A recent analysis by the Rural Policy Research Institute found that 111 rural counties, most located between the Mississippi River and the Rocky Mountains, do not have pharmacies that can give vaccines. This could leave thousands of vulnerable Americans struggling to find vaccines, which in turn threatens to prolong the pandemic in many hard-hit rural regions.
And in areas without local pharmacies, rural residents may have to drive long distances to get vaccines, and do this twice for double-dose vaccines. An analysis by the University of Pittsburgh School of Pharmacy and the West Health Policy Center found that 89% of Americans live less than five miles from a pharmacy. However, more than 1.6 million people must travel more than 20 miles to the nearest pharmacy, which can mean facing difficult weather and road conditions in remote areas.
“If pharmacies are closed, especially in places where there is no other health care provider, then you essentially have a health desert,” said Michael Hogue, president of the American Pharmacists Association. “You have to depend on a mobile clinic from another area to provide vaccines, or citizens will have to drive further to get the vaccine.”
So far, with a limited amount of doses and strict restrictions on who is eligible, this has not been an issue. But as vaccination opens up to the general public and vaccine supply increases, local health departments may become overwhelmed with demand and may need to shift the task of vaccinating local residents to other health care providers. .
“It is probably not ending yet because we are not getting enough supply,” said Keith Mueller, director of the Rural Policy Research Institute’s Center for Rural Health Policy Analysis. “This means that we have some time for local health departments to find out: Who on my radio, if they want, has the capacity to administer vaccines?”
From 2003 to 2018, 1,231 independent rural pharmacies closed, Mueller’s team found, leaving about 630 rural communities without a drugstore. Economic changes in the pharmacy sector have killed them, a combination of expanding and consolidating national pharmacy chains, large stores and supermarkets opening their own competing pharmacies and pharmacy benefit managers devouring the profits of small pharmacies. Mail order options diverted business.
And you cannot receive vaccines in the mail.
‘Without medical infrastructure’
In many cities, these pharmacies represented the last bastion of health care in their communities. Now, more than ever, residents are feeling emptiness.
“We don’t have medical infrastructure,” said DeAnne Gallegos, a spokesman for the health department of San Juan County, in southwest Colorado. “We don’t even have a doctor.”
With the nearest pharmacy located in a neighboring county, an hour away in Durango, vaccines in San Juan County were administered by the director of public health and two nurses. They run weekly vaccination clinics if they receive a dose. As of February 18, the health department had fully vaccinated 298 of its 700 residents.
Counties receive doses based on their populations throughout the year, but the health department hopes to vaccinate out-of-state residents as well. San Juan County is dealing with a influx of tourists and secondary homeowners from states like Texas, Arizona and Florida, where the pandemic has hit most hard and vaccination rates are declining. Therefore, the health department may end up vaccinating more than 200% of the official population of San Juan County to keep Covid-19 out.
“Our attitude is, no matter what your driver’s license or zip code says, if you live within our restricted community, it’s someone we hope the state will allow us to include in the herd,” said Gallegos.
But it emphasizes what she called the fragile structure that the department had in the first place.
“It is our responsibility to make appointments, manage data, make contact, receive calls,” said Gallegos. “When you don’t have the staff or the budget to hire additional staff, it also makes things very difficult.”
Further east, Custer County has not had a pharmacy in years. Recently, a pharmacist who lives in the county, but works in an adjacent county an hour away, started delivering prescriptions to Custer residents when she returns home after each shift.
But she can’t bring home vaccines from work.
Instead, a public health nurse who was due to retire in late 2020 decided to stay to vaccinate residents with the help of another nurse and retired health professionals who maintained their licenses. According to Custer County Public Health Agency Director Dr. Clifford Brown, they vaccinated more than 630 of the county’s 5,200 residents.
In an ideal world, they could have transferred the task to a pharmacy.
“We feel the squeeze,” said Brown. “I wake up around 3 in the morning thinking, how in the world are we going to stretch things out to cover this day?”
Pharmacies offer distinct advantages as vaccine suppliers. Hospitals, which traditionally did not vaccinate the general public, had to create programs to distribute their allocated doses.
In Colorado, pharmacies give more than a million flu shots each year, said Emily Zadvorny, executive director of the Colorado Society of Pharmacists, and, particularly in smaller cities, have a much closer relationship with their customers than do major health care providers. She pointed to a pharmacist in Kiowa County, Colorado, who pulled out a list of all her clients aged 70 and over and called each one to schedule their Covid-19 vaccines.
“They have a lot more capacity than supplies,” said Zadvorny. “It is just a slow process of acceleration.”
A ‘learning curve’ for pharmacies
Even where pharmacies exist, it has been a challenge for independent drugstores to participate in the launch of the Covid-19 vaccine. For vaccines against influenza, pneumonia or herpes zoster, stores usually ask how many doses they think they can sell, which are delivered with the pills they distribute.
Covid-19 vaccines, on the other hand, are being distributed through a national program that presents a significant learning curve for pharmacies. The Federal Centers for Disease Control and Prevention have partnered with 21 pharmacy chains, including four independent community pharmacy chains that give smaller drugstores more purchasing power. According to the National Community Pharmacists Association, these four networks include about 8,000 of the 21,000 community pharmacies across the country. Pharmacies that are not part of these networks can apply to provide vaccines in their states.
“The biggest hurdle for most pharmacies is just getting approved,” said Kyle Lancaster, director of pharmacy at Our Valley Pharmacy, a chain of three pharmacies in rural Lincoln County, Wyoming.
Our Valley signed up for federal and state health agencies and had to update its freezers with digital data recorders, which load pharmacy refrigerator and freezer temperatures and report them directly to the CDC.
Most small pharmacies like his, he said, were limited to the Modern vaccine, which has less stringent temperature requirements than the Pfizer version. The Johnson & Johnson vaccine, which was recently approved, will be even easier to handle by rural pharmacies.
Lancaster said he is not sure how many doses of the vaccine his chain will receive or when.
These uncertainties leave residents like Nan Burton, 63, worried about how to get vaccinated. Last year, she and her husband decided to tackle the pandemic at their Lincoln County vacation home, exchanging their Seattle apartment for the open, physically distant spaces of the Star Valley Ranch, 8 miles from the Our Valley branch. nearest. With plans to fully retire next year, now they will stay forever.
So far, Lincoln County – a region three times the size of Rhode Island – has vaccinated about 2,500 of its nearly 20,000 residents, mostly through the local hospital. But without a large network of pharmacies in the region, the county must wait for independent community pharmacies, such as Our Valley, to catch up.
Burton said she and her husband have little choice but to wait and hope that the logistics of delivering the vaccine will be resolved. They would be willing to drive for hours to get a vaccine if they knew they were not getting it out of someone else in need.
“Until there is some kind of national effort to reach rural communities, I think we are going to have problems,” said Burton.
KHN (Kaiser Health News) is a non-profit news service that covers health issues. It is an independent KFF (Kaiser Family Foundation) editorial program that is not affiliated with Kaiser Permanente.