Covid-19 vaccines are slowly arriving in rural America

The drive to rapidly immunize the majority of the American population against coronavirus is already one of the most ambitious public health efforts the nation has ever made. Reaching rural communities and small towns that have some of the highest infection rates and often have weaker health infrastructure is one of the most formidable challenges, according to health experts.

“These small towns are where those who need more health services and have fewer options available live,” said Alan Morgan, executive director of the National Rural Health Association. “You have a population that Covid has hit hard and that has a very fragile safety net when it comes to suppliers.”

Although the pandemic initially wreaked havoc in major cities like New York last spring, it later spread to less populated areas. According to a Wall Street Journal analysis of data from Johns Hopkins University, all 25 counties with the highest per capita case rates reported in the past two weeks had populations of less than 50,000 people and 18 had less than 10,000.

The challenges of inoculating people living in smaller cities, far from population centers, are to store vaccines safely in cold temperatures, have enough healthy hospital staff, and reach people and clinics away from hospitals.

Some states like New Mexico use their health departments and the National Guard to analyze mass shipments of 975 doses of a vaccine developed by Pfizer Inc.

and BioNTech SE and send them to rural hospitals that cannot store so many in the required range of -76 to -112 degrees Fahrenheit. After thawing, the vaccine can be refrigerated for up to five days.

Sanford Health, the country’s largest nonprofit rural health system, has positioned five ultra-cold freezers it recently bought in Dakota and Minnesota to distribute the Pfizer vaccine to its front-line health workers. Sanford, which has so far received several thousand doses, said it planned to use its own courier service to help transport vaccines to rural facilities.

But in other states, rural areas have to wait. In Texas, 34 of the state’s 254 counties were assigned initial vaccine shipments, with the majority destined for large metropolitan areas such as Houston and Dallas.

“We had rural hospitals that were not only ready to be vaccination sites, but they had bought equipment,” said John Henderson, CEO of the Texas Organization of Rural and Community Hospitals. “They partnered with each other regionally so that … they didn’t waste any [doses]. But they were still left out. “

Chris Van Deusen, a spokesman for the Texas State Department of Health Services, said the state initially gave priority to facilities that said they had at least 975 front-line workers. He said more than 460,000 doses of a vaccine from Moderna Inc.

it is scheduled to arrive in Texas next week and some will be shipped to more geographically remote areas.

Edmondson said he expects Peterson Health to get the first vaccines next week as part of the Texas distribution of the first doses of Moderna. The Modern vaccine is easier to transport, as it can be stored at less than 4 degrees Fahrenheit and refrigerated for up to 30 days.

Some small Pennsylvania health centers said they had no idea when Moderna’s shipments would arrive or how many doses might be included, making planning difficult.

“We’ve been told it could come at any time from next week through mid-January,” said Michael Colli, chief physician at Keystone Health Center, located about 150 miles west of Philadelphia and serving to an agricultural region. “Obviously, we prefer next week.”

Many rural facilities hope that vaccinations will help them cope with the persistent shortage of staff they have suffered during the pandemic.

Earlier this month, at one of Keystone Health’s clinics, nearly a third of the pediatric nursing staff were recently on Covid-19. “It just demonstrates the vulnerability that we are,” Dr. Colli said.

Rural communities have been the focus of opposition to public health measures – such as wearing masks – that experts recommend. Some hospital leaders are now concerned about vaccine skepticism among community members and staff.

Mark Burnett, executive director of Scott County Hospital in Scott City, a city of less than 5,000 people on the plains of Kansas, near the Colorado border, said three of its eight-member teams were report that they were not yet interested in getting the vaccine. . It is a proportion that he anticipated would be reflected in a similar way to the community.

William Curry, associate dean of primary care and rural health at the University of Alabama at Birmingham, is helping pilot a state program where rural health departments, community groups and churches will participate in vaccine distribution and work to overcome skepticism. In Alabama, he noted, eight of the ten counties with recent positivity rates above 50% are rural.

“Really, it won’t be uniform in all counties,” he said about vaccine distribution in less populated areas. “But if we build a logistically sound operation and use so many layers of opportunities for people to get the vaccine, I think we can make a very respectable attack on that.”

—Anthony DeBarros contributed to this article.

Write to Dan Frosch to [email protected] and Elizabeth Findell to [email protected]