Covid-19 vaccines are slow to reach rural America

The push to rapidly immunize most of the U.S. population against the coronavirus is already one of the most ambitious public health efforts the nation has ever undertaken. According to health experts, one of the most formidable challenges is reaching rural communities and small towns that are struggling with some of the highest rates of infection and often weaker healthcare infrastructure.

“These small towns are home to those who are most in need of healthcare and have the fewest options available,” said Alan Morgan, CEO of the National Rural Health Association. “You have a population that has been hit hard by Covid and that has a very vulnerable safety net when it comes to providers.”

While the pandemic initially wreaked havoc in major cities such as 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 rates of reported cases per capita in the past two weeks had a population of less than 50,000 people, and 18 with less than 10,000.

The challenges of vaccinating people living in smaller towns, far from population centers, include keeping vaccines safe at low temperatures, having enough healthy hospital staff, and reaching people and clinics far from hospitals.

Some states, such as New Mexico, use their health departments and the National Guard to split up bulk shipments of 975 doses of a Pfizer-developed vaccine. Inc.

and BioNTech SE and ship them to rural hospitals that cannot store as 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 nation’s largest nationwide nonprofit healthcare system, has installed five ultra-cold freezers it recently purchased around the Dakotas and Minnesota to distribute the Pfizer vaccine to its primary care health workers. Sanford, which has received several thousand doses so far, said it planned to use its own courier service to transport the vaccines to facilities nationwide.

But in other states, rural areas have to wait. In Texas, 34 of the state’s 254 counties were assigned the first shipments of the vaccine, most of them to major metropolitan cities such as Houston and Dallas.

“We had rural hospitals that were not only prepared to be vaccination sites, but they had also bought equipment,” said John Henderson, CEO of the Texas Organization of Rural & Community Hospitals. “They worked together regionally so that … they wouldn’t waste anything [doses]. But they were still on the sidelines. “

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

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

Mr. Edmondson said he hopes Peterson Health will receive its first vaccines next week as part of the distribution of the early Moderna doses across Texas. The Moderna vaccine is easier to transport because it can be stored at about minus 4 degrees Fahrenheit and stored in the refrigerator for up to 30 days.

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

“We’ve been told it could come any time from next week to 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 area. “Obviously, we prefer next week.”

Many rural facilities hope vaccinations will help them address the persistent staff shortages they faced during the pandemic.

Earlier this month, at one of Keystone Health’s clinics, nearly a third of pediatric nursing staff were recently free from Covid-19. “It just shows how vulnerable we are,” said Dr. Colli.

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

Mark Burnett, chief executive of Scott County Hospital in Scott City, a town of less than 5,000 people in the Kansas plains near the Colorado border, said three of his eight-member executives told him they weren’t interested in getting the vaccine. . It’s a part he expected to be reflected in the community in the same way.

William Curry, associate dean of primary care and rural health at the University of Alabama in Birmingham, is helping to implement a state program that will involve rural health departments, community groups and churches in spreading the vaccine and working to overcome skepticism. In Alabama, he noted, eight of the ten counties with recent positivity rates of more than 50% are nationwide.

“Realistically it will not be uniform in every province,” he said of the distribution of vaccines in less populated areas. “But if we build a logistically sound operation, and we take advantage of as many layers of opportunities as possible for people to get the vaccine, I think we can make a very respectable attack on this.”

—Anthony DeBarros contributed to this article.

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