Personal touch, word of mouth: how US rural communities manage to put COVID-19 injections into guns

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

Guerra, the top elected official in rural Jim Hogg County, Texas, met with local school superintendent Susana Garza, who was helping him lead vaccination planning. They called hundreds of vaccine-qualified residents to schedule appointments, in stark contrast to major cities, where residents report struggling with maddening online registration processes.

Guerra, who spent his entire life in Jim Hogg, said he knew almost everyone he cared for and trusted him.

The next day, he and his team set up a makeshift clinic in a local pavilion normally used for livestock exhibitions – a plan they had drawn up days before. Garza donated staff to help register patients, while a local home care company offered to screen everyone for fever.

With Texas health department nurses administering injections, the team ran out of vaccine supplies within hours of arriving.

Many rural counties like Jim Hogg have excelled in getting weapons injections quickly and efficiently, overtaking large cities, despite disadvantages in healthcare infrastructure and finance, according to a Reuters review of vaccination data in several states until the end of January.

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

Authorities in rural communities said that personal ties to constituents made it easier to overcome vaccine hesitation and identify those eligible for early vaccines, according to interviews with 20 local and national authorities, health professionals and vaccine recipients.

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

States dominated by rural communities, such as Alaska, West Virginia and Minnesota, vaccinated a larger portion of their populations than geographically mixed states, according to data from the United States Centers for Disease Control and Prevention.

As the fledgling vaccination campaign across the country gains momentum, rural county officials have expressed concern that they will receive less from future vaccine distributions as urban areas clamor to achieve them. But the initial trend sheds light on an immunization program that falls short of the initial goals.

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

Authorities in the most successful counties quickly set up makeshift vaccination sites with little bureaucratic red tape and resorted to personal or word of mouth appeals to complete consultations.

While these measures are difficult to duplicate in large cities, there are lessons to be learned as federal authorities become more involved in the process.

COVID-19 has killed more than 427,000 people in the United States and threatens to overburden hospital systems across the country, making a successful vaccination campaign crucial to keeping the pandemic in check.

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

President Joe Biden has promised to speed up distribution and give states up to three weeks notice of the next delivery to resolve some of the current chaos, especially in the larger states.

In the meantime, rural health officials solved the problem on their own from the start.

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

The state recruited local pharmacies to vaccinate long-term care residents, rather than 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 nimble,” said Krista Capehart, director of the West Virginia Board of Pharmacy. The state began vaccinating long-term care patients on December 15, shortly after delivery and about two weeks before most states launched CVS and Walgreens.

LAUNCHING

From the deserts of Texas to the forests of the Upper Peninsula of Michigan and the coast of Florida, rural health officials have called on local hospitals, pharmacies, schools, police and firefighters to help establish vaccine clinics.

In Amarillo, for example, firefighters, park staff and library staff helped by distributing water to those on the vaccine line at the local civic center and monitoring patients after vaccination.

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

A Kaiser Family Foundation survey of 1,560 Americans in mid-January found that 54% of rural respondents said they had sufficient information on where to get vaccinated against 38% among urban people.

In Menominee County, Wisconsin, Yvonne Tourtillott, a receptionist at the only public health clinic, abandoned everything to conduct a blitz over the phone when the county received doses of vaccine in December and January, making hundreds of appointments with the help of an Excel spreadsheet. .

The effort was worth it. The county of 4,500 residents vaccinated more than 400 people in mid-January, which represents the third highest rate in Wisconsin’s 72 counties at the time.

Vaccination data is in constant flux, however, and some small counties that started at the top of their state’s ranking have fallen as states have adjusted allocations to be equitable.

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

‘NEWS TRAVELS FAST’

In Menominee County, which also serves as a Menominee Indian reservation, devising a mass communication strategy is a major obstacle, said Dr. Amy Slagle, medical director of the county’s public health clinic. The authorities fear that telephone blitzes are not practical, as more doses arrive and many in the poor county 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 recover.

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

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

Dr. Emilie Prot, the DSHS officer in charge of the region, said that the vaccination rate is one of many factors that determine allocation. “We want to make sure that we are fair and we cannot go back to the same places week after week.”

Some counties with strong vaccination efforts are getting more business than they expected.

Rural Davie County, which led North Carolina’s vaccination rate for many weeks, attracted vaccine candidates from other parts of the state, said Wendy Horne, a spokeswoman for the local health department.

Residents of Davie, Sue and Dave Sidden, a retired couple who recently received the second dose of the vaccine, attribute the success of their county to its cohesive nature.

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