Facing deep mistrust stoked by rampant conspiracy theories, local health officials are fighting for influence when the only sure strategy for beating back the virus is getting more people vaccinated.,

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SHREVEPORT, La. — Dr. Martha Whyte, the top public health official in the northwest corner of Louisiana, was sitting at the back of a City Council meeting here on a muggy day recently when she was called to the front of the room to respond to an attack on the coronavirus vaccine.

Candy Peavy, a resident, had warned that the Biden administration would send people door to door to “document unvaccinated Americans” — a false but widespread conspiracy theory. Not only that, Ms. Peavy had told the hundreds in attendance, but the vaccine was an “experimental gene therapy” that had killed thousands in the United States.

“We should refuse to be tracked, discriminated against, bribed, controlled, threatened, shamed or coerced into compliance,” she had shouted to applause.

Dr. Whyte calmly began a practiced monologue on the vaccine. It does not integrate into one’s DNA, she said. No one in Louisiana has died from the vaccine — one of the safest ever produced, she added. Several women yelled and swore at her before they were asked to leave.

“We’re stuck,” Dr. Whyte, 55, said in an interview days later in her fifth-floor government office, surrounded by awards she has received over almost 20 years as medical director of a public health region in Louisiana bordering Texas and Arkansas. Coronavirus variants are swarming the area and threatening a major uptick in cases and deaths.

2,000
4,000
6,000 cases
Apr.
2020

May

Jun.

Jul.

Aug.

Sept.

Oct.

Nov.

Dec.

Jan.
2021

Feb.

2021

Mar.

Apr.

May

Jun.

Jul.

New cases

7-day average

2,414

These are days with a reporting anomaly.

About this data
Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of a day and the previous six days of data.

Facing deep mistrust that has been stoked by conservative news outlets and lawmakers and by rampant misinformation online, local health officials like Dr. Whyte are fighting for influence when the only sure strategy for beating back the virus is getting more people vaccinated. Dr. Whyte considers herself a target at a time when many public health officials around the country have resigned or been fired during the pandemic, including the top vaccine official in Tennessee this month.

A year and a half into the crisis, their battered departments are now struggling to contain the spread of the Delta variant with testing and contact tracing — the best resources, despite their limited reach, in the many places where vaccination rates remain low. They are facing new heights of hostility, and new battles are looming over what safety measures schools and businesses should put in place in the fall, decisions the Centers for Disease Control and Prevention has said should be made in consultation with local health officials.

Nowhere is the struggle as urgent as in this pocket of Louisiana, one of the white-hot centers of what has become a two-track pandemic. Only 30 percent of the more than 500,000 people in the region are fully vaccinated, almost 20 points below national figures. A recent study by researchers at Georgetown University showed that Shreveport was in the middle of one of five main clusters of unvaccinated people in the United States vulnerable to large surges and new variants, putting the rest of the nation at risk.

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A testing site at a car dealership in Shreveport, La., where cases are multiplying quickly.Credit…Emily Kask for The New York Times

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Camille Baylor, 15, receiving a shot in Shreveport. Only 30 percent of the more than 500,000 people in the region are fully vaccinated, almost 20 points below national figures.Credit…Emily Kask for The New York Times

Louisiana ranks near the bottom in vaccination rates nationally, and cases are again multiplying, with the second-highest average daily case count per 100,000 people in the country.

“We are unfortunately the leading edge of the Delta surge,” said Dr. Joseph Kanter, the state’s top health official. “We lost all the progress we had made.”

The immediate crisis is confounding and demoralizing Dr. Whyte and other officials in Shreveport, where just over half the population is Black and nearly 40 percent is white, with a mix of moderate Democratic and far-right conservative politics.

With so few of its residents vaccinated, the city is largely relying on the complex work of disease surveillance and intimate block-by-block, person-by-person engagement. And without as many resources as some larger health departments, the region has turned to other public institutions to fill the void. The backbone of the city’s response in recent months has been a dilapidated former Chevrolet dealership converted to a vaccination and testing site by Louisiana State University Health Shreveport, where a team of workers weaves around test and vaccination kits stacked floor to ceiling, planning mobile unit outings.

The fight against the virus in the region is a study in the kind of small-scale response that has the best chance of working, albeit painfully slowly, at this stage of the pandemic, said Dr. John Vanchiere, a professor of pediatrics and infectious disease at L.S.U. Health Shreveport who works closely with Dr. Whyte. A recent visit to a chicken processing plant, where they delivered a dozen presentations to groups of workers, led to gradual uptake of the vaccine, he said. He and Dr. Whyte spoke last Sunday at a Black Baptist church to encourage vaccinations. Congregants raised claims they had heard about the vaccine causing infertility and magnetizing people’s bodies — both false.

“It’s a lot of small battles in different places,” Dr. Vanchiere said, “and every battle is going to be different.”

The church event and other visits with local organizations are only part of what has become a round-the-clock operation run by Dr. Whyte to carry out testing and vaccinations and conduct education and outreach across the region. She manages a dozen public health clinics with drive-through tests and vaccinations. She consults almost daily with Dr. Vanchiere and the National Guard on where to send mobile units to do the same. And she appears several times a week on local radio and television to encourage vaccination.

Half a mile from Dr. Vanchiere’s testing site, Dr. Jeremy Kamil, an associate professor of microbiology and immunology at the medical center, oversees a team of scientists reading the genomes of positive virus samples each week, often with guidance from Dr. Whyte on which outbreaks to survey.

