Face to Face, Word of Mouth: How American Rural Communities Manage COVID-19 Shots

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

Guerra, the senior elected civil servant in rural Jim Hogg County, Texas, joined local school superintendent Susana Garza, who helped him plan the vaccination. They called hundreds of residents eligible for vaccines to schedule appointments, in stark contrast to the major cities, where locals report struggling with maddening online registration processes.

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

The next day, he and his staff organized a makeshift clinic in a local pavilion normally used for livestock exhibits – a plan they had come up with days earlier. Garza donated staff to help register patients, while a local home care company volunteered to screen everyone for fever.

With nurses from the Texas state health department administering injections, the team exhausted their vaccine supply just hours after it arrived.

Many rural counties, like Jim Hogg, excelled at getting injections into the guns quickly and efficiently, outpacing major cities despite the drawbacks in health care infrastructure and finances, according to a Reuters review of vaccine data in several states through the end of January.

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

Officials in rural communities said personal ties to voters made it easier to overcome vaccine reluctance and identify those eligible for early injections, according to interviews with 20 local and state officials, health professionals and vaccine recipients.

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

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

As the fledgling nationwide vaccination campaign gets underway, rural officials have expressed concern that they will get less from future vaccine allocations as urban areas seek to catch up. But the early trend sheds light on an immunization program that falls short of its original goals.

With the Biden administration aiming to vaccinate every US resident over 16 years old by the end of the summer, Reuters analysis suggests strong local communication and scrappy vaccination strategies will be crucial.

Officials in the most successful countries quickly set up makeshift vaccination sites with little red tape and relied on personal calls or word of mouth to fulfill appointments.

While those measures are difficult to duplicate in big cities, there are lessons that can be learned 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 getting the pandemic under control.

The lack of federal guidance or funding to distribute vaccines under former US President Donald Trump left states and provinces to their own devices, resulting in a patchwork of strategies across the country.

President Joe Biden has vowed to speed up distribution and give states up to three weeks in advance of the impending delivery to address some of the current chaos, especially in larger states.

Meanwhile, rural health officials took matters into their own hands early on.

West Virginia – one of the poorest and most rural states in the country with one of the oldest and sickest demographics – had inoculated 9.2% of the population by January 26, more than any other mainland state.

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

“That allowed us to be a little more nimble,” said Krista Capehart, a director of the West Virginia Board of Pharmacy. The state began vaccinating long-term care patients on Dec. 15, shortly after giving birth and about two weeks before most states started CFS and Walgreens.

IN PITCHEN

From the deserts of Texas to the forests of Michigan’s Upper Peninsula and Florida’s coastline, rural health officials called on local hospitals, pharmacies, schools, police, and firefighters to help set up vaccine clinics.

In Amarillo, for example, firefighters, park officials, and library workers did their part to hand out water to those in the meandering vaccine line at the local civic center and to keep an eye on patients after the vaccination.

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

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

In Menominee County, Wisconsin, Yvonne Tourtillott, a receptionist at the only public health clinic, dropped everything to do phone blitzes when the county received vaccine doses in December and January, scheduling hundreds of appointments using an Excel spreadsheet.

The effort paid off. The 4,500-resident district had vaccinated more than 400 people by mid-January, making it the third-highest percentage of 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 rankings have sunk as states adjusted allocations to be fair.

Brock Slabach, senior vice president at the National Rural Health Association, said rural health departments were generally well connected, but added that access to vaccine offerings became a challenge.

‘NEWS TRAVEL FAST’

In Menominee County, which also serves as the Menominee Indian Reservation, devising a mass communications strategy is a major hurdle, said Dr. Amy Slagle, medical director of the district’s public health clinic. Officials fear phone blitzes won’t be practical as more doses are coming in and many in the poor province lack 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 catch up.

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

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

Dr. Emilie Prot, the DSHS official responsible for the region, said vaccination coverage is one of many factors determining allocation. “We want to make sure we’re honest, and we can’t go back to the same places from week to week.”

Some counties with strong vaccination efforts are getting more sales than they bargained for.

Rural Davie County, which led North Carolina for weeks on vaccination coverage, has attracted vaccine seekers from other parts of the state, said Wendy Horne, a spokeswoman for the local health department.

Davie residents Sue and Dave Sidden, a retired couple who recently received their second vaccination dose, attribute their country’s success to its close-knit nature.

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