Older adults leave a vaccination site located inside the Fort Washington Avenue Armory on a bus operated by a senior center in New York. Many older adults and low-income people lack transportation to Covid-19 vaccine sites.(AP Photo/John Minchillo)

This article was produced by Stateline, an initiative of The Pew Charitable Trusts.

Jane Campbell is frustrated.

Campbell, the town commissioner in Davidson, North Carolina, worries that some of her constituents, especially older adults, don’t have a way to get to Covid-19 vaccine sites.

From Davidson, the nearest locations for anyone seeking a shot have been at mass vaccination events in the Charlotte area—more than a half hour away, Campbell said. For many older adults who needed transportation, that was too far.

“I can get the volunteers to drive them, but I don’t think it’s prudent or safe to put a volunteer and a person needing the vaccine in the same car for a 35-minute drive each way,” she said. “It needs to be Covid-safe transportation.”

While state and local governments have been busy planning for and distributing vaccines, many have left out an important piece: how to provide transportation to people who can’t get to those sites.

Millions of older adults and low-income people of color who are at higher risk of contracting the virus don’t have cars, don’t drive or don’t live near public transit. Some are homebound. Some live in rural areas far from vaccination sites.

“It’s incredibly complicated how the vaccine planning played out across the country. Transportation was overlooked,” said Denny Chan, a senior staff attorney at Justice in Aging, a national legal advocacy organization for low-income older adults.

Many older adults and poor people also may not have family or friends to drive them, said Chan, who is a member of the California Community Vaccine Advisory Committee, which recommends ways state officials can equitably distribute and allocate vaccines.

“We have, unfortunately, not spent as much time talking about how we are actually going to get the vaccine to people,” Chan said. “You’re creating a situation where you’re building the plane while you’re trying to fly it.”

The vaccine rollout largely has been left to state and local governments, which are busy trying to keep up with heavy demand and short supply. While transportation hasn’t been a priority, some areas, from New York City to Spokane, Washington, have come up with different ways to address the problem.

Aside from getting their own agencies and departments involved, state and local officials also should be partnering with charities and nonprofits that can help with transportation, said Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation, a nonprofit group that promotes access to health care for people with debilitating illnesses.

“Transportation is often neglected, but it’s often one of the biggest barriers to health care,” Donovan said.

The Homebound

One of the biggest challenges for state and local officials is getting vaccines to homebound older adults, said Steven Albert, chair of the University of Pittsburgh Graduate School of Public Health’s department of behavioral and community health sciences.

An estimated 2 million people 65 and older are mostly or completely homebound and another 5 million have health conditions that make it hard to get out, according to the Commonwealth Fund, a foundation that funds health policy research.

“This is an invisible population. They’re not like long-term care residents in nursing homes,” Albert said. “They are very elderly and frail and they live at home and are an afterthought, in some cases.”

One obstacle is that both the Pfizer and Moderna vaccines have stringent cold-storage requirements, which creates logistical difficultiesfor transporting and administering vaccines in people’s homes, he added.

“Someone like a nurse would have to travel with a cooler or refrigerator to keep the vaccine at the right temperature and then give the injection,” Albert said.

Some organizations that offer services to older adults are helping to bring vaccines to those who are homebound or to find transportation to vaccine clinics.

“Transportation is just critical to this,” said Sandy Markwood, CEO of the National Association of Area Agencies on Aging, a Washington, D.C.-based membership group of local agencies that provide services directly or through contractors to older adults to help them age at home and in the community.

In central Indiana, for example, an area agency has been reaching out to older adults to help them receive vaccines in their homes or to locate transportation to take them to vaccine sites.

And the Greater Wisconsin Agency on Aging Resources is working with transportation providers and volunteer drivers, some of whom have been vaccinated, to bring older adults to vaccination appointments, according to Markwood.

“I know everyone is struggling to do their best,” Markwood said, “but right now, there needs to be a realization that when you’re looking to serve older adults and people with disabilities there needs to be a level of support there, and without planning, it won’t happen.”

Poor Neighborhoods

Vaccine transportation is also a problem for low-income communities of color, which are disproportionally affected by the virus. Public transit operations also have been reduced in many cities during the pandemic.

The private ride-sharing sector is offering some assistance. Uber announced in December a partnership with the National Urban League and other groups in which it will offer 10 million free or discounted rides to communities of color.

Lyft joined with corporate partners and nonprofit groups in December to launch a program that would provide 60 million rides to and from vaccination sites for members of low-income, uninsured and at-risk communities.

But local officials say they, too, need to reach out to those communities. Some counties already are setting up mobile vaccine units that will travel to underserved areas where accessibility is a challenge, said Blaire Bryant, associate legislative director for health at the National Association of Counties.

Officials in some local communities are considering using churches, schools and grocery stores as places where residents can get vaccinated.

