On a recent hot Thursday evening at the Broadway Neighborhood Center in Iowa City, a group of University of Iowa student volunteers set up a mobile COVID-19 vaccination clinic.
The neighborhood is filled with apartment complexes that house many immigrant and refugee families, but the clinic struggles to attract local residents.
Andrew Coghill-Behrends, the site director for the community center, hit the streets. His goal this day was to get at least 20 people in for the shot.
The clinic's staff distributed multilingual flyers, but residents may not have seen them, he said.
"It's really about talking to people and seeing if you can find them where they're at, and encourage them to come over," he said.
Coghill-Behrends approached several people outside, but they all turn him down.
The University of Iowa mobile clinic has given more than a thousand shots in vulnerable communities since March.
But at the end of the clinic's hours, just five people get vaccinated.
Coghill-Behrends said a clinic held at the Pheasant Ridge Neighborhood Center in March attracted dozens.
"I was hoping for the same here," he said. "But it's hard to know how many of the folks in this area have taken advantage of the clinics that have been already held here."
Andrea Arthofer, a third-year medical student at the University of Iowa who oversees the mobile clinic program, said demand was high during clinics in the spring.
But in recent weeks, that's changed, she said.
"I think now the biggest barrier is vaccine hesitancy and just general, like, not knowing you what the risks and benefits are to the COVID-19 vaccine," Arthofer said.
Nearly 60 percent of Iowa’s adults are fully vaccinated for COVID-19. This puts the state above the national average of 55 percent of American adults.
But as the demand for the vaccine has dropped sharply, it’s unclear when — or if — the state will get to that 70 percent mark experts say constitutes herd immunity.
A poll of 12,000 Americans on the COVID-19 vaccine released last week by the Commonwealth Fund and the African American Research Collaborative found 66 percent reported facing two or more barriers to getting the shot, such as being too busy or not knowing they were eligible.
But it also found 37 percent reported being hesitant about getting the vaccine, with 44 percent of Republicans and 43 percent of independents reporting hesitancy, as compared to 26 percent of Democrats.
A New York Times analysis last month using COVID-19 vaccination rates and the Centers for Disease Control and Prevention's Social Vulnerability Index found counties nationwide that were ranked more vulnerable — considered to be a rating of 0.5 or higher — had lower vaccination rates.
But an IPR analysis this month of these two factors in found no correlation between Iowa vaccination rates and counties' social vulnerability ranking.
"I would attribute most of our issues to vaccine hesitancy and skepticism about the vaccine, rather than accessibility," said Stanley Perlman, a University of Iowa professor of immunology and pediatrician.
The Commonwealth Fund poll found some top concerns among unvaccinated people included the idea that President Joe Biden has distributed unproven vaccines, the shots makes people sick and the belief people have a personal right to opt out.
That last reason is what Lindee Thomas, the administrator for the Van Buren County Public Health Department, hears a lot.
"It's mainly personal choice, you know, on what they think," she said. "I think a lot of this has been, I guess, party-driven or government-driven. And so I think there's a lot of mistrust and misinformation."
Just 41 percent of Van Buren County’s adult population is fully vaccinated, one of the lowest rates in the state.
But Thomas said she doesn’t feel it’s her place to persuade people to get the shot.
"I think all we can do is educate people, and they have to make that choice," she said.
This month, state officials launched a statewide ad campaign to push more people to get vaccinated. While some counties like Polk and Black Hawk have set up vaccine lotteries, Gov. Kim Reynolds has declined to set up a statewide lottery.
But experts say there’s little research on whether these lottery incentives really work.
Elvin Geng, a professor of medicine at Washington University in St. Louis, said one study found it only works to persuade those who are more open to getting the shot.
"If you are resistant to it, or you think there's something wrong with it, and they say, ‘Oh, you could win some money,’ it actually makes people think of that entire thing as less attractive," he said.
Geng said what does work is getting primary care physicians to encourage their patients to be vaccinated.
"The reason why people trust their doctors is because there's a relationship, right? You know this person as a human being, and you know that you've seen them in the past, and you expect to see them again in the future," he said.
If Iowa doesn’t reach herd immunity, Geng said it’s the counties that have low vaccination rates that are at a greater risk for COVID-19 outbreaks.
This is what worries Chris Estle, the administrator for the Jefferson County Public Health Department. In her county, just 43 percent of the adult population is fully vaccinated.
"Honestly, at this point, I don't know that we're going to move the needle," she said. "People don't want to hear me say that. They don't. But that's the reality of where we're at."
Estle said the highly contagious Delta variant has been confirmed in the county. She said she expects to see a spike in cases at some point. She just doesn’t know when.