Access to Covid-19 vaccines may have more to do with where you live than whether you belong to one of the groups on the priority list for immunization, interviews with rural health experts reveal.
In Texas, not enough of the state’s 2.1 million allocated doses have made their way to rural areas, said the leader of a hospital association.
In rural Washington state, some hospitals are so far ahead in distribution they may wind up waiting for Seattle to catch up before they can move to the next phase of vaccinations.
And nationally, the lack of a database on vaccine distribution makes it impossible to track progress and flag trouble spots, a rural health leader said.
Rural Texas Makes Do
As of January 14, Texas had administered more doses of Covid-19 vaccine than any other state, according to the Bloomberg News vaccine tracker. But rural hospitals haven’t received a sufficient supply to get front-line workers completely vaccinated.
“As of January 14, many rural Texas hospitals still had not received a single dose of vaccine,” said John Henderson, president and CEO of Texas Organization of Rural & Community Hospitals (TORCH).
Only about 10% of workers at rural Texas hospitals have received their second dose of the vaccine, Henderson said.
Fifteen of the state’s 157 rural hospitals have yet to receive vaccine allocations from the state. They’ve turned to their neighbors for help.
“(The) good news is on Tuesday (January 12), we confirmed all of the 15 (hospitals) were able to vaccinate front line workers with doses shared by neighboring hospitals, clinics, or pharmacies,” he said.
Henderson said none of the rural Texas hospitals were on the initial Pfizer distribution list, meaning rural hospitals didn’t start getting doses of the vaccine until the Moderna vaccine came out in the third week of December.
He blamed some of the slow distribution on red tape.
“Our hospitals have been stuck in the state’s nine-step registration process for different reasons (no data logger, missing Chief Medical Officer signature, missing fields, wrong browser, etc…),” he said in an email interview.
A Vaccine “Surge” in North Central Washington
In some rural areas, however, vaccine rollout is nearly finished for the first phase of distribution, which is supposed to reach front-line healthcare workers and residents of long-term care facilities.
In Ferry County, Washington, Ferry County Public Hospital District President and CEO Aaron Edwards said the Phase 1a recipients have already received their second dose. In fact, he’s working with counties around him, he said, to ensure residents in assisted-living facilities there get the vaccine.
“One of my doctors is the head of the Northeast Tri-County Health Department, and he had a bunch of facilities where they started seeing deaths,” Edwards said. “We got lucky and a neighboring hospital had some extra vaccines, so he went up there and started vaccinating them on Christmas Eve.”
Edwards said that while his county is ahead of the curve in getting the Phase 1a people vaccinated, it stops there. According to Washington state policy, until all of the Phase 1a people in the state get vaccinated, no one can move on to vaccinating the Phase 1b people.
“That means I have to wait until King County [population 2.3 million] and Seattle get all of their people taken care of,” he said.
In some states, like West Virginia, initial rollouts of the vaccine have been successful. West Virginia Governor Jim Justice used independent pharmacies to get vaccines to those in the first phase, Phase 1a, of vaccination – healthcare workers and those in assisted-living facilities. Understanding that many of the counties in his state didn’t have access to large, chain pharmacies, Justice made the decision to get the vaccines to smaller pharmacies as well.
And it’s worked. West Virginia has announced that it has given the vaccine to all of those in group 1a and is working on getting them their second doses.
The state has also decided that those 80 and older are eligible to receive the vaccine, as are teachers and other school staff.
Exacerbating the Divide?
Meanwhile, the federal government is urging states to expand distribution to more types of individuals. Instead of helping, that push could exacerbate gap in access to the vaccine for rural Americans, according to Alan Morgan, CEO of the National Rural Health Association.
“There is a nationwide political pressure to get as many shots in arms as you can nationally,” Morgan said. “The easiest way to do that is to have large urban vaccination sites. This will exacerbate the rural/urban divide.”
The Trump administration is also looking to shift administering vaccines away from hospitals and toward pharmacies, public health clinics, and community health centers. But even that presents problems in rural communities.
More than 300 counties in the U.S. don’t have pharmacies, Morgan said. And relying on rural public health, which Morgan called “underfunded, understaffed and under siege,” without providing them with additional funding and resources won’t solve the problem and raises more questions.
“Our team has been very concerned about the lack of transparency in data,” Morgan said.
“We’re flying blind. Fortunately, the (Department of Health and Human Services) has asked for more info from hospitals on a voluntary basis. For the last three weeks, we’ve just been calling up our members to see what the situation on the ground is. We have a lot of data on Covid hotspots, but very little data on vaccines. That has to happen.”
Fauci Addresses Rural Concerns
Speaking on RFD-TV’s Rural Health Matters earlier this month, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said that opening up the vaccine to more people will ultimately benefit the country.
“We don’t want to not vaccinate the 18-65-year-olds by being too stringent on who gets the vaccine,” he said. “We don’t want the perfect to be the enemy of the good. The best way to stop the virus is to stop it from replicating, and the best way to stop it from replicating is to stop transmission.”
Fauci said he was confident that rural areas would have access to vaccines.
“As part of the planning for the distribution and putting things in people’s arms, we’ve been very conscious of rural America,” he said. “We have to be able to have access to the vaccine, but remember that there are those in our country who may not be next door to a CVS or Walgreens.”
More vaccines are on their way, as well, Fauci said. Vaccines from AstroZeneca, Novavax, and others are expected to finish their clinical trials soon. With more vaccines, Fauci said, we should see more rollout in all areas of the country.