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Many veterans don't trust coronavirus vaccines. For a VA crew in the rural West, that means changing minds, one by one.

Logan, 11, and his father, U.S. Air Force veteran Mike Jellesed, 61 of Libby, Mont., after a long discussion, receives the Moderna Vaccine from RN Mark Sheldon on March 30, 2021.

TONY BYNUM/THE WASHINGTON POST

By LISA REIN | The Washington Post | Published: April 18, 2021

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LIBBY, Mont. — On the morning he was scheduled to get his first shot of coronavirus vaccine, Mike Jellesed woke in a fury and wheeled his pickup out of his trailer park, headed for the Veterans of Foreign Wars post in town.

A giant star-spangled bus that had crossed 160 miles of the Rocky Mountains from Spokane, Wash., was waiting for him in the parking lot. Inside were three Department of Veterans Affairs workers and 26 Moderna syringes ready to go. Jellesed, a 61-year-old Air Force veteran with scarred lungs that left him vulnerable to COVID-19, had driven there with his 11-year-old son to tell the VA crew all the reasons — despite his scheduled appointment — he didn't believe in the vaccine.

He felt like a lab rat: "That's what I am," he said. "I don't like being told what to do."

The VA mobile medical unit's third visit since January to Libby, an old mining and lumber town 70 miles from the Canadian border in a deep-red band of America, had been unexpectedly rough.

Even as the Biden administration's campaign to inoculate the country accelerates each day, the agency has struggled to persuade a vulnerable population to protect itself and help the country get to herd immunity. The rugged communities that stretch from eastern Washington through the Idaho Panhandle into northwestern Montana include some of the country's highest concentrations of former service members. Mostly conservative and White, they are also highly suspicious of coronavirus vaccines.

In many cities and suburbs, millions are lining up for shots they have waited more than a year to get. Here, the political and cultural currents are pulling in the other direction, against the federal government, public health experts and a new president many of these veterans distrust. VA's halting and labor-intensive effort may be a warning for the country as vaccine advocates seek to persuade unwilling Americans to sign up.

To counter the wariness, the agency's Spokane hospital embarked in January on a mission to convince the roughly 46,000 veterans under its care that whatever was holding them back was the real danger. The 45-foot bus previously used as a primary-care clinic — 10 feet longer than a Greyhound and the height of a tractor-trailer, with two exam rooms, a triage room with a hospital bed, and a centrifuge to spin blood — has since logged 2,500 miles in a carefully waged campaign against skepticism.

Nationally, about 3 in 4 Americans have indicated a willingness to accept a vaccine. Yet just 1 in 4 veterans contacted by the Spokane VA for an appointment on the bus have said yes. And on a trip early this month, roughly 1 in 6 with appointments canceled or didn't show.

When Jellesed arrived, he complained that the scheduler had unfairly pressured him by warning that his VA benefits, now the only source of income for his family of six, would be cut off if he turned down the shot.

He feared the vaccine was meant to harm people, to eventually cause cancer in those who got it.

"My wife's totally against it," he said. He explained that his reluctance came from "all the things I've read on Facebook."

Yet he also knew people who had died in the pandemic and how lonely those deaths could be. A close childhood friend had flown in from California to see his mother when she was hospitalized with COVID-19 last year, but the hospital in Libby wouldn't even let him inside before she died.

Jellesed's elderly mother was home recovering from a stroke. If something else happened to her, he wanted to make sure the hospital would let him in to see her.

A little after 10 a.m., Mark Sheldon came to hear him out. The Gulf War combat Marine, now an emergency room nurse, is the Spokane hospital's chief weapon on the ground. In almost three months on the road running the mobile clinic, along with a nurse practitioner and a driver, he had learned that pressure tactics do not work on cynical veterans.

He gently made the pitch for the vaccine, sharing that he also had wavered, after taking experimental drugs to protect against nerve agents during the war. He sensed that, for all Jellesed's fury, the veteran could be swayed.

"I don't want you to get this shot if it's not what you want," Sheldon told him. He promised Jellesed wouldn't lose his benefits, regardless.

The outreach to veterans in the 64,000 square miles served by the Spokane VA begins with a phone call from a 20-year-old medical support assistant working in a cubicle at the hospital. She is paid $25,000 a year.

Kylee Flower, known by the staff for her oatmeal cookies and grace under pressure, is the agency's first point of contact with hesitant veterans, a role requiring deft navigation around the minefields of politics, culture and misinformation.

As the bus rolled toward Libby, Flower was working ahead, trying to set up appointments for its next trip. She scrolled down an Excel file on her computer that listed veterans by age and illness, put on her headphones and wrapped her white Vans sneakers around the base of her chair.

"Hello, this is Kylee calling from the Spokane VA," she began. "I'm calling for John. Hi, John! How are you? I was just calling to see if you wanted to get the coronavirus vaccine in Colville."

