Personal Touch, Word of Mouth: How Rural America’s Communities Get Vaccinated Against COVID-19

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

Guerra, the chief elected official of rural Jim Hogg County, Texas, met with local school principal Susana Garza, who was helping him plan the vaccination. They have called hundreds of vaccine-eligible residents to schedule appointments, unlike large cities, where residents report struggling through infuriating online registration processes.

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

The next day, he and his staff set up a makeshift clinic at a local pavilion normally used for cattle shows – a plan they had come up with days before. 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 Department of Health administering vaccines, the team ran out of vaccine supplies just hours after arriving.

Many rural counties like Jim Hogg have excelled at getting gunshots quickly and efficiently, edging larger cities despite drawbacks in health infrastructure and finances, according to a Reuters review of immunization data in several states up to at the end of January.

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

Leaders in rural communities said personal connections with voters made it easier to overcome reluctance to immunize and identify those eligible for the first vaccines, according to interviews with 20 local and national officials, health and vaccines.

“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 handles vaccinations for neighboring rural counties.

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

As the nascent nationwide immunization campaign gains momentum, rural county officials have expressed concern that they will not get less from future vaccine allocations as urban areas clamor for catching up. But the initial trend highlights a vaccination program that is lagging behind the initial targets.

With the Biden administration aiming to vaccinate all US residents over 16 by the end of the summer, Reuters analysis suggests that strong local communication and scrap vaccination strategies will be crucial .

Officials in more prosperous counties quickly set up makeshift vaccination sites with little bureaucratic paperwork and relied on personal calls or word of mouth to fill appointments.

While these measures are difficult to replicate in large cities, there are lessons to 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 bringing the pandemic under control.

Lack of federal leadership or funding to distribute vaccines under former US President Donald Trump left states and counties to fend for themselves, 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 notice of upcoming supplies to alleviate some of the current chaos, especially in the larger states.

In the meantime, rural health officials took matters into their own hands from the start.

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

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

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

LAUNCH

From the deserts of Texas to the forests of Michigan’s upper peninsula and the Florida coast, rural health officials have called on local hospitals, pharmacies, schools, police and fire departments to help set up clinics vaccination.

In Amarillo, for example, firefighters, park officials and library workers rallied, distributing water to those in the serpentine immunization line at the local municipal center and monitoring patients after immunization. .

Data from Michigan, Wisconsin, Florida, Texas and North Carolina – states chosen for their availability of data on counties and their rural / urban divisions – showed that they were generally the main urban counterparts in terms of vaccination rate at the start of the deployment.

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

In Menominee County, Wisconsin, Yvonne Tourtillott, receptionist at the only public health clinic, gave up everything to conduct phone blitzes when the county received doses of the vaccine in December and January, making hundreds of appointments yourself using an Excel spreadsheet.

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

Immunization data is constantly changing, however, and some small counties that started at the top of their state’s rankings have sunk as states adjusted allowances to be fair.

Brock Slabach, senior vice president of the National Association of Rural Health, said rural health services tend to be well connected, but added that accessing vaccine supplies was becoming a challenge.

‘NEW TRIP QUICKLY’

In Menominee County, which also serves as the Menominee Indian Reservation, devising a mass communication strategy is a big hurdle, said Dr Amy Slagle, medical director of the county’s public health clinic. Officials fear that blitzes over the phone may be impractical as more doses arrive and many people in the poor county lack reliable internet.

Many local officials are also concerned that they will be effectively punished for their early effectiveness as state governments divert future doses to help other counties catch up.

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

In Jim Hogg County, Guerra urged the Texas Department of State Health Services (DSHS) to keep vaccines going to the deeply impoverished county, saying it “remains at a disadvantage” in accessing health care. health – a factor that may contribute to an increased COVID-19 death rate.

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

Some counties that are making big efforts to immunize are doing more business than they bargained for.

Rural Davie County, which for many weeks led North Carolina in vaccination rates, has attracted vaccine seekers from other areas of the state, said Wendy Horne, spokesperson for the Department of local health.

Davie residents Sue and Dave Sidden, a retired couple who recently received their second dose of the vaccine, attribute their county’s success to its tight-knit nature.

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