Covid-19 vaccines are slowly arriving in rural America

The effort 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 undertaken. Reaching rural communities and small towns that face some of the highest infection rates and often have poorer health care infrastructure is one of the most formidable challenges, according to health experts.

“These small towns are home to those who need health care the most and have the fewest options available,” said Alan Morgan, executive director of the National Association for Rural Health. “You have a population that has been hit hard by Covid and that has a very fragile safety net when it comes to suppliers.”

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

The challenges of inoculating people living in smaller cities away from population centers include safe storage of vaccines at low temperatures, having enough healthy staff in the hospital and reaching people and clinics away from hospitals.

Some states, such as New Mexico, use their health departments and the National Guard to break down the 975 bulk shipments of vaccine developed by Pfizer. Inc.

and BioNTech SE and ship them to rural hospitals that can’t store as many at the required range of -76 to -112 degrees Fahrenheit. After thawing, the vaccine can be refrigerated for up to five days.

Sanford Health, the nation’s largest nonprofit rural health care system, has positioned five ultracold freezers it recently purchased in Dakota and Minnesota to distribute the Pfizer vaccine to its front-line health workers. Sanford, which has so far received several thousand doses, has said it intends 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 received initial vaccine allocations, most going to large metropolitan areas such as Houston and Dallas.

“We had rural hospitals that were not only ready to be vaccinated, but they bought equipment,” said John Henderson, CEO of the Texas Organization of Rural and Community Hospitals. “They collaborated with each other at the regional level, so that … no one wasted [doses]. But they remained on the sidelines. “

Chris Van Deusen, a spokesman for the Texas 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.

are scheduled to arrive in Texas next week, and some will be sent to geographically more remote areas.

Mr Edmondson said he hoped Peterson Health would receive the first vaccines next week as part of Texas’ distribution of the first Modern doses. The Moderna vaccine is easier to transport because it can be stored at about minus 4 degrees Fahrenheit and refrigerated for up to 30 days.

Some small health centers in Pennsylvania have said they have no idea when Moderna shipments will come or how many doses may be included, making planning difficult.

“We were told it could come anytime from next week until mid-January,” said Michael Colli, chief medical officer at Keystone Health Center, which is located about 150 miles west of Philadelphia and serves 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 faced during the pandemic.

Earlier this month, at one of Keystone Health’s clinics, nearly a third of its pediatric health care staff recently left with Covid-19. “It simply demonstrates how vulnerable we are,” said Dr. Colli.

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

Mark Burnett, executive director of Scott County Hospital in Scott City, a town of less than 5,000 people on the Kansas Plains near the Colorado border, said three of his eight management team members told him no. are still interested in receiving the vaccine. . It is a proportion that he anticipated to be similarly reflected in 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 in which rural health departments, community groups and churches will be involved in distributing the vaccine and overcoming skepticism. In Alabama, he noted, eight out of 10 counties with recent positivity rates of more than 50 percent are rural.

“Realistically, it will not be uniform in every county,” he said of the vaccine distribution in less populated areas. “But if we build a solid logistics operation and use as many layers of opportunity as possible for people to receive the vaccine, I think we can make a very respectable attack on that.”

—Anthony DeBarros contributed to this article.

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