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This rural, red Southern county was a vaccine success story. Not anymore

Brett Kelman, Kaiser Health News on

Published in News & Features

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.


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