Lee Wright was hard at work, building a nail salon near an abandoned hospital in downstate Cairo, when Jody Johnson stopped by to introduce himself.
For Johnson, who works for the University of Illinois’ extension program, it was the first step in trust in the city of fewer than 2,200 people as extension programs across the United States — long valued in rural communities for helping farmers and supporting 4-H clubs — expand to include educating the public about COVID-19 vaccines.
Wright, 68, was unvaccinated even though he’d followed other public health guidelines during the coronavirus pandemic. When it came to the shots, he was putting his fate in his faith.
“Doctors are good, don’t get me wrong,” Wright said. “But we got to have something that we can really depend on.”
Johnson didn’t talk with Wright about the vaccines that day. He just listened.
“No one wants to feel ashamed or belittled because they’re not doing something,” Johnson said later.
Only 16% of the people living in Alexander, County, home to Cairo, are fully vaccinated against COVID, the lowest rate in Illinois, according to the state Department of Public Health.
And case counts of coronavirus infections are rising. So the nation’s Cooperative Extension System, which is tied to a network of land-grant universities, plans to spend the next two years talking about vaccines in Cairo and elsewhere.
The extension system has a tradition of bringing research-based information to communities on a wide range of topics, including water quality, food safety and disaster preparedness. With roots sunk deep in rural America, where vaccines have been slow to catch on, the system is using state and federal funding to pay for immunization education efforts tailored to specific communities.
In Illinois, the agency has a COVID resource guide for families, business owners and farmers. The office covering the southern part of the state is looking to hire someone in the community to help spread the word on why vaccinations matter. Johnson also wants to work with churches, civic groups and business owners.
And 4-H clubs have been making masks and face shields.
“This is not our first global pandemic,” said Carissa Nelson, a 4-H spokesperson in Illinois, noting that the organization’s agents and club members nursed patients during the 1918 flu pandemic.
In Cairo, a long history of racial tension dating to the Civil War still stings. As in rural towns across the United States, many in the downstate town feel underappreciated and misunderstood. And vaccine apathy is common in Cairo, where infection rates remained low until recently.
“We haven’t had great turnouts,” said Tyrone Coleman, president and co-founder of the Alexander and Pulaski NAACP chapter, which has helped organize vaccine clinics in Cairo.
In June, Coleman invited the health department to a Juneteenth celebration at St. Mary’s Park. More than 300 people attended. But a state pop-up clinic drew just two people seeking vaccinations, Coleman said.
More than 15,000 people lived in Cairo in the early 20th century, helping it earn the nicknames “Little Chicago” and “the Gateway to the South.” Old factories, antebellum homes, an ornate library and a vacant hospital remain as reminders of the city’s past. The library prominently displays the work of Mark Twain, who, after traveling through Cairo, wrote about the city in 1884 in “The Adventures of Huckleberry Finn.”
In the novel, Cairo represents freedom and the chance for a better life.
But the hospital was shut down in 1987. The only grocery store in Cairo closed years ago, public housing was torn down in recent years, and the only nursing home was closed during the pandemic without much notice.
Fewer than 2,200 people, most of them Black, live in Cairo, which is often mislabeled by reporters and travel guides as abandoned.
“Cairo is not a ghost town,” said Ronnie Woods, a pastor and retired schoolteacher. “It’s not dead at all.”
Tourists still stop by to see the confluence of the Mississippi and Ohio rivers.
But they don’t typically see the rocky riverbank where locals fish for their dinner. Beverly Davis, 60, heads there often, rod in hand, giving much of her catch away to others. The scenic waterfront, though, is carpeted with driftwood and dead fish that washed ashore.
“I guess it’s meant to be like this,” Davis said, standing on the riverbank among the fish carcasses. ” ‘Cause, if not, it would be better.”
But many continue to believe their city will return to its past glory.
“The world hears that this is a negative part of the country, and it’s not,” Johnson said. “We’ve got too many good things and people here.”
University of Illinois Extension director Jody Johnson (right) exchanges contact information with Lee Wright (left) and his son Roman Wright. The extension’s office in southern Illinois has launched a vaccination education program that aims to win over the unvaccinated in Cairo.Cara Anthony /KHN
On a recent day, the only outdoor basketball court in town, anchored by a single hoop, was busy in a rural community that already was fighting to stay alive long before the pandemic. The men playing didn’t seem worried about COVID.
“I haven’t had COVID, so I feel like I don’t need to get vaccinated right now,” said Jeffery DeWitt, 24. “I’ll just take it as it goes.”
Wright’s son Roman Wright, 36, said much the same thing while helping his father build the nail salon across town. He works for the prison system, and one of its facilities nearby reported COVID cases. But he hadn’t contracted the virus and, like his father, said he didn’t plan on getting the shots.
“I’m like my dad,” he said. “I was born and raised in church all my life. So I say we believe in God. I know my parents pray for me. We pray for each other, and we just believe in God.”
Woods, the pastor, has a different view. He keeps his vaccination card in a plastic sheath and carries it wherever he goes.
“I have strong faith,” said Woods, 66. “And, at my age, my risk factors, I just felt that God placed science there to help us.”
But Woods said it’s going to take work to persuade others in Cairo to get vaccinated even if they know someone who died of COVID.
Tourists still stop by to see the confluence of the Mississippi and Ohio rivers in Cairo, where commercial ships dock on the banks.Cara Anthony / KHN
“It’s going to take more than explaining,” Woods said. “It is going to take a cultural shift because people are just not trusting.”
That’s one reason Johnson is searching for a local voice to lead the extension service’s vaccine education program. As a 51-year-old white man who grew up in a predominantly white community 45 miles away from Cairo, he recognizes that locals would be more likely to share their thoughts with someone who lives in town. He is searching for someone who will spend time with locals who don’t hold titles and positions.
“Everybody doesn’t think like me,” Johnson said. “So we need to take that into consideration.”
KHN (Kaiser Health News) produces in-depth journalism on health issues.