In these six states, the rate of first vaccinations per 100,000 residents for rural areas is higher than the national rate of 14,600 per 100,000. Data is available for only 24 states as of late February. (Daily Yonder/Covid Act Now)

Some experts worried initially that the nation’s Covid-19 vaccination roll-out might leave rural areas behind. But early numbers from states that provide county-level data on vaccinations show that in about two-thirds of the cases, rural areas holding their own.

Data from the week of February 26 shows that in 17 of 24 states analyzed by the Daily Yonder, the rate of people who have received their first Covid-19 vaccine shot in rural areas is as good, if not better than, their state’s largest metropolitan areas. 

On the negative side of the equation, only six of the 24 states had rural vaccination rates above the national average vaccination rate of 14,600 per 100,000 (14.6%). Those were Illinois, Maryland, Maine, Minnesota, New Mexico, and Washington. Wyoming, New York, and Michigan had rural vaccination rates that were nearly as high as the national average.

Nevertheless, the rural rollout of Covid-19 vaccines is going better than some predicted. 

For instance, in Illinois, rural areas have a rate of the first vaccine administered of 15,419 per 100,000. In major metropolitan areas, that rate is only 13,393. But in places like Florida, Oregon and Ohio the rural rate of first vaccination is lower than that of major metropolitan areas. 

Carrie Henning-Smith, Ph.D, deputy director of the Rural Health Research Center, said she’s not surprised by the findings that show some rural areas with higher rates of vaccination than large metros. 

“I would actually expect to see the sort of numbers that we’re seeing, at least in the early part of the vaccine roll out,” she said. “And that’s because of the way that we have been prioritizing the roll out in most states. (It) started really with healthcare workers and older adults, and… rural areas have pretty dramatically higher percentages of older adults than urban areas.”

Other phases of the roll out also target rural populations, she said. With the addition of eligibility because of medical conditions like diabetes, obesity, high blood pressure and cardiovascular disease, that too would encompass more rural residents, because they are more likely to have those conditions, she said. 

“We should still see higher rates of vaccines in rural residents than in urban residents for a while,” she said. “Really, until we get to the point where it’s opened up to the general population, people who are middle aged or younger and relatively healthy and are not healthcare workers or front line workers, I think that trend will continue.”

A recent review of data by Becker’s Hospital Review on the Centers for Disease Control and Prevention (CDC) vaccine distribution and administration data tracker, found that more rural states were doing better at administering the vaccines they received. As of 6 a.m. on February 23, a total of 82,114,370 vaccine doses had been distributed in the U.S, and 65,032,083 had been administered – 79.20%. 

The five state’s with the highest percentage of doses administered compared to doses received were Montana (93%), New Mexico (92%), West Virginia (91%), North Dakota (90%) and Wisconsin (89%). At the bottom of the list were Pennsylvania (72%), Kentucky (72%), Mississippi (70%), Maryland (69%) and Arkansas (68%). 

The Daily Yonder has found county-level vaccination data for 24 states through Covid Act Now and state departments of health web pages. This graph shows the rate of first vaccination for those states by county type. The rate is the number of first vaccinations administered per 100,000 in population. (Daily Yonder/Covid Act Now, state health departments)

Henning-Smith said she found those rankings surprising, but felt that some of the success of those rural states could be related to the nature of rural communities. 

“One advantage that more rural areas and more rural states have here is this benefit of the relationships that are already there,” she said. “You have fewer competing systems, fewer competing players in the game… in some ways, having a smaller and more rural population can be an advantage because you can get everyone on the same page more quickly.”

Dr. George Garrow, chief medical officer with Primary Health Network in northwestern Pennsylvania, said he thinks it has more to do with the closeness between people in rural communities. 

“Part of me wonders if it’s not about the relationships in rural areas,” he said. “In rural communities, you know your neighbors, you know your pharmacist, you know your healthcare providers. Having those kinds of relationships with people can go a long way in helping to overcome vaccine hesitancy.” 

Primary Health covers 16 counties, most of them rural. Although the health network is spread out geographically, it is considered a federally qualified health center (FQHC) – a community-based health-care provider that receives federal funds to provide primary care services in underserved areas. In his counties, people fall into two groups, he said – those with “vaccine hesitancy” and those who really want it. 

“They are either very hesitant, or they are very enthusiastic,” he said. 

But the hesitancy may be waning a bit. Garrow said that among the staff at Primary Health, many of the ones who did not want to get the vaccine are now getting it.

His staff is also actively reaching out to members of the communities they’re in to tell them they are eligible to receive a vaccine. 

“Our organization is reaching out to our patients who are over 65,” he said. “We have lists of individual patients and a whole call center making calls to our patients who qualify to get a shot. If they agree they want one, our call center helps to navigate them to a vaccine solution.” 

Cameron Webb, a senior policy advisor for the Covid-19 Vaccine Equity Task Force for the Biden administration, said ensuring rural residents get the vaccine is very important to the administration. 

“Equity is about more than race and ethnicity; it’s about rural areas, disabilities and other factors” he said. “And we’ve designed the roll out with equity in mind.” 

Webb said the administration is working closely with states to ensure the vaccines are getting out, but that the effort would take a whole of government approach. 

“It can’t be just the federal government or state government. It’s got to be both,” he said. “The states are in control of their roll outs. We have really extensive data from all over the country and we stay in touch with states all the time.” 

The administration on February 15 began providing vaccines directly to FQHCs to create a Community Health Centers Vaccination Program, as an effort to reach those in underserved areas. The initial phase will provide vaccines to 25 FQHCs, and expand to 250 in the coming weeks. In a few months, Webb said, the administration hopes to expand the program to all of the nearly 1,400 FQHCs. 

Webb said there are plans to roll out a mobile vaccination program as well, which will be critical to reaching frontier and rural communities. 

With Covid-19 affecting rural populations more, ensuring that those residents get the vaccine is crucial in helping to stem the tide of the pandemic, he said. 

“We saw that people were dying in rural America, and we want to continue to work on that by getting them the vaccine,” he said. 

Henning-Smith cautioned though that these comparisons will likely change as the vaccine roll outs continue. 

“I think it’s too soon to completely celebrate,” she said. “We still have enormous logistical hurdles. We still have vaccine shortages. We still have a lot of misinformation and distrust. We still have tremendous transportation barriers, and all of those are causing some people to have trouble getting the vaccine. There are things to celebrate here, and there are some rural success stories I’m excited about, and that gives me some hope.”

The Daily Yonder’s vaccination analysis included data from 24 states. Twenty two came via Covid Act Now and two through state government web sites (Iowa and Tennessee). New Mexico had the higher rate of first vaccination, at 27% of the population.  North Carolina had the lowest, at 9.6% of the population.