The Guardian
34 bus stops: the obstacles that rural Americans face in reaching vaccination sites
Elderly, low-income, prisoners at home or disabled people face disorderly obstacles to getting a vaccine in a distribution plan largely centered on cars. Pharmacy technicians prepare doses of the Pfizer-BioNTech vaccine at a mass vaccination event in Denver, Colorado. Photo: Michael Ciaglo / Getty Images If you live in Belle Glade, Florida, a predominantly African American rural town on the southern shore of Lake Okeechobee, and want to get a Covid-19 vaccine appointment, you will need a car or $ 2 is a long time. That’s because the nearest and functioning Covid-19 vaccination site that accepts new appointments is in a Publix supermarket almost 30 miles away in Loxahatchee Groves, an oppressively white and oppressive city. And without a car, you’ll need to take a bus that runs once an hour, change trains and cycle 34 stops in total to get there. Meanwhile, the leaders of a health clinic based in Belle Glade have been pleading with local authorities for vaccines since the single 200-dose shipment ended. “We have been begging and begging,” said Yolette Bonnet, CEO of FoundCare, the Belle Glade-based clinical group. “In less than a week, we administer all vaccines.” Bonnet now has a waiting list of thousands of people, including the hardest-to-reach populations, who are often criticized by government health officials. Bonnet providers are experts in the communities they serve, familiar with patient history and with skeptics’ confidence in vaccination. Those who want vaccines are enthusiastic. But it’s not enough. “Unfortunately for us, we don’t have access to the vaccine,” said Bennet. Belle Glade is not alone. From snow-covered grasslands to sun-drenched swamp roads, the elderly, low-income, homeless or handicapped people already face disorderly obstacles to getting a vaccine in a distribution plan largely centered on cars, and at a time when systems public transport are consuming billions – haircuts in dollars. Belle Glade was specifically the victim of a “pilot” program, in which the Florida centralized health department decided to transfer the distribution of all vaccines in Palm Beach County to Publix supermarket pharmacies. Health care providers like Bonnet approve Publix to distribute vaccines – they say the problem is that the chain cannot be the only distributor. “This is problematic for me,” said Thomas A Arcury, professor of family and community medicine at Wake Forest School of Medicine in North Carolina. “Publix is a luxury grocery store first of all, secondly, most low-income people live in areas without grocery stores.” But the location of the vaccination site is emblematic of another major problem: if government officials do not carefully position vaccination sites, people without a car may find it very difficult to obtain the Covid-19 vaccine. And the people affected – usually communities of color – are likely to be the most affected by the pandemic. Hundreds of cars line up as people wait to receive a dose of Pfizer vaccine at a drive-thru vaccination event in Clermont, Florida. Photo: Paul Hennessy / LightRocket / Getty Images “The issue of transportation remains important,” said Arcury. “Simply put, if you can’t get to a health care provider, you can’t get health care,” he said. The Biden government recognized the problem. The administration’s 200-page plan on how to tackle Covid-19 addresses transportation barriers, promising to “leverage federal authorities and resources to ensure vaccine distribution in underserved communities, including providing convenient and accessible vaccination sites, increasing clinical and community based workforce for outreach, education and vaccination, and comprehensive support services ”. The government also promises to guarantee paid leave and subsidized transport. One of Joe Biden’s first executive orders called for the formation of a Covid-19 stock task force. The group’s mission is to drive to the heart of disparities, such as lack of transportation, which are the root cause of increased vulnerability to Covid-19 in black communities. This task force is chaired by Dr. Marcella Nunez-Smith, dean of equity research in health at the professor at Yale University. Ensuring that people have paid time off and can access vaccination sites is a “moral imperative,” said Nunez-Smith at the Covid-19 task force’s first press conference. “It is simply the right thing to do to ensure that those who are most affected or most at risk have the opportunity to remain safe and healthy during this pandemic.” As work at the federal level begins, local officials said these goals remain ambitions only, and the road to achieving them has been made more