Even as COVID-19 infections and deaths are rising once again in South Dakota, resistance to getting vaccinated remains entrenched among some state residents, and the political divide over whether to get vaccinated shows no signs of narrowing.

Two new sets of polling data on vaccine-hesitancy rates and reasons have raised concerns of health and medical professionals in South Dakota who see widespread vaccination against COVID-19 as the only way to reduce hospitalizations and deaths and forge a path to a return to normalcy.

A statewide poll conducted by South Dakota State University researchers in late July and early August showed that 65% of unvaccinated respondents were “very unlikely” to get vaccinated against COVID-19 and that another 16% were “somewhat unlikely” to get the shots. Less than 1% of unvaccinated respondents said they were “very likely” to get vaccinated in the future.

That same poll showed that while 87% of Democrats said they were vaccinated, only 61% of Independents and 46% of Republicans were vaccinated, a troubling trend in a state dominated by GOP voters and elected officials.

Meanwhile, a new national review of statewide polling data on vaccine hesitancy showed that South Dakota has a higher-than-average rate of residents who oppose vaccinations because they don’t think the vaccines are needed, because they don’t trust the vaccines or government, or because they don’t see COVID-19 as a big threat.

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A series of recent SDSU polls have consistently shown that state residents of both political parties, especially Republicans, have aligned their views with messaging from national and state party leaders on major issues such as taxes, welfare, foreign policy and now the COVID-19 vaccines and masking, said Filip Viskupic, an SDSU political science professor who helped design the most recent poll.

“It’s remarkable how this issue has gone from a medical or public-health issue and is now seen through a political lens,” Viskupic said.

Prior SDSU Poll results show that when it comes to pandemic-related issues, Democrats in South Dakota have indicated high trust in science and scientists, including Dr. Anthony Fauci and the Centers for Disease Control and Prevention, while Republicans have adopted views more closely aligned with Republican Party leaders, some of whom have resisted mask and vaccine mandates and expressed lukewarm or no support for widespread vaccination against COVID-19.

The split in support of vaccines between Democrats and Republicans in South Dakota does not bode well for health officials who are trying to reach herd immunity in a GOP-dominated state, Viskupic said. Herd immunity is the condition where enough members of a population are vaccinated or have obtained immunity after being infected so as to greatly limit spread of a virus.

“It does not make the jobs of doctors or public-health officials easier,” Viskupic said.

One national data analyst who has tracked vaccine-hesitancy poll results across the country for months said resistance to the COVID-19 vaccines has been higher in states where political leaders have expressed doubt about vaccines or presented mixed messages to the public.

Data analyst Nick VinZant said recent U.S. Census Household Pulse Survey data has consistently shown a high level of vaccine hesitancy in South Dakota compared with the rest of the nation, and noted that resistance to the vaccines has appeared to “harden” in recent months in the Rushmore State.

VinZant, an analyst with QuoteWizard, a firm that provides research to insurance companies, said it is possible that Gov. Kristi Noem’s consistent rhetoric opposing COVID-19 vaccine mandates has fueled hesitancy and distrust of the vaccines in South Dakota.

“The messages that are coming from politicians are absolutely a factor in people’s vaccine hesitancy and you can see that in South Dakota,” VinZant said.

South Dakota Gov. Kristi Noem posted this image of herself getting the first dose of the Pfizer COVID-19 vaccine on Twitter in April. Noem has urged residents to get vaccinated, but has opposed vaccine mandates that some experts say could lead to higher vaccination rates across the state. (Photo courtesy Gov. Noem's office)
South Dakota Gov. Kristi Noem posted this image of herself getting the first dose of the Pfizer COVID-19 vaccine on Twitter in April. Noem has urged residents to get vaccinated, but has opposed vaccine mandates that some experts say could lead to higher vaccination rates across the state. (Photo courtesy Gov. Noem's office)

Ian Fury, spokesperson for Noem, said the Republican governor received the Pfizer vaccine regimen soon after it became available and has supported widespread vaccination of South Dakotans. In April, the governor posted a photo of herself receiving her first dose of the vaccine on Twitter.

But Noem, who has resisted COVID-19 restrictions on businesses and events such as the Sturgis motorcycle rally, has been highly vocal on social media and on national television in opposition to vaccine mandates. Noem in April issued an executive order banning “vaccine passports” in South Dakota, and continues to decry vaccine mandates. In early September, she threatened to sue the federal government after President Joe Biden announced a plan to force large employers to require employees to be vaccinated.

“Gov. Noem is vaccinated and has encouraged South Dakotans to choose to get vaccinated as well. The governor is keeping her campaign promise of standing up to federal overreach. The Biden Administration does not have the authority to put forward the kind of mandates that they are proposing,” Fury wrote to News Watch in an email.

Resistance to vaccination has not only allowed COVID-19 to spread more readily among adults and children, but has also opened the door to the emergence of coronavirus mutations such as the delta variant, a more transmissible form of the virus that is now the dominant strain in South Dakota, according to Dr. Shankar Kurra, vice president of medical affairs at Monument Health in Rapid City.

Shankar Kurra
Shankar Kurra

The longer and more frequently a virus spreads, the more likely it is to develop new strains that may be more resistant to current vaccination regimens, Kurra said.

Kurra said the delta variant has raised the level of vaccinations needed to reach herd immunity because it is so highly transmissible to as much as 85% or 90% of the population.

“If we don’t do the right thing and get that number [of vaccinations] up really quickly, we can expect more variants because this is the nature of this virus,” he said.

Dr. Jeremy Cauwels, chief physician at Sanford Health in Sioux Falls, said patient data show that COVID-19 remains “a pandemic of the unvaccinated” in the Great Plains and Midwest, where Sanford operates 46 hospitals in 10 states.

Of the roughly 145 patients hospitalized with COVID-19 across the Sanford system in early September, only 11 were fully vaccinated and most of those “breakthrough” patients were elderly or had co-morbidities that made them more susceptible to complications from the virus, Cauwels said.

Jeremy Cauwels
Jeremy Cauwels

The age of patients hospitalized with COVID-19 has fallen throughout 2021 as vaccinations have risen among older people and vaccine hesitancy has remained present among many younger adults, Cauwels said.

“Right now, the virus is attacking younger, healthier individuals who have chosen not to or are unable to get vaccinated,” he said.

Like other health and medical professionals, Cauwels places much of the blame for vaccine hesitancy on misinformation spread on social media, untrustworthy news outlets and a political divide in the U.S.

“It really, to me, is sort of sobering that we have a very effective vaccine or cure for it, and we have people out there who are absolutely afraid or unwilling to get the vaccine," he said.

Dr. David Basel, vice president of clinical quality for the Avera Medical Group in Sioux Falls, said he has seen a recent rise in interest in getting vaccinated among South Dakotans, likely driven by the rise in cases due to the delta variant.

He likened the effort to combat vaccine hesitancy to how the medical community successfully promoted smoking cessation — through a clear, consistent message delivered over a long period of time. But Basel said some vaccine-hesitant people may need to see a close friend or relative get sick or die from COVID-19 to spur them to get vaccinated.

Enhancing efforts to make it easy for people to get vaccinated in as many physical locations as possible is another strategy that may increase vaccinations, Basel said.

Kurra said there is no way out of the pandemic without widespread vaccinations.

“This is preventable, and we’ve got a solution and it’s called a vaccine," Kurra said. “It really is a dangerous option to not be vaccinated, because you are staking the potential on the one hand for a good, healthy life and on the other hand living a life that is full of morbidity and frequent visits to the hospital.”