Personal touch, word of mouth: how rural communities in the United States manage to shoot COVID-19 in the arms

(Reuters) – When Juan Carlos Guerra received the call on January 12 that his county would receive 300 doses of COVID-19 vaccine the next day, he went straight to work.

Guerra, the top elected official in rural Jim Hogg County, Texas, met with local school superintendent Susana Garza, who helped him direct vaccination planning. They called on hundreds of vaccine-eligible residents to schedule appointments, in contrast to large cities, where locals report having trouble driving online registration processes.

Guerra, who has spent his entire life with Jim Hogg, said he knew almost everyone he called and trusted him.

The next day, he and his staff organized a makeshift clinic in a local pavilion that was normally used for livestock shows, a plan they had drawn up days before. Garza donated staff to help register patients, while a local home care company volunteered to detect fever in everyone.

With nurses from the Texas state health department administering the vaccines, the team ran out of vaccine supplies just hours after they arrived.

Many rural counties like Jim Hogg have excelled in getting gun injections quickly and efficiently, outpacing large cities despite the disadvantages of infrastructure and health finances, according to a Reuters review of vaccination data in several states until the end of January.

Data from Michigan, Wisconsin, Texas, North Carolina, and Florida showed that higher per capita vaccination rates often belonged to less populated counties.

Rural community officials said personal ties to the components facilitated overcoming vacancy and identifying those eligible to receive early shots, according to interviews with 20 local and national officials, health workers and vaccine recipients. .

“We know each other here. We can pick up the phone and call each other, ”said Casie Stoughton, director of public health in Amarillo, Texas, who is in charge of vaccinations for nearby rural counties.

States dominated by rural communities, such as Alaska, West Virginia and Minnesota, have vaccinated a higher proportion of their populations than geographically more mixed states, according to data from the U.S. Centers for Disease Control and Prevention.

As the new nationwide vaccination campaign gains momentum, rural county officials expressed concern that they will get less of future vaccine allocations as urban areas claim to recover. But the first trend shows a vaccination program that lags behind the initial goals.

With the Biden administration aiming to vaccinate all U.S. residents over the age of 16 by the end of the summer, Reuters analysis suggests that strong local communications and poor vaccination strategies will be crucial.

The most successful county officials quickly created makeshift vaccination sites with little bureaucratic bureaucracy and relied on personal appeals or word of mouth to meet appointments.

While these measures will be difficult to duplicate in large cities, there is a need to learn as federal officials become more involved in the process.

COVID-19 has killed more than 427,000 people in the United States and threatens to overwhelm hospital systems across the country, making a successful vaccination campaign crucial to controlling the pandemic.

The lack of federal guidance or funding to distribute vaccines under former U.S. President Donald Trump left states and counties to fend for themselves, leading to a lot of strategies throughout. the country.

President Joe Biden has promised to speed up distribution and give states notice with three weeks ’notice of the upcoming supply to address some of the current chaos, particularly in larger states.

Meanwhile, rural health officials took matters into their own hands at first.

West Virginia, among the country’s poorest and most rural states with one of the oldest and sickest demographics, had vaccinated 9.2% of its population as of Jan. 26, more than any other continental state.

The state recruited local pharmacies to vaccinate long-term care residents instead of opting for the federal government’s association with national pharmacy chains of CVS Health Corp and Walgreens Boots Alliance Inc.

“This has allowed us to be a little more agile,” said Krista Capehart, director of the West Virginia Board of Pharmacy. The state began vaccinating patients with long-term care on Dec. 15, shortly after delivery and about two weeks before most states launched CVS and Walgreens.

ENTERING

From the deserts of Texas to the forests of the upper Michigan peninsula and the Florida coast, rural health officials called on local hospitals, pharmacies, schools, police and firefighters to help establish vaccine clinics.

In Amarillo, for example, firefighters, park officials and library workers were stationed, who distributed water to the snake vaccine line at the local civic center and supervised patients after vaccination.

Data from Michigan, Wisconsin, Florida, Texas, and North Carolina – states chosen for the availability of county data and their rural / urban divisions – showed that they were typically the leading urban counterparts in vaccination rates at the start of deployment. .

A Kaiser Family Foundation survey of 1,560 Americans in mid-January found that 54% of rural respondents said they had enough information on where to get vaccinated against 38% among their urban counterparts.

In Menominee County, Wisconsin, Yvonne Tourtillott, a receptionist at the only public health clinic, left everything to make phone bubbles when the county received doses of vaccine in December and January, scheduling hundreds of appointments with the help of an Excel spreadsheet.

The effort paid off. The 4,500-resident county had vaccinated more than 400 people by mid-January, giving it the third-highest rate in Wisconsin’s 72 counties at the time.

However, vaccination data is in constant flux and some small counties that started at the top of their state ranking have collapsed as states adjusted allocations to be equitable.

Brock Slabach, senior vice president of the National Rural Health Association, said rural health departments used to be well connected, but added that access to vaccine supply was becoming a challenge.

‘FAST TRAVEL NEWS’

In Menominee County, which also serves as the Menominee Indian Reservation, designing a mass communication strategy is a major hurdle, said Dr. Amy Slagle, medical director of the county’s public health clinic. Officials fear phone intermittencies will be impractical as more doses come in and many of the towns in the county do not have reliable internet.

Many local officials also fear that they could be effectively punished for their early efficiency, as state governments divert future doses to help other counties recover.

A new batch of data released Jan. 25 from Wisconsin showed Menominee’s per capita vaccination rate had dropped from third to 29th in the state, with Slagle saying they had only received 10 doses the previous week.

In Jim Hogg County, Guerra has urged the Texas Department of Health Services (DSHS) to keep vaccines flowing in the county deeply depleted, saying it “remains at a disadvantage” in access to health care. , a factor that may contribute to increased COVID-19. mortality rates.

Dr. Emilie Prot, head of the DSHS region, said the vaccination rate is one of many factors determining the allocation. “We want to make sure we’re fair and we can’t go back to the same places week in and week out.”

Some counties with strong vaccination efforts are getting more business than they negotiated.

Rural Davie County, which for many weeks led North Carolina’s vaccination rate, has attracted people seeking vaccines from other parts of the state, said Wendy Horne, a spokeswoman for the local health department.

Residents of Davie, Sue and Dave Sidden, a retired couple who recently received their second dose of vaccine, attribute their county’s success to its narrow nature.

“There’s no secret in a small community,” Sue said. “News travels fast here.”