Posted May 19, 2022, 6:40 am

Brett Kelman

Kaiser Health News

MEIGS COUNTY, Tenn. — At a glance, it seemed like a Southern pandemic success story in a most unlikely place.

A small county northeast of Chattanooga, along the twisting banks of
Chickamauga Lake, for much of the past year has reported the highest COVID-19 vaccination rate in Tennessee and one of the highest in the
South.

Meigs County, which is overwhelmingly white, rural, and conservative —
three demographics that strongly correlate with low vaccination rates —
appeared to have broken a pattern of hesitancy and distrust that has
stymied vaccination efforts across the U.S.

“They are a rural county, and they have the highest vaccination rate
in the state,” said Tennessee Gov. Bill Lee in September as the delta
variant savaged his state, praising Meigs County for “leading the way on
vaccines.”

If only it were true.

The rate in Meigs County was artificially inflated by a data error
that distorted most of Tennessee’s county-level vaccination rates by
attributing tens of thousands of doses to the wrong counties, according
to a KHN review of Tennessee’s vaccination data. When the Tennessee
Department of Health quietly corrected the error last month, county
rates shifted overnight, and Meigs County’s rate of fully vaccinated
people dropped from 65% to 43%, which is below the state average and
middling in the rural South.

The health department attributed the error to software from STChealth,
an Arizona company paid as much as $900,000 a year to host and maintain
Tennessee’s immunization information system. STChealth provides similar
services to at least eight other states, and officials in West Virginia
and Montana said ZIP code errors have also affected their county-level
vaccination data.

The data error misplaced vaccinations of Tennessee residents who live
in ZIP codes that straddle more than one county and incorrectly
attributed all vaccinations in those areas to whichever county contains
most of the ZIP code. Meigs, with a population of 13,000, got credit for
about 2,900 extra vaccinations, largely from neighboring Roane County.

The inverse occurred in Moore County, which had been labeled Tennessee’s least-vaccinated area.
Many of Moore County’s vaccinations were misattributed to surrounding
counties, and once the error was corrected, its rate nearly doubled —
from 21% to 40%.

Dr. William Schaffner, an infectious disease expert at Vanderbilt
University Medical Center in Nashville, said the ZIP code error was
emblematic of the nation’s piecemeal public health infrastructure.
Reports of diseases and vaccinations limp upward from local hospitals
and clinics through county and state governments and eventually to the
federal Centers for Disease Control and Prevention, “all with different
computer systems and levels of training on the way,” he said.

Schaffner wondered: What if Meigs County gave Tennessee leaders misplaced confidence in rural vaccination efforts?

“Good data don’t guarantee good decisions,” Schaffner said. “But
faulty data — aha! — you can be sure they lead to bad decisions.”

In Meigs County, residents said they had long been skeptical of such
high vaccination statistics in an area where many openly distrust the
vaccines. When told of the data error, some lamented the county’s
once-enviable rate. Some shrugged. Few were surprised.

“If I had a million dollars and I could place a bet, I would have bet
this place wasn’t the highest,” said Steven Woisin, owner of a Meigs
County hemp shop, who said he has caught COVID twice and remains
unvaccinated.

Betty Pillion, a longtime resident who works in the county mayor’s
office, insisted the data error should not overshadow the county’s
uphill efforts to vaccinate every willing resident — even if the total
was ultimately less than half.

“To be from this county and know that we worked hard enough to get to
44%, we’ll take it,” Pillion said. “That’s better than 10%. Or 0%.”

Sarah Tanksley, a spokesperson for the Tennessee Department of
Health, first confirmed the ZIP code problem in February and said a
software update from STChealth was expected to fix it. The health
department stopped waiting for that software update on April 1 and
tasked its staff with geocoding vaccination data to the correct
counties.

This fix shuffled the rates and rankings of counties on Tennessee’s COVID-19 website,
with the most dramatic shifts occurring among smaller and narrow
counties with more partial ZIP codes. The CDC still publishes the
incorrect statistics daily.

The Department of Health declined to provide any official to discuss
the data error in detail or answer further questions. STChealth
initially agreed to an interview with KHN but canceled after being
provided more details about the focus of this article. The company did
not respond to additional requests for comment.

There are signs Tennessee knew about the data problem long before it was confirmed or corrected.

Dr. Michelle Fiscus, who was fired
from her position as Tennessee’s top vaccine official in July amid
anti-vaccine political pressure from state lawmakers, told KHN that the
health department knew as of last year that county-level data became
skewed as it was pulled from the state’s immunization information
system, known as TennIIS, to be reported to the CDC and the public.

TennIIS was designed long before the pandemic to track routine
vaccinations across the state and was not intended to be used to
calculate county rates, Fiscus said.

“[TennIIS] has never been used for, pre-COVID, to produce
county-level reports on vaccination rates because the data has always
been incomplete,” Fiscus said. “When the data was pulled out, each ZIP
code had to be ascribed a county because there wasn’t another good way
to do it.”

Allison Adler, a spokesperson for the West Virginia health
department, said the state records vaccinations from ZIP codes that
cross county lines the same way as Tennessee “a majority of the time.”
But, Adler added, the state takes steps to make the data more accurate
after it is received from STChealth.

Megan Grotzke, a spokesperson for the Montana health department,
confirmed the state faced similar issues in “isolated instances” where
ZIP codes straddle county lines and said the agency “has made an effort
to correct these.”

Other states appear to have avoided the ZIP code issue before it
skewed their public vaccination data. Health department officials in
Arizona, Louisiana, and Ohio — all of which employ STChealth’s services
similarly to Tennessee — said the COVID vaccination data is geocoded by
the agency to ensure vaccinations are attributed to the proper county or
parish.