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Ohio has seen a sharp drop in the number of COVID-19 vaccinations in recent weeks, and many Northeast Ohio residents who are reluctant to get the shot live in rural communities.

Holmes County has the lowest vaccination rate in the state, with just 13 percent of residents who have received the first dose.

鈥淲e have definitely seen the demand for the vaccine taper off in recent weeks,鈥� said Jennifer Demuth, community relations director at the Tuscarawas County Health Department. 鈥淲e did initially get a rush when younger adults were eligible, but that rush did not last as long as maybe we anticipated.鈥�

Tuscarawas and several other rural counties in Northeast Ohio, including  . About 30 percent of residents in each of those counties have received one dose of the vaccine, according to state data.

Health officials in these communities, as well as in northern rural counties like Ashtabula, are scrambling to try to encourage more residents to get vaccinated, Demuth said.

The first step is identifying the root causes for the hesitancy, said Pam Swarny, director of the pharmacy at Cleveland Clinic Union Hospital in Dover. The hospital is one of two in Tuscarawas County, and also serves patients in surrounding counties such as Wayne and Holmes, she said.

鈥淛ust based on my observation of vaccine uptake overall, I鈥檓 not surprised that we鈥檝e seen it drop off. The vaccination rates for (the) flu vaccine appear to me to be pretty stagnant, at least on the population that I鈥檓 aware of, and I don鈥檛 see people鈥檚 minds being changed from year to year,鈥� Swarny said.

Accessibility issues and infertility concerns contribute to low vaccine uptake

About 40 percent of Ohioans have received at least one dose of the vaccine 鈥� much lower than the rate needed for herd immunity, which is about 70 or 75 percent.

Some health officials believe most people who want the shots already got them, so reaching herd immunity may be farther away than we thought.

Lack of information 鈥� and in some cases, misinformation 鈥� about the technology and safety of the COVID-19 vaccines seems to be driving much of the hesitancy, Demuth said.

Residents have expressed concern about the long-term effects of the vaccines and belief that they may cause infertility, she said.

鈥淥f course, that strikes a heart chord for a lot of women, and it鈥檚 something that makes them pause,鈥� Demuth said. 鈥淲e鈥檙e just doing the best we can to share the facts and messages to help people make an informed choice about what鈥檚 right for them.鈥�

In rural Ashtabula County, at the tip of Northeast Ohio, health officials are also targeting misinformation.

Dr. Kevin Andryc, director of University Hospitals (UH) emergency departments in Geauga and Ashtabula counties, has even heard hesitancy from patients admitted with COVID-19.

鈥淚 purposely ask that very question 鈥� 鈥榟ave you had your vaccine?鈥� And all of them have been a no, and a lot of them give me a look like they don鈥檛 trust it,鈥� he said. 鈥淭he understanding of the science behind it, especially the mRNA one, is kind of misunderstood, or not understood enough to know that it鈥檚 safe and works very well.鈥�

Accessibility to the vaccines also seems to be an issue in this area, said Denise DiDonato, director of operations and clinical services at UH Geneva and Conneaut Medical Centers.

Health officials have heard of people not getting vaccines due to transportation issues and lack of broadband connection, particularly in the county鈥檚 senior population when the shots were first being administered, she said.

In Tuscarawas County, both Swarny and Demuth agree there are enough providers in the county to guarantee anyone a vaccine who wants one. The overall issue, they said, is lack of interest.

Vaccine reluctance on track with rural areas nationwide

Vaccine hesitancy in Ohio鈥檚 rural areas follows a national trend.

A .

A recent , with the highest refusal rates reported by Republican men.

Political beliefs could be factors behind the low vaccine uptake, Demuth said, although health officials have not heard many specific political reasons.

Officials are struggling, however, to reach some religious communities such as the Amish. In Holmes County, where more than half of the population is Amish, many Amish residents are refusing to get COVID-19 vaccines, according to health officials.

Amish communities in Geauga and Ashtabula counties have been resistant to COVID-19 vaccines as well, DiDonato at UH said.

鈥淭hat is a piece of the population for us that we are trying to take the clinics to, but it doesn't necessarily mean they're accepting the vaccine,鈥� she said.

Health officials stepping up educational outreach

While misinformation about the vaccines is not unique to residents of rural areas, it can be more challenging to educate and inform them about the facts, DiDonato said.

鈥淵ou鈥檝e got to be a little more creative and do some more grassroots because it鈥檚 that person-to-person talking that really gets the message out in a small rural community. They have to have somebody that they trust delivering the message,鈥� she said.

DiDonato hopes to soon offer vaccine clinics at businesses to make it more convenient for people who can鈥檛 take off work to go get their shot.

Union Hospital officials plan to release public service announcements on YouTube and local radio stations, particularly addressing the infertility concerns, Swarny added.

Health officials also hope to plan more pop-up, walk-in vaccine clinics.