NASHVILLE, Tennessee (AP) – Rita Fentress feared she might get lost as she traveled the unknown forested one-lane road in rural Tennessee in search of a vaccine against the coronavirus. Then the trees disappeared and the Hickman County Farm Pavilion appeared.
The 74-year-old woman was not eligible for vaccination in Nashville, where she lives, because there were so many health workers there to vaccinate. But a neighbor told her that the state’s rural counties had already moved into younger age groups, and she had found an appointment 60 miles away.
“I felt a little guilty about it,” she said. “I thought maybe I took it from someone else.” But late that February day, she said there were five more openings for the next morning.
The US vaccination campaign has heightened tensions between rural and urban America, where complaints from Oregon to Tennessee to upstate New York are surfacing of a real – or perceived – inequality in vaccine allocation.
In some cases, allegations of how scarce vaccines are distributed have taken a partisan tone, with rural Republican lawmakers in Democratic-led states complaining about ‘choosing winners and losers’, and city dwellers traveling for hours to rural GOP-leaning communities to get COVID -19 shots to score if none are in their city.
In Oregon, the state’s GOP lawmakers left a legislative session on the Democratic governor’s vaccine plans last week, citing nationwide vaccine distribution among their concerns. In New York State, rural public health officials have complained about differences in vaccine allocation, and in North Carolina, national lawmakers say too many doses went to massive vaccine centers in major cities.
In Tennessee, Missouri and Alabama, a lack of admissions in urban areas with the largest number of health workers has resulted in seniors spending hours away from home. The result is a hodgepodge of approaches that can seem like the exact opposite of equality, with those most likely to be vaccinated being people with the skill and resources to seek an opportunity and travel to wherever it is.
“It’s really, really flawed,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, who noted that there are even vaccine hunters who will find a dose for money. “Ideally, allocations would meet the needs of the population.”
With little more than general guidelines from the federal government, states have taken it upon themselves to decide what it means to distribute the vaccine fairly and reach vulnerable populations.
Tennessee, like many states, has divided doses primarily based on the county population, not the number of residents who belong to eligible groups, such as health professionals. The Tennessee health commissioner has defended the allotment as the “most equitable,” but the approach has also uncovered yet another layer of haves and have-nots as the introduction of vaccines accelerates.
In Oregon, the issue led government officials to stop dosing in some rural areas that had finished vaccinating their health workers, while clinics elsewhere, including the Portland metro area, were catching up. The metabolism last month provoked an angry response, with some GOP lawmakers blaming the Democratic governor of playing favorites with the city dwellers who chose her.
Public health leaders in Morrow County, an agricultural region in northeastern Oregon with one of the highest COVID-19 infection rates, said they had to postpone two vaccination clinics because of the state’s decision. Other rural counties have delayed vaccines for seniors.
States face many challenges. Rural counties are less likely to have the freezer equipment needed to store Pfizer vaccines. Health workers are often concentrated in large cities. And rural counties were particularly hard hit by COVID-19 in many states, but their residents are among the most likely to say they will “absolutely not” be vaccinated, according to recent polls from the Kaiser Family Foundation.
Adalja said most of these complications were foreseeable and could have been avoided with proper planning and funding.
“There are people who know how to do this,” he said. “They just aren’t in charge.”
In Missouri, where Facebook groups have appeared with reports of available appointments in rural areas, Senate Leader John Rizzo, a Democrat from the Kansas City suburb of Independence, mentioned the need to send more vaccine to urban areas.
The criticism provoked an angry rebuke from Republican Gov. Mike Parson, who said vaccine distribution is proportional to population and that critics are using “cherry-picked” data.
“There is no division between rural and urban Missouri,” Parson said during his weekly COVID-19 update last week.
In Republican-led Tennessee, health commissioner Lisa Piercey notes that the Trump administration viewed the state’s plan as one of the most just in the country. Additional doses go to 35 counties with a high score on the Social Vulnerability Index – many small and rural, but also Shelby County, which includes Memphis, with a large black population.
Last week, state officials revealed that about 2,400 doses had been wasted in Shelby County the past month as a result of miscommunication and insufficient administration. The county also had nearly 30,000 outrageous doses in its inventory. The situation prompted the Centers for Disease Control and Prevention to investigate and the county health director to resign.
In Nashville, Democratic Mayor John Cooper says that the fact that city dwellers can take photos elsewhere is a good thing, even if the road trips are “a little tedious.”
“I’m thankful other counties haven’t said, ‘Oh my god, you always have to be a resident of this county to get the vaccine,’ Cooper said.
Nashville educators Jennifer Simon and Jessica Morris took sick days last week to make the four-hour tour of tiny Van Buren County, which has fewer than 6,000 residents.
They got their first photos there in January, when Republican Governor Bill Lee urged schools in the Nashville and Memphis area to return to in-person classes. Republican lawmakers even threatened to withdraw money from districts that stayed online.
Personal classes started a few weeks ago, but the city only started vaccinating teachers last week.
“It was scary, frustrating and felt really betrayed,” said Simon.
Flaccus reported from Portland, Oregon. Jim Salter in O’Fallon, Missouri; Bryan Anderson in Raleigh, NC, and Carla Johnson in Washington State contributed.