John had signed up to get his shot at the local fire station. The next veteran, Donald, had already gotten vaccinated. The next call went to voice mail and Flower wrote herself a note to try again — twice. Then Ronald picked up.

"Hi, Ronald. How are you?" Flower asked. Did he want the vaccine? "No? OK. Sounds good. Thank you for letting me know."

The "no" answers tend to be nonnegotiable.

"That's the hard part," Flower said after hanging up. "What I've been told is if they say no, no is OK. I don't want to argue with them." She said she would never threaten to pull benefits.

The veterans' "no" reactions rest on several theories, she explained. The vaccine injects a microchip that will let the government track their movements. It can't be safe, because it was developed too fast. They've quarantined for this long, so they don't need it. Former president Donald Trump says they don't need to get it, so they're not getting it. None of these claims are true, but that doesn't matter.

To settle on the right messaging, a hospital administrator wrote the objections on Post-it Notes and stuck them on the wall at a staff meeting. Everyone concluded that the workers should stay away from the word "government" in their conversations with the veterans.

That was only one issue to untangle in months of planning and improvisation at the 70-bed facility, which, as a test-pilot site, is still troubleshooting a rocky rollout of VA's new electronic health-records system. For the vaccine push, fifteen schedulers were pulled from other duties to call veterans in five-year age increments, starting with a 102-year-old World War II veteran, who said yes.

Since late January, the schedulers had been making 580 calls a day, but the effort needed to get more shots in arms. The staff tried to speed up the system with a mass vaccination site at the city's armory (but vaccine supplies were too unreliable) and email blasts (low response). After giving shots in the hospital's dental clinic, the staff also took over the offices for treating substance abuse as they searched for more space last month.

For those beyond driving distance from the city, however, the one constant is the bus.

The crew had been 10 weeks on the road in cold and snow, 620 shots in with six weeks to go, and now, finally, the sun was shining on the VFW parking lot in Libby. Because of the town's painful history — residents were exposed to toxic dust as mining company W.R. Grace dug millions of tons of asbestos-laced vermiculite from a nearby mountain — Libby was a priority. But this visit was quickly becoming muddled.

Even before Jellesed showed up, an Air Force veteran named Connie Giles arrived, angry that the new computer system was spitting out old prescriptions and medical records.

Bob Sonderman, the mobile clinic's bus driver, who served in the Marines after the Vietnam War, was scrambling on the phone with colleagues in Spokane to find replacements for the no-shows. Those who actually canceled told him they had decided not to get the shot.

"I tell them, 'That's your choice, but you realize we're gonna have to throw a COVID shot away?' " he said in frustration. The crew hadn't had to waste a syringe yet, but now the possibility was there. (The agency has not been allowed to give the vaccine to nonveterans, although a recently approved law expands eligibility.)

William Bishop, a 57-year-old Army veteran sitting nearby for 15 minutes of observation after his shot, said he had lost his father to COVID last year. "It's a duty to myself and a duty to my community," he said, explaining why he was getting vaccinated. "I'm a veteran. Duty is what it's about."

His was not the prevailing view. For most veterans, the pressure not to get the shot was enormous.

"We have a lot of anti-vaxxers here," said Dorian Bolling, a 39-year-old disabled Army veteran. "It's growing. I mean, I'm hearing about microchips. VA here doesn't have the best image with the vets." But a bout with pneumonia a few years back had convinced her that she never wanted to feel that awful again.

"A lot of people think this is just the flu," said Valerie Downing, next up for the shot with her husband, Clifford, whom she met in the Navy. Valerie got the coronavirus last year from the couple's 6-month-old granddaughter, and four other members of the family got sick, too.

"A lot of people think they haven't gotten sick yet, so why do I need a shot?" Clifford said. "Well, we know that life matters to God," his wife said.

Mark Sheldon had managed to coax Jellesed and his son onto the bus. The nurse, now 50, with piercing blue eyes and a linebacker's build, had returned from shooting shoulder-launched rockets in the Persian Gulf with herniations in his back, still-unexplained rashes and mental health issues, he said — along with a facility for de-escalating tense situations.

The two men sat around a small counter, and Jellesed rolled up his flannel sleeve. The nurse explained that the vaccine had definitely not been rushed into being. "They didn't cut any corners. It's a quality product," Sheldon said.

"I'm not liking it, but I'm doing it because I have family I need to see," Jellesed responded.

"We all have our whys," Sheldon said. "My grandson is my why."

The shot went in, and they shook hands. Sheldon told Jellesed that if he had truly felt he would lose VA care if he didn't get the shot, "I need to fix that, because we're better than that."

On the dirt parking lot that afternoon, a veteran wheeled a battered bike toward the bus to get a closer view. He was homeless, 61 and at risk for the virus. He didn't see the point of the vaccine, he said, mostly because "they could track you by this injection."