In New Orleans, City Councilwoman Cyndi Nguyen put together a task force that includes health and social services providers and community and faith-based leaders to map out a plan for her district, which includes the Lower Ninth Ward, a low-income Black neighborhood that was devastated by Hurricane Katrina.

“My concern is that in those areas, low-income and elderly people are not going to have access to the vaccine,” Nguyen said. “If they don’t have access, they may lean toward saying, ‘I’m not going to take it.’”

In the Lower Ninth Ward, she said, there is only one clinic and no pharmacies, so officials need to come up with other solutions.

“You have to get the vaccine to where people are at. We’ve got to look at bringing in mobile vaccine buses and exploring other options like churches,” she said. “We don’t want people frustrated and overwhelmed because they don’t have ways of getting to the vaccine.”

Rural Communities

In rural areas, some residents also are facing serious challenges getting to vaccine sites, which are often far away.

Big chain stores and pharmacies that have been signing up to provide vaccines across the country are nonexistent in many rural areas, so local pharmacies will be key, said Keith Mueller, director of the RUPRI Center for Rural Health Policy Analysis at the University of Iowa.

“You really want to reach as many people as possible,” he said. “These smaller, independent pharmacies are able to put the shot in the arm.”

Mueller pointed to West Virginia, one of the states that has given out the highest percentage of vaccine doses. Officials there decided to bypass the federal program in which large pharmacy chains were responsible for vaccinating long-term care residents and instead delivered vaccines to 250 pharmacies, mostly small, independent ones.

But West Virginia later came under criticism for holding vaccination clinics for residents mostly in its most populous counties. In late January, the state announced it would expand those hubs so that there would be one clinic in each county by early February.

Even if state and local governments can make vaccines available at pharmacies, federally qualified health centers, hospitals and rural health clinics, lots of residents don’t live near one of them.

A December study by the University of Pittsburgh School of Pharmacy and the nonprofit West Health Policy Center found that 35% of U.S. counties have two or fewer such facilities per 10,000 residents. For older adults, the researchers found, in 12% of counties, at least half of the older population has a more than 10-mile drive to get to one.

“The transportation piece is a huge issue for rural,” said Carrie Cochran-McClain, a vice president of the National Rural Health Association. “There was an assumption that somehow the vaccine would get out, and the logistics of the transportation piece wasn’t always factored in.”

Cochran-McClain said at least 15% of the U.S. population lives in rural areas, according to the U.S. Census Bureau, and overall, they are older, sicker and poorer than the rest of the country.

Social service organizations and food pantries could be used as vaccine sites, she said. Home health workers, nurses or aides also could visit homes and administer vaccines, if cold storage issues could be worked out.

“This is a community that has had a big problem with Covid and mortality,” Cochran-McLain said. “The more we can get vaccines into these communities, the more likely we will be to make a connection with those hard-to-reach individuals.”

Some Solutions

While transportation hasn’t been a priority, some areas have come up with ways to get people to vaccines—or vaccines to people.

New York City has launched a program for residents age 65 and over who have made a vaccine appointment at a city-operated site but don’t have transportation. Staffers direct them to paratransit, ambulette and taxi ride-hailing services. Some senior center programs also will provide transportation. City officials say they’ll be able to offer about 10,000 rides a week.

In Miami Beach, fire rescue workers administered vaccinations last month at affordable senior housing buildings and the homes of homebound older adults. So far, they have vaccinated more than 900 older adults, and they plan to continue if they can get more vaccines, according to city spokesperson Melissa Berthier.

In Franklin County, Ohio, the Office on Aging last month provided free transportation to people 75 and older who had a vaccine appointment.

In Washington state, Spokane Transit is giving older adults door-to-door paratransit rides to their appointments at a mass vaccination site. The cost: $2 one way or $4 round trip for those who don’t have a paratransit bus card.

In Austin, Texas, the regional public transit system, Capitol Metro, will send a wheelchair-accessible paratransit van to pick up and bring home vaccine patients, said Dottie Watkins, the chief operating officer.

“Anyone in the public is able to use it, but our focus is supporting our lower-income and elderly community,” she said. “Our goal is to make sure that transportation is not a barrier to people getting their vaccine.”

So far, only18 customers havetaken rides to vaccine sites, she said, but that’s because few appointments have been available.

And in Davidson, North Carolina, where commissioner Campbell has been working hard to come up with a transportation solution, the town board voted last week to seek a partnership with the county or regional hospitals to set up a drive-thru vaccination location.

“We can use our police, fire or volunteers to handle the logistics and make it happen,” Davidson said.

But the town isn’t relying only on government or large health providers to help, she added.

“Even if it’s a local pharmacy or a nonprofit that partners with us, that would be fine,” she said. “We need to do all we can to make these vaccines available here so people can get to them.”