tortuous by the Trump administration’s insistence on individual states to develop vaccination plans. In Wisconsin, Republican state deputy Joe Sanfelippo said he was concerned that a number of rural residents would reach vaccination sites, from low-income people with government health insurance to the elderly. “They talk about having mobile vaccination clinics in the future, but they don’t tell us when the future is,” said Sanfelippo, who chairs the assembly’s health committee. “There are a lot of older people who don’t leave the house so easily – especially in winter in bad weather.” Meanwhile, the plan to provide new vaccination appointments in Palm Beach only through Publix supermarket pharmacies outraged mayors whose communities would have difficult access. “Imposing such a barrier on an already vulnerable and highly needy population cannot happen,” said the mayors of Belle Glade, Pahokee and South Bay in a letter to Republican Governor Ron DeSantis (a Trump ally). The plan was “simply unacceptable and, frankly, unscrupulous.” DeSantis later defended the plan, and state health officials praised him as a “wonderful” pilot, according to the Palm Beach Post. The Palm Beach County Health Department said in response to questions from the Guardian that, “The next vaccinations in the Glades area will be state-sponsored efforts,” and directed new investigations to state officials. Bennet has been pleading with officials for vaccines, fearing that vaccination sites set up by agencies outside the community will not attract vaccine skeptics. “With conspiracy theories out there about vaccines in the community, some of them are reluctant to get vaccinated,” said Bonnet. “They are willing to come and get the vaccine because they know their doctors are going to take care of them and they trust us.” The elderly wait for their turn to receive their dose of the Pfizer vaccine at Mission Commons, an elderly community that lives in Redlands, California. Photo: Watchara Phomicinda / The Riverside Press-Enterprise / Getty Images In North Carolina, agricultural cities are expecting the return of seasonal farm workers this spring, but without specific information on how these workers – essential to the country’s food supply – will be vaccinated. . Farm workers often share overcrowded housing and rely on transportation provided by the employer. “The way to deal with this, as we saw more than 100 years ago, is to bring health to where the poor are,” said Arcury. His research focuses on rural health in agricultural communities, especially poultry processing workers, who have been hit hard by Covid-19. Difficulties in accessing medical care are well documented and studied and cover urban and rural communities. A 1996 study of HIV-positive adults revealed 15.4% of delayed care because they could not find transportation to a clinic. A disproportionate share of study participants was black or Latin. A 2004 study of adults over 65 found that among those who were unable to see a doctor, 20% cited transportation as a barrier. A 2006 survey in Minnesota found that 39% of Native Americans had difficulty finding transportation, compared to 18% of white Americans. In Dayton, Ohio, in 2012, researchers asked 413 adults about going to the doctor: one third (128 people) said it was “difficult” or “very difficult” to find a ride. About half of the group was composed of women and 42% were black. In 2005, Arcury conducted a survey of more than 1,000 adults in rural North Carolina. He found that people with chronic health problems went to the doctor twice as often when they had a driver’s license. There are also promising programs. In Massachusetts, independent pharmacies are preparing to run outside vaccination clinics in low-income residential complexes for the elderly, where few people have cars. “It’s a good combination for independent pharmacies because they don’t usually have much space in their pharmacies, but they are very adept at leaving the premises,” said Todd Brown, vice president of Northeastern University’s pharmacy and executive school director of the Massachusetts independent pharmacists. At Belle Glade, the people that FoundCare serves usually have low incomes and some have no papers. Many work in agriculture or are unemployed and live in overcrowded, multigenerational housing. “We have more than 1.5 million people living in Palm Beach County,” said Bonnet. “I don’t want 1.5 million vaccines, because I wouldn’t be able to accommodate them. But I serve [close] for 2,700 patients between reach and primary care, as well as the Covid test. ”Without a robust vaccination program, she fears that Covid will continue to spread. “The health of the entire community depends on the weakest link,” said Bonnet.