Open spaces, no pharmacies: Rural areas in the U.S. confront vaccine void
SURRY, Va.— When Charlome Pierce searched where her 96-year-old father could get a COVID-19 vaccine in January, she found zero options anywhere near their home in Virginia. The lone medical clinic in Surry County had none, and the last pharmacy in an area with roughly 6,500 residents and more land mass than Chicago closed years ago.
To get their shots, some residents took a ferry across the sprawling James River to cities such as Williamsburg. Others drove more than an hour past farms and woodlands — the county got its first stoplight in 2007 — to reach a medical facility offering the vaccine.
At one point, Pierce heard about a state-run vaccination event 45 minutes away, No more appointments were available, which perhaps was for the best: the wait there reportedly could last up to seven hours.
“That would have been a daunting task,” she said, citing her father’s health conditions and frequent need to use the bathroom. “I could not have had him sit in a car and wait for something that might happen. We’re not in a Third World country.”
As the nation’s campaign against the coronavirus moves from mass inoculation sites to drugstores and doctors’ offices, getting
vaccinated remains a challenge for residents of “pharmacy deserts,” communities without pharmacies or wellequipped health clinics. To improve access,” the federal government has partnered with 21 companies that run free-standing pharmacies or pharmacy services inside grocery stores and other locations.
More than 40,000 stores are expected to take part, and the Biden administration has said that nearly 90% of Americans live within five miles of one, from Hy-Vee and Walmart to Costco and Rite-Aid.
But there are gaps in the map: More than 400 rural counties with a combined population of nearly 2.5 million people lack a retail pharmacy that’s included in the partnership. More than 100 of those counties either have no pharmacy or have a pharmacy that historically did not offer services such as flu shots, and possibly lacks the equipment or certified staff to vaccinate customers.
Independent pharmacies that have traditionally served rural areas have been disappearing, casualties of mail-order prescriptions and more competition from chains like Walgreen’s and CVS with greater power to negotiate with insurance companies, according to Keith Mueller, director of the University of Iowa’s RUPRI Center for Rural Health Policy Analysis.
“There are a lot of counties that would be left out” of the Federal Retail Pharmacy Program, said Mueller, whose research center compiled the pharmacy data on the 400 counties. “In the Western states in particular, you have a vast geography and very few people.”
Challenges to obtaining a vaccine shot near home aren’t limited to rural areas. There is a relative dearth of medical facilities in some urban areas, particularly for Black Americans, according to a study published in February
by the University of Pittsburgh’s School of Pharmacy and the West Health Policy Center.
The study listed 69 counties where Black residents were much more likely to have to travel more than a mile to get to a potential vaccination site, including a pharmacy, a hospital or a federally qualified health center. One-third of those counties were urban, including the home counties of cities such as Atlanta, Houston, Dallas, Detroit and New Orleans.
Additionally, the study identified 94 counties where Black residents were significantly more likely than white residents to have to go than 10 miles to reach a potential vaccination site. The counties were mostly heavily concentrated in the southeastern U.S. — Virginia had the most of any state with 16 — and in Texas.
The shortage of pharmacies and other medical infrastructure in some of the nation’s rural areas highlights the health care disparities that have become more stark during the coronavirus pandemic, which has disproportionately affected members of racial minority and lower-income groups.
The former drug store in Surry County, where about 40% of the residents are Black, is now a cafe. No one seems to remember exactly when the Surry Drug. Co. closed, but cafe co-owner Sarah Mayo remembers going there as a child. Now, she drives 45 minutes to a Walmart or CVS.
“I don’t know if more people would take the vaccine” if the pharmacy still existed, Mayo, 62, said. “But at least you would have a local person that you trust who would explain the pros and cons.”
Surry County residents also used to pick up prescriptions at Wakefield Pharmacy in neighboring Sussex County until it, too,
closed in November. The owner, Russell Alan Garner, wanted to retire and couldn’t find a buyer.
“We’ve become dinosaurs,” Garner said.
In January, Surry County officials saw vaccines arrive in other parts of Virginia that had more people or more coronavirus cases. Fearing doses might not arrive for months, if ever, they began to pressure state officials.
In a letter to the governor’s office, Surry joined with surrounding communities to express concerns about vaccine “equity,” particularly for low-income and other disadvantaged populations. Some of those communities said they had reallocated money to support vaccination efforts.
“The thing about living in a rural community is that you’re often overlooked by everybody from politicians right on through to the agencies,” said county Supervisor Michael Drewry.
Surry County Administrator Melissa Rollins wrote to the regional health district, stating that driving outside the county wasn’t practical for most residents. She said Surry was willing to sponsor a mass vaccination site, had devised a plan to recruit people who could administer shots and make sure that eligible residents would be ready.