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Sandy Spann, a medical technician, working with coronavirus samples at Louisiana State University Health Shreveport, which is tracking where Delta and other variants are spreading.Credit…Emily Kask for The New York Times

A run of samples this week found the number of cases involving the Delta variant had exploded.

“When your neighbor has it, or you know that it’s in your area, or your cousin sent in a swab and found out that they had the Delta variant,” Dr. Kamil said, “it drives people to be like, ‘Yeah, this is real.'”

Dr. Vanchiere said a growing public awareness of local Delta cases was one reason his team was now vaccinating twice as many people as a month ago — as many as 100 a day.

As Delta surges, a network of canvassers directed by Dr. Whyte is conducting the door-to-door work that some conspiracy theorists have falsely labeled a nefarious surveillance campaign. The workers are part of Bring Back Louisiana, a publicly financed statewide effort that has relied on local data to target socially vulnerable, lower-vaccinated ZIP codes. One recent afternoon, Roberta Moses approached a block of single-story homes in the shadow of the city’s main airport, her visor guarding against a blazing sun. She carried fliers and an invitation to a vaccination event at a church that weekend.

Ms. Moses, a retiree who has lived in Shreveport for more than 50 years, said that when she succeeds at engaging people, “they realize we’re not there to ask you your personal business.”

“‘Have you had your Covid vaccination?’ We don’t ask people that,” she said. “That’s not our business. We’re here to ask you, ‘Would you like to schedule a Covid vaccination?'”

Understand the State of Vaccine Mandates in the U.S.

College and universities. More than 400 colleges and universities are requiring students to be vaccinated for Covid-19. Almost all are in states that voted for President Biden.Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get the Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force. In N.Y.C., workers in city-run hospitals and health clinics will be required to get vaccinated or else get tested on a weekly basis.Can your employer require a vaccine? Companies can require workers entering the workplace to be vaccinated against the coronavirus, according to recent U.S. government guidance.

Between multiple rejections and a warning from one resident to get out of the neighborhood, she received only one sign-up for a vaccination appointment on a clipboard she carried.

One of her canvassing colleagues, the Rev. Quincy Gardner, a pastor, said he was going to even greater lengths to drum up interest, waking early to hop on public buses in Shreveport and join outdoor games of dominoes to encourage vaccinations.

Dr. Whyte said her days often revolved around phone calls with nervous school officials and business owners fearing the Delta surge. Businesses are worried they cannot afford another shutdown, she said, and are wondering what they can do to avoid it. She tells them to be spokespeople for vaccination, and to enforce mask-wearing where they can. Once again, she is talking about what a mask mandate might look like, and how it might be received.

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Roberta Moses, a retiree who has lived in Shreveport for more than 50 years, knocking on doors to inform people about the vaccine. Shreveport is largely relying on person-to-person interactions to combat the virus.Credit…Emily Kask for The New York Times

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Mayor Adrian Perkins of Shreveport announced a new mask advisory on Friday.Credit…Emily Kask for The New York Times

Mayor Adrian Perkins, a Shreveport native and graduate of West Point and Harvard Law School who served in the Iraq and Afghanistan wars, was sued last year when he tried one. On Friday, he announced a new advisory urging residents to wear masks indoors, a day after the parish commission voted to postpone action on a mandate.

The falsehoods filling social media feeds dwarf whatever vaccine salesmanship power he has, he said. One complicating phenomenon, he said, was the sharing of misinformation between the Black community with a long-held skepticism of vaccines and a white population that sees the vaccine and virus restrictions as government overreach.

Dr. Whyte framed her struggles getting people vaccinated as part of a broader negligence of public health. She said her department was continually underfunded despite significant rates of syphilis and maternal and infant mortality. It is wrestling with infant vaccinations and the spread of sexually transmitted diseases, and is fighting an increase in drug overdoses.

Her department has 99 employees, but few for preventing and tracking infectious disease. She oversees one epidemiologist and a community health worker supervisor who has no one to supervise. She is starting to see some help from federal funding appropriated during the pandemic: She plans to hire three community health workers soon, a social worker to replace one who retired years ago, and at least one more epidemiologist, most likely with funds provided by the C.D.C. She manages contact tracing with a small team.

As Dr. Whyte explained the city’s challenges in an interview, Calandre Singh, an epidemiologist in Shreveport for the state health department, interrupted with a warning. The funeral for a police deputy in neighboring Webster Parish was set for the next day and was likely to draw hundreds of people indoors, likely without masks — a possible superspreading event. Dr. Whyte and her team consulted with the organizers, who promised to enforce social distancing and a mask requirement. No outbreak has been tied to the event thus far, she said.

Within a month, Dr. Whyte anticipates even knottier debates about the need for masks and vaccines in schools. Federal regulators have not yet authorized the vaccine for the youngest children, but those 12 to 15 have been eligible for the Pfizer-BioNTech vaccine since May.

At times over the last year, Dr. Whyte has felt so emotionally wrung out that she has been tempted to quit. Her otherwise healthy husband, a physician, spent two months on a ventilator last year, an experience she describes vividly in her pitches to community members about vaccination. The exchange with Ms. Peavy at the City Council meeting had left her angry and depleted.

“I’m just telling you the science,” she said later, going over a script she has used more times than she can count. “You have to decide that you’re open-minded enough.”

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A recent study showed that Shreveport was in the middle of one of five main clusters of unvaccinated people in the United States vulnerable to large surges and new variants.Credit…Emily Kask for The New York Times