An Air Force veteran in a camouflage jacket named Mike Aja walked up with his 4-year-old son, Shane. He was a "no," too. He said he had heard that the average death rate had dropped last year, proof that the government was making too big a deal out of the virus. (Deaths actually are up markedly.) He said there was no way President Joe Biden was serious about the pandemic because he was letting thousands of undocumented immigrants flow across the border.

"You're convincing us not to trust you," Aja said, directing his skepticism at the president.

A small crowd had gathered at the VFW post, where the slot machines were in full use. The charismatic manager, Julie Mason, is a self-described conspiracy theorist with a QAnon sticker on her car's rear windshield.

The post no longer carries broadcasts of NFL or Major League Baseball games "due to the disrespect shown towards our American Flag and the men and women that have sacrificed so much to defend it," a sign on the back wall says.

Kenny Rayome Jr., an operator at the local water plant, and his wife, Megan, a lawyer in town, were relaxing over beers at the bar. They got mild cases of COVID-19 last year, and Kenny's uncle died of it. Megan suffers from lupus, an autoimmune illness. Still, they have no plans to get vaccinated.

"I'm just not afraid of it, I guess," said Kenny, 40, whose family goes back six generations in Libby. During six years as a Navy submariner, he explained, "they told me what to do. Don't tell me what to do now."

It was the same sentiment around the bar. "I got plenty of little bugs overseas," said Rob Hughes, 51, a retired Marine who owns a gun shop in town. "I've been shot at for a living. It's not gonna hurt my feelings if a bug kills me."

On the bus, the VA crew had found veterans for the unclaimed shots. But four had already canceled in Sandpoint, Idaho, their next stop, where a planned two-day visit had been condensed into one because not enough people were signing up.

Before sunrise, the bus rolled out of the Venture Inn and onto two-lane roads flanked by firs, bull pines and tamarack trees, with snow-covered mountains in the distance. It drove west past long-shuttered silver mines and sawmills, bald eagles, elk and deer, and small white markers where car crashes had taken lives on the winding roads.

Just across the Idaho border loomed a giant billboard that read: "Welcome to Trump Country." Sandpoint's spectacular lakefront setting is attracting wealthy outsiders; the picturesque ski town, population 8,400, now boasts art boutiques and a Sotheby's storefront, while the long dirt roads around Lake Pend Oreille wind through the mountains to cabins where veterans and retired law enforcement officers settled years ago.

As the bus stopped on a side street near a clinic serving low-income residents, Jayne Shoda, the mobile clinic's nurse practitioner, began pulling boxes of gloves, alcohol swabs and hand sanitizer from the cabinets. Sonderman fired up Paul McCartney's "Wings" on the bus speakers, printed out Moderna information sheets and started calling to confirm appointments.

"Bob's got the last flip phone in the VA!" Sheldon ribbed his colleague, as he pulled vaccine vials from the medical-grade refrigerator and loaded syringes.

After weeks on the road, they were a tight crew, despite political differences they had learned to live with. They all worried what the day would bring. "These are the first shots where we're having such attrition," Shoda said.

A young Marine veteran who had served in Iraq, with brown hair down to his shoulders, showed up without an appointment and explained that his doctor at the private clinic next door had just told him the vaccine was safe. It was hard to know whom to listen to, he said. "I've got anti-vaxxers in my life, and they're full of fear and skepticism." The veteran, who got the shot, spoke on the condition of anonymity, saying he was fearful of the pressure not to be vaccinated.

A Vietnam veteran named Knut Lyssand, 69, arrived in cowboy boots and a T-shirt that read: "The answer is beer." He had been ready to cancel after talking to fellow veterans, but when he couldn't sleep at 4 a.m., he turned on the television to Newsmax and heard a doctor say it was OK to get vaccinated.

By noon, there were still three no-shows. Sonderman reached one by phone who claimed he had never agreed to be vaccinated, "and I will never take a COVID shot." The crew had to throw out its first syringe in 10 weeks.

On the way back to Spokane the next morning, Sheldon concluded they needed to regroup. They were running out of willing veterans, and after second doses in Libby and Sandpoint, the bus would return to primary-care work. The hospital had canceled the upcoming clinic in Colville, Wash., after Flower, the medical support assistant, had trouble filling appointments.

"I feel by now if you wanted this shot, you'd be hustling to get it done," Sheldon said.

The bus will head back to Libby for second doses April 27. Jellesed's already on the list. After his first dose, he told family and friends the shot didn't hurt — and had no side effects. But he is adamant that even after the second one, his vaccination will be just .01 percent more protection against the virus than if he hadn't gotten it. "I'm just not seeing any benefit," he said, explaining that he had read the statistic somewhere.

His wife and kids won't get inoculated. But Jellesed is comforted in knowing that if his mother ends up in the hospital, he will be able to see her.

"These are the things you do for family," he told his children. "It's not for me. It's for her."
 

The VA mobile medical unit has made three trips to Libby, Mont., since January.
TONY BYNUM/THE WASHINGTON POST