The first clinic in Surry County was held Feb. 6 at the high school in the small town of Dendron. The school district was inoculating teachers and other staff members when officials with the county and regional health district staff learned of extra doses, prompting a rush to get the word out.
Surry already had a waitlist of eligible people through a survey it designed to reach vulnerable residents. It used its emergency alert telephone system, since internet access is spotty.
Pierce got the call and quickly headed out with her
father, Charles Robbins. It was a 20-minute drive to the high school and a two-hour wait. Pierce, 64, also got a shot, along with about 240 other people that day.
Three more vaccination clinics have been held in the county. And the regional health district had administered 1,080 doses there as of March 2. The number makes up the majority of doses that county residents have received, although several hundred received their shots outside of the county.
All told, about 1,800 county residents have received at least one dose. That’s about 28% of the population and was almost twice the state’s average rate. About half the people who’ve received vaccines are Black.
The Virginia Department of Health said that vaccine distribution has been based on population and COVID rates. But moving forward, the department said it’s considering tweaks to ensure more geographical and racial equity.
Pierce and her father were relieved to get their second shots in late February. But she said Surry’s rural character placed it at a disadvantage in the beginning.
“I have close friends, people who are essential workers, who’ve had to go as far away as an hour to get a shot,” she said. “You shouldn’t be marginalized by your zip code.”
But driving vast distances is a way of life for many in rural areas, said Bruce Adams, a cattleman and commissioner for Utah’s San Juan County, which is nearly the size of New Jersey and overlaps with the Navajo Nation.
“I got both shots, and I had to drive 44 miles roundtrip for each one to a public health center,” Adams, 71, said. “I don’t think it’s any more of a problem than anything else we do normally in our lives…going to the doctor, the dentist, getting your haircut.”
PLAINS OF UR, Iraq — Pope Francis walked through a narrow alley in Iraq’s holy city of Najaf for a historic meeting with the country’s top Shiite cleric, and together they delivered a powerful message of peaceful coexistence in a country still reeling from back-to-back conflicts over the past decade.
In a gesture both simple and profound, Grand Ayatollah Ali al-Sistani welcomed Francis into his spartan home. Afterward, he said religious authorities have a role in protecting Iraq’s Christians, and that Christians should live in peace and enjoy the same rights as other Iraqis. The Vatican said Francis thanked al-Sistani for having “raised his voice in defense of the weakest and most persecuted” during some of the most violent times in Iraq’s recent history
Al-Sistani, 90, is one of the most senior clerics in Shiite Islam, and his rare but powerful political interventions have helped shape present-day Iraq. He is a deeply revered figure in Shiite-majority Iraq and his opinions on religious and other matters are sought by Shiites worldwide.
Later in the day, the pope met with Iraqi religious leaders in the shadow of a symbol of the country’s ancient past — the 6,000year-old ziggurat in the Plains of Ur, also the traditional birthplace of Abraham, the biblical patriarch revered by Jews, Christians and Muslims.
Such interfaith forums are a staple of Francis’ international trips. But in strife-torn Iraq the televised gathering of figures from across the country’s religious spectrum was nearly unheard of: From Shiite and Sunni Muslims to Christians, Yazidis and Zoroastrians and tiny, lesser known, ancient and esoteric faiths like the Kakai, a sect among ethnic Kurds, Mandaeans and Sabaean Mandaeans. Missing from the picture was a representative of Iraq’s once thriving, now nearly decimated Jewish community, though they were invited, the Vatican said.
Together, the day’s two main events gave symbolic and practical punch to the central message of Francis’ visit, calling for Iraq to embrace its diversity. It is a message he hopes can preserve the place of the thinning Christian population in the tapestry.
Still, it faces a tough sell in a country where every community has been traumatized by sectarian bloodshed and discrimination and where politicians have tied their power to sectarian interests.
In al-Sistani, Francis sought the help of an ascetic, respected figure who is immersed in those sectarian identities but is also a powerful voice standing above them.
Their meeting in al-Sistani’s humble home, the first ever between a pope and a grand ayatollah, was months in the making, with every detail painstakingly negotiated beforehand.
Early Saturday, the 84year-old pontiff, travelling in a bullet-proof MercedesBenz, pulled up along Najaf’s narrow and columnlined Rasool Street, which culminates at the goldendomed Imam Ali Shrine, one of the most revered sites in Shiite Islam.
He then walked the few meters (yards) down an alley to al-Sistani’s home. As a masked Francis entered the doorway, a few white doves were released in a sign of peace. He emerged just under an hