of the unvaccinated are children who are ineligible to receive the shots: around 5 million Texans are under 12. But still 83% of Texans, or 24 million residents, are eligible for the vaccine. With 15 million Texans who have received at least one shot as of August 1, that leaves nine million eligible Texans who have not gotten their vaccine yet.

This places the state’s vaccination rate at 36th in the country and has helped drive another troubling wave in the pandemic.

COVID hospitalizations in Texas quadrupled in July. Preliminary data from the state indicates that more than 99.5% of people who died due to COVID-19 in Texas from Feb. 8 to July 14 were unvaccinated. The percentage of fully vaccinated residents has gone from 3% to 42% in that time span.

The Texas Tribune analyzed the demographic and geographic trends of Texans who have not gotten their shot yet. Here are some of our main findings:

  • In Texas’ largest counties — Harris, Dallas, Tarrant, Bexar and Travis — neighborhoods with the highest proportions of Black and Hispanic populations are some of the least vaccinated areas.
  • Neighborhoods with median incomes below the county’s median income also hold vaccination rates lower than that of the county’s.
  • Rural counties have consistently lagged behind the state’s fully vaccinated rate.

Offutt lives along Lake Marble Falls with his wife, Dr. Amy Offutt, an integrative medicine physician who’s also choosing not to get vaccinated.

“It matters if you live in a city which is more densely populated, versus where we live which is not that populated and most of what we do are outdoor things,” Brad Offutt said.

But data shows that’s not necessarily true. Across Texas, the counties with the highest case rates are outside the urban centers.

Still, attitudes like Offutt’s are common among white conservative rural folks, said Dr. David Lakey, the chief medical officer of the University of Texas System. According to the Tribune’s analysis, 33% of people in rural or nonmetropolitan counties are fully vaccinated as of Aug. 1, behind the state’s rate of 44%.

In the state’s biggest cities, the story is different. Vaccination rates are higher in the metropolitan areas, but the cities’ poorer neighborhoods and the neighborhoods with more people of color tend to have much lower vaccination rates. Overall, Black and Hispanic Texans hold the lowest vaccination rates among racial groups statewide, at 28% and 35% respectively.

“In an area like Houston or Dallas or Austin, the overall rates may look good, but you can have significant differences and disparities between one ZIP code and another,” Lakey said. “… one part of town can be very different from another part of town.”

For example, in Dallas County, 58% of the people in neighborhoods that are majority white were fully vaccinated as of July 26. Those rates are far ahead of neighborhoods that are majority Black and Hispanic, which are 37% vaccinated.

Lakey added that East Texas’ vaccination rates have been lagging behind the rest of the state since “it tends to be older, and it’s an area of the state that has a significant African American population and also a significant conservative white population, and is also a more rural area.”

Why are they unvaccinated?

Mistrust is the leading cause of vaccine hesitancy, Lakey said, and the core of the mistrust usually depends on a person’s culture.

Hesitancy for white conservatives, he said, hinges on “distrust of government,” while for Hispanic and Black residents it’s often a “lack of trust in the health care system” because of generations of disparities in the American system.

“For some individuals who have not had a lot of experience interacting in the health care system — perhaps they don’t have a primary care physician — this might create further doubt when we start talking about a vaccine because these kinds of experiences are new,” said Dr. John Carlo, CEO of Prism Health North Texas.

He added that while he wishes fewer people were hesitant about the vaccine, he understands the uncertainty.

“I think the big thing that I would say is that we just have to continue to listen and see where people are on this because oftentimes, people aren’t completely opposed to it,” Carlo said. “There’s a lingering concern and maybe questions could be answered.”

Alma Peña, a 40-year-old Austin resident, didn’t trust the coronavirus vaccine when it first came out and resisted getting it all of spring.

“I was afraid that something would happen to me when I got the vaccine,” she said in Spanish.

But the recent surge of cases and hospitalizations made being unvaccinated scarier than the shot’s potential side effects for Peńa. She’s a housecleaner, and since she spends most of her days hopping from home to home, she pushed her apprehensions aside and rolled up her sleeve in July.

The way to convince more families like the Peñas to get vaccinated, Carlo said, is to “make sure we have one message with many voices.”

Of the six ZIP codes in Travis County in which Hispanics make up more than half of residents, all but one ZIP code has a fully vaccinated rate lower than that of the county’s 56%, according to the Tribune’s analysis.

The gap is also seen when comparing neighborhoods by median income. Of the 14 ZIP codes that have median incomes lower than that of the county’s, 10 are also under the countywide fully vaccinated rate. Of the 20 Travis County ZIP codes with incomes above the county’s median income, just four are below the county’s rate.

Ana Todd is the director of the VAMOS clinic where Joseph got his shot, and said a lack of easy access to health care and transportation are also key reasons why some Black and Hispanic residents haven’t received a vaccine. But above all, “mistrust is one of the biggest reasons” Texans are turning away from the shot, she said.

Todd said efforts that take the time to meet and talk to residents are crucial to mending the relationship between Austin’s Hispanic and Black communities and the health care system. And that’s why the organization hosts clinics at local churches, which Todd says people trust more.

“We have been consistently working to build trust,” Todd said. “And even more importantly, we’ve been listening to why they don’t want to get the vaccine or why they haven’t.”

A note on methodology:

Higher- and lower-income ZIP codes are defined as ZIP codes with median incomes above or below the county’s median after accounting for margin of error. ZIP codes were included in a demographic majority if more than half of its residents are in that demographic group after accounting for margin of error. Income and racial demographic data was taken from the 2019 U.S. Census Bureau’s American Community Survey.

Portions of this article originally appeared in The Texas Tribune at The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans – and engages with them – about public policy, politics, government and statewide issues.