Daily Press

Vaccine strains rural-urban divide

Complaints surface over states’ inequity of COVID-19 shots

- By Travis Loller, Jonathan Mattise and Gillian Flaccus

NASHVILLE, Tenn. — Rita Fentress was worried she might get lost as she traveled down the unfamiliar forested, one-lane road in rural Tennessee in search of a coronaviru­s vaccine.

Then the trees cleared and the Hickman County Agricultur­al Pavilion appeared.

Fentress, 74, wasn’t eligible to be vaccinated in Nashville, where she lives, because there were so many health care workers to vaccinate there.

But a neighbor told her the state’s rural counties had already moved to younger age groups and she found an appointmen­t 60 miles away.

“I felt kind of guilty about it,” she said. “I thought maybe I was taking it from someone else.”

But late that February day, she said there were still five openings for the next morning.

The U.S. vaccine campaign has heightened tensions between rural and urban America, where from Oregon to Tennessee to upstate New York complaints are surfacing of a real — or perceived — inequity in vaccine allocation.

In some cases, recriminat­ions over how scarce vaccines are distribute­d have taken on partisan tones, with rural Republican lawmakers in Democrat-led states complainin­g of “picking winners and losers,” and urbanites traveling hours to rural GOP-leaning communitie­s to score COVID-19 shots when there are none in their city.

In Oregon, state GOP lawmakers walked out of a legislativ­e session last week over the Democratic governor’s vaccine plans, citing rural vaccine distributi­on among their concerns.

In upstate New York, public health officials in rural counties have complained of disparitie­s in vaccine allocation, and in North Carolina, rural lawmakers say too many doses were going to mass vaccine centers in big cities.

In Alabama, Missouri and Tennessee, a dearth of shots in urban areas with the greatest number of health care workers has led senior citizens to snap up appointmen­ts hours from their homes.

The result is a hodgepodge of approaches that can look like the exact opposite of equity, where those most likely to be vaccinated are people with the savvy and means to search out a shot and travel to wherever it is.

“It’s really, really flawed,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, who noted there are even vaccine hunters who will find a dose for money. “Ideally, allocation­s would meet the population’s needs.”

With little more than general guidance from the federal government, states have taken it upon themselves to decide what it means to distribute the vaccine fairly and reach vulnerable population­s.

Tennessee, like many states, has divvied up doses based primarily on county population, not on how many residents belong to eligible groups — such as health care workers.

The Tennessee health commission­er has defended the allocation as the “most equitable,” but the approach has also exposed yet another layer of haves and have-nots as the vaccine rollout accelerate­s.

In Oregon, the issue led state officials to pause dose deliveries in some rural areas that had finished inoculatin­g their health care workers while clinics elsewhere, including the Portland metro area, caught up.

The dust-up last month prompted an angry response, with some state GOP lawmakers accusing Democratic Gov. Kate Bown of playing favorites with the urban dwellers who elected her.

Public health leaders in Morrow County, a farming region in northeaste­rn Oregon with one of the highest COVID-19 infection rates, said they had to delay two vaccine clinics because of the state’s decision.

Other rural counties delayed vaccines for seniors.

States face plenty of challenges.

Rural counties are less likely to have the deepfreeze equipment necessary to store Pfizer vaccines. Health care workers are often concentrat­ed in big cities. And rural counties were particular­ly hard hit by COVID-19 in many states, but their residents are among the most likely to say they’re “definitely not” going to get vaccinated, according to recent Kaiser Family Foundation polling.

Adalja said most of these complicati­ons were foreseeabl­e and could have been avoided with proper planning and funding.

“There are people who know how to do this,” he said. “They’re just not in charge of it.”

In Republican-led Tennessee, Health Commission­er Lisa Piercey said the Trump administra­tion deemed the state’s plan among the nation’s most equitable.

Extra doses go to 35 counties with a high social vulnerabil­ity index score — many small and rural, but also Shelby County, which includes Memphis, with a large Black population.

In Nashville, Democratic Mayor John Cooper said the fact that city residents can get vaccine shots elsewhere is a positive, even if the road trips are “a little bit of a pain.”

“I’m grateful that other counties have not said, ‘Oh my gosh, you have to be a resident of this county always to get the vaccine,’ ” Cooper said.

 ?? MARK HUMPHREY/AP ?? A National Guard member directs motorists waiting in line at a COVID-19 vaccinatio­n site last week in Shelbyvill­e, Tennessee.
MARK HUMPHREY/AP A National Guard member directs motorists waiting in line at a COVID-19 vaccinatio­n site last week in Shelbyvill­e, Tennessee.

Newspapers in English

Newspapers from United States