More than a quarter of South Carolinians age 15 and older have been vaccinated against COVID-19, but residents in some counties are getting the jab at much higher rates than others.
The proportion of residents who have received at least one shot ranges from 14% in Jasper County on the state’s southernmost tip to more than 40% in McCormick County, a rural retirement haven on the northwestern Georgia border, according to vaccination data provided by the state Department of Health and Environmental Control.
A variety of unique local factors, both demographic and geographic, likely impact an area’s vaccination rate, but availability of the vaccine seems to be a primary factor. The age of a county’s residents also has an outsize role.
Vaccine availability has been driven largely by health care infrastructure. Counties with more health care facilities, especially large hospitals capable of carrying out mass vaccination clinics, generally have received more doses per capita than counties with limited health care resources.
With a few notable exceptions, counties with large senior populations that have been shipped the most doses relative to their population generally have the highest rates of vaccinated residents. Counties that have received the fewest doses per capita, even some with sizable senior populations, tend to lag in vaccination rates, The State’s analysis of vaccination data found.
The findings illustrate how DHEC’s early approach to distributing shots, which was not done equitably, may have shaped vaccination rates in different pockets of the state.
Until last week, when the agency began allocating doses based on regional population and several other demographic and disease factors, DHEC had not used a statistical formula to ensure doses were being doled out fairly.
The agency’s original allocation method, which took into account vaccine supply, providers’ order requests and utilization rates, favored urban areas over rural ones. It also appears to have advantaged counties with hospitals, even rural ones, which were given a head start on other vaccine providers and had the infrastructure to more quickly and efficiently ramp up inoculations.
Many less populous counties with limited health care resources quickly fell behind in vaccinations and were left to forge partnerships with regional hospitals or ask DHEC to hold pop-up clinics in their communities.
State health officials last month acknowledged the urban-rural divide in vaccinations and have since taken steps to push more doses into rural and underserved parts of the state through targeted vaccination clinics and outreach to local community leaders.
DHEC has held hundreds of pop-up clinics across the state in recent months, mostly in rural areas, and shipped doses to independent pharmacies and community health centers in underserved areas.
For now, however, disparities persist.
Some counties have received far more than their fair share and others far less than they would have gotten had doses been distributed based on population from the beginning.
The biggest beneficiaries of DHEC’s initial distribution model were the mid-sized counties of Georgetown, Florence and Greenwood, which each house medical centers that have received large numbers of vaccine doses.
All three have received double the doses they would have been afforded by a straight per capita allocation, The State’s analysis found.
Berkeley, Barnwell, Dorchester, Saluda and Union counties, on the other hand, were most disadvantaged by DHEC’s early vaccine distributions, with each receiving less than a third of what they would have gotten under a population-based model.
Counties with the highest vaccination rates
Tiny McCormick County, a rural outdoor recreation destination in the Savannah River basin and one of eight South Carolina counties without a hospital, might initially seem an unlikely vaccination leader.
But the tight-knit county of just 9,500 people has easily the highest vaccination rate in the state — 40.4% of residents age 15 and older have gotten at least one shot — despite having received only half as many doses as would be equitable based on its population.
The likely reasons for that, DHEC officials said, are the area’s elderly population — McCormick County boasts more senior citizens per capita than anywhere else in the state — and its active community partners, like New Hope Missionary Baptist Church.
New Hope hosted its first DHEC vaccination clinic on Jan. 20, just a week after people age 70 and older became eligible for a shot, and has hosted clinics every Monday and Wednesday since.
“It’s about relationships,” McCormick County administrator Columbus Stephens said. “We’ve actually been preparing for the vaccine since the time we were doing the (COVID-19) testing.”
Stephens credited DHEC and hospitals in two neighboring counties, Abbeville Area Medical Center and Self Regional Healthcare in Greenwood, for working together to provide McCormick County residents vaccine options in their own community.
He said it also has helped that residents feel connected to county government and have bought into the vaccination messaging officials are putting out.
“McCormick County has done so much with so little for so long,” Stephens said. “I think we built a lot of trust with the residents over the years.”
Cooperation also has been key in Florence County, which boasts the seventh highest rate of vaccinated residents in the state.
Unlike McCormick, Florence County has two major hospitals, McLeod Regional Medical Center and Medical University of South Carolina’s Florence Medical Center, and its residents have benefited from the increased vaccine access.
Local officials believe, however, that vaccinations would not be occurring at as brisk a pace in Florence County without their extensive coordination and communication efforts.
Weekly COVID-19 conference calls, which Florence-area officials have held since the pandemic’s outset, have been crucial in getting everyone on the same page, county emergency management director Dusty Owens said.
The calls bring together representatives from area hospitals, federally qualified health centers, rehabilitation facilities, state and county health officials, and local, county and even federal government officials.
“One call we had like 20 people participating from various different disciplines and it was pretty daggone amazing,” Florence City Councilman George Jebaily said. “Someone made the comment that this was a powerhouse call because you had so many principals and so many of the players.”
In the pandemic’s early days, when personal protective equipment and hand sanitizer were hard to come by, the calls facilitated sharing of those then-scarce resources, Jebaily said.
They’ve since come to serve as a channel for discussing COVID-19 infection trends, disease mitigation strategies and, in recent months, vaccination efforts.
“You don’t want three people setting up a vaccination event across the street from each other,” Jebaily said. “Sharing information and sharing who’s doing what probably has been a benefit to spreading out the reach and going into more parts of Florence County.”
Counties with lowest vaccination rates
All eight South Carolina counties that lack medical centers have been shorted vaccine doses, but only four — Calhoun, Lee, Marlboro and Saluda — have commensurately low rates of vaccinated residents, The State’s analysis found.
Marlboro County Administrator Ron Munnerlyn said not having a hospital in his county has made it challenging to inoculate residents.
Only 20% of Marlboro County residents age 15 and older have gotten a COVID-19 shot, the sixth lowest rate in the state, according to DHEC data.
“We are so isolated here that we’re different from some counties without hospitals,” he said. “Our situation is a little more extreme than some others.”
Access to doses was so limited locally in the early days of the state’s rollout that Marlboro County was forced to send its first responders to Chesterfield County for shots, Munnerlyn said.
Seniors with means also traveled out of the county, and sometimes even out of the state, for potentially life-saving jabs.
“That’s really the only choice they had,” Munnerlyn said.
Vaccine access in Marlboro County has improved over time, he said, but only after local officials reached out to DHEC and area hospitals for help.
“They’ve tried to accommodate us,” Munnerlyn said. “It’s just that we’re sitting here and until we rang that bell, nothing was happening. There was no guidance from DHEC or anyone on what we should do, we were just sort of an afterthought.”
Not all of South Carolina’s least vaccinated areas are rural, health care deserts, though.
Large swaths of the population in some mid-sized counties with medical centers also remain unvaccinated, according to DHEC data.
The neighboring counties of Berkeley and Dorchester, for example, lag in the rate of residents vaccinated, despite being more populous and economically prosperous than most counties in the state.
The paltry supply of vaccine doses flowing into both Lowcountry counties is likely to blame, as is the relatively small number of seniors living there.
Only Richland County has a lower percentage of residents age 65 and older than Berkeley and Dorchester, according to U.S. Census data.
Nick Davidson, DHEC senior deputy for public health, attributed the low vaccination rates in Berkeley and Dorchester counties — fourth and ninth lowest in the state, respectively — to their proximity to Charleston County, which has gotten more doses than any county in the state.
“There are just so many providers who are asking for and receiving vaccine in the Charleston area,” Davidson said. “And not that Berkeley and Dorchester aren’t also receiving those vaccines, but just the concentration is so large in the Charleston area that I think so many of the individuals are living … so very close to Charleston that so many folks are being offered options.”
Despite living adjacent to the county most flush with vaccine, Berkeley and Dorchester residents, especially those most distant from Charleston County, have struggled to tap into the supply, DHEC’s ZIP code-level vaccination data shows.
Mario Formisano, Dorchester’s director of emergency management, said the county’s vaccination rate has suffered because of the limited number of doses available locally and the dearth of large vaccination clinics.
“The reason the administration is low is primarily due to the fact that there isn’t a hospital in the county doing any mass vaccination events like Roper and MUSC,” he said in a statement.
Summerville Medical Center, part of the Trident Health system, has inoculated only about 600 people, according to DHEC data, and Formisano said it was not planning to hold any community vaccine events. A hospital spokesman told The State that Summerville had focused on inoculating health care workers and first responders, but did not immediately provide information about its community vaccination efforts.
Formisano said to get shots residents have had to either travel to Charleston or compete for doses at smaller clinics run by DHEC and the Family Health Center at St. George.
“A lot of these limitations are due to vaccine supply issues,” he said.
Berkeley County’s low vaccination rate also comes down to inadequate supply, the county’s emergency management director Ben Almquist said.
Almquist said the county had been approved as a vaccine provider and was ready to put shots in residents’ arms, but had not yet been shipped doses by DHEC.
“We have expressed our concerns over the current process to DHEC on numerous occasions,” he said in a statement. “We believe we are better suited for the role of mass vaccination operations and clinics than hospitals that must compete with existing patient care needs and do not always have a readily available logistical network in each county.”
Roper St. Francis, which operates a hospital in Berkeley County, has inoculated tens of thousands of people over the last three months. But, according to DHEC data, only 42 of the nearly 32,000 people Roper administered COVID-19 shots got them by way of the Berkeley County hospital.
Until recently, the heath care system had directed nearly all its doses to its mass vaccination site at the North Charleston Coliseum.
At DHEC’s request last week, however, Roper set up a pop-up vaccination clinic at a Berkeley County recreation complex, hospital spokesman Andy Lyons said.
“We did an entire week of vaccinations in Moncks Corner because state DHEC reached out to us and said look, Berkeley County is at an alarmingly low vaccination rate,” he said.
Roper worked behind the scenes with local churches and grass roots organizations to promote the five-day clinic before notifying the media to ensure rural and underserved residents got first dibs on the doses.
Lyons said DHEC gave the health care system more than 4,700 Moderna doses for use at the Berkeley County clinic, on top of the Pfizer doses it normally receives and administers in Charleston County, and the hospital went through all of them.
Hospital staff will return to Moncks Corner in a few weeks to provide second doses to all of last week’s vaccine recipients, but has no current plans to hold any additional first dose clinics in Berekley County, he said.
There’s also some question about whether DHEC is actually counting every Berkeley County resident who has been vaccinated.
SIMON, the agency’s immunization database that feeds its online vaccination dashboard, assigns a person’s county of residence based on their ZIP code and city of residence.
Since some South Carolina cities and ZIP codes cross county lines, the system may mistakenly categorize residents as living in one county when they actually reside in a neighboring county, DHEC spokeswoman Laura Renwick said.
That’s what appears to have happened with Daniel Island residents, who live in the city of Charleston but are technically residents of Berkeley County, she said.
The same issue has prevented a full accounting of vaccinated residents in Jasper County, which has the lowest inoculation rate in the state, according to DHEC data.
The Island Packet reported earlier this month that the agency appears to be miscategorizing at least some Jasper County vaccine recipients as Beaufort County residents.
In a ZIP code that spans both counties, DHEC’s online dashboard showed Wednesday that 11,361 vaccine recipients came from the Beaufort County side, while only 37 were from Jasper County.
A local mayor told the Island Packet it was “virtually impossible,” so few Jasper County residents in that ZIP code had gotten shots.
Renwick said DHEC was aware of the issue and had a dedicated data team working “continuously” to sort it out.
It’s not clear how much of a difference, if any, the agency’s data sorting errors might have on county vaccination rates.
DHEC officials said they review county-level vaccination data daily and use it to steer localized vaccination efforts to ensure equitable access to all South Carolinians.
“Even neighboring counties can have pretty different wants and needs, and we are prepared to be flexible and shift doses as needed to meet local demand,” Renwick said. “We don’t want doses sitting with a provider at some location in some county where there isn’t demand. However, we also want to use this data to help us connect with those communities that don’t have comparable demand so that we can better understand why that is, identify any limitations, address those limitations, and make sure all South Carolinians have fair and equal access to their shots.”
SC vaccination rates
The following chart shows vaccination rates by county ranked from highest to lowest. It also shows how a county’s actual number of doses administered — which is roughly equivalent to the doses it has received — compares to the number of doses the county would have received based on a per capita distribution plan.
A value of 100% in the second column means the county has received exactly as many doses as would be equitable based on its population. A value higher than 100% means the county has gotten more doses than is equitable and a value less than 100% means it has gotten fewer doses than is equitable.
The third column shows the proportion of county residents age 65 and older, according to 2019 U.S. Census data.
Percent of age 15+ population vaccinated
Proportion of actual doses administered vs. expected
% of 65+ residents
*Data as of March 24, 2021; Source: DHEC