NASHVILLE, Tenn. (AP) – Rita Fentress was worried about getting lost while traveling through the unknown forest, a one-lane road in rural Tennessee in search of a coronavirus vaccine. Then the trees cleared and the Hickman County Agricultural Pavilion appeared.
The 74-year-old woman was not eligible to be vaccinated in Nashville, where she lives, because there were too many health professionals to vaccinate there. But a neighbor told her that the state’s rural counties had already moved to younger age groups and she found an appointment 60 miles away.
“I felt a little guilty about it,” she said. “I thought maybe I was getting it from someone else.” But at the end of that February day, she said there were still five spots left for the next morning.
The US vaccination campaign has increased tensions between America’s rural and urban areas, from Oregon to Tennessee and upstate New York, complaints are emerging about a real – or perceived – inequality in the distribution of vaccines.
In some cases, recriminations about how scarce vaccines are distributed have taken on party tones, with rural Republican lawmakers in Democratic-led states complaining of “choosing winners and losers” and city dwellers traveling for hours to rural communities leaning towards the Republican Party to get COVID -19 shots when there are none in your city.
In Oregon, state legislators from the Republican Party came out of a legislative session last week because of the Democratic governor’s vaccine plans, citing rural vaccine distribution among their concerns. In upstate New York, public health officials in rural counties complained of disparities in vaccine allocation, and in North Carolina, rural lawmakers say too many doses were going to mass vaccine centers in major cities.
In Tennessee, Missouri and Alabama, the shortage of vaccines in urban areas with the largest number of health professionals has led elderly people to schedule times at home. The result is a hodgepodge of approaches that may seem exactly the opposite of equity, in which the most likely to be vaccinated are people with experience and the means to look for an injection and travel wherever you are.
“It’s very, very flawed,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Safety, who noted that even vaccine hunters will find a dose for the money. “Ideally, allocations would meet the needs of the population.”
With little more than general guidance from the federal government, states have taken on the responsibility of deciding what it means to distribute the vaccine fairly and reach vulnerable populations.
Tennessee, like many states, divided doses based primarily on the county’s population, not on how many residents belong to eligible groups – such as health professionals. The Tennessee health commissioner defended the allocation as the “fairest”, but the approach also exposed another layer of who has and who doesn’t, as the vaccine’s launch accelerates.
In Oregon, the problem prompted state officials to stop delivering doses in some rural areas that have finished inoculating their health workers, while clinics elsewhere, including the Portland metropolitan area, have recovered. The confusion last month sparked a furious response, with some state Republican lawmakers accusing the Democratic governor playing favorites with the urban residents who elected her.
Public health leaders in Morrow County, an agricultural region in northeastern Oregon with one of the highest rates of COVID-19 infection, said they had to postpone two vaccination clinics because of the state’s decision. Other rural counties have delayed vaccines for the elderly.
States face many challenges. Rural counties are less likely to have the deep freezing equipment needed to store Pfizer vaccines. Health professionals tend to be concentrated in large cities. And rural counties have been particularly hard hit by COVID-19 in many states, but its residents are among the most likely to say that “definitely not” will be vaccinated, according to a recent survey by the Kaiser Family Foundation.
Adalja said that most of these complications were predictable and could have been prevented with proper planning and funding.
“There are people who know how to do that,” he said. “They are simply not in charge of this.”
In Missouri, where Facebook groups have emerged with posts on availability of appointments in rural areas, state Senate minority leader John Rizzo, a Democrat from the Kansas City suburb of Independence, cited the need to target more vaccines for urban areas.
The criticism sparked a furious rebuke from Republican Governor Mike Parson, who said that the distribution of the vaccine has been proportionate to the population and critics are using “handpicked” data.
“There is no divide between rural and urban Missouri,” said Parson during his weekly update of COVID-19 last week.
In Republican-led Tennessee, health commissioner Lisa Piercey notes that the Trump administration considered the state’s plan to be among the fairest in the country. Extra doses go to 35 counties with a high social vulnerability score – many small and rural, but also Shelby County, which includes Memphis, with a large black population.
Last week, state officials revealed that nearly 2,400 doses were lost in Shelby County during in the previous month due to poor communication and poor record keeping. The county has also accumulated some 30,000 overdoses 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 the fact that city residents can take pictures elsewhere is positive, even if road trips are “a little painful.”
“I am grateful that other counties have not said, ‘Oh my God, you have to be a resident of this county always to get the vaccine,'” said Cooper.
Nashville educators Jennifer Simon and Jessica Morris took sick leave last week to make the four-hour round trip to tiny Van Buren County, with a population of less than 6,000.
They had their first photos back in January, when Republican Governor Bill Lee was pushing schools in the Nashville and Memphis area to return to face-to-face classes. Republican lawmakers even threatened to withdraw funds from districts that remained online.
Face-to-face classes started a few weeks ago, but the city only started vaccinating teachers last week.
“It was scary, frustrating and I felt really betrayed,” said Simon.
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Flaccus reported from Portland, Oregon. Jim Salter in O’Fallon, Missouri; Bryan Anderson in Raleigh, NC, and Carla Johnson in Washington State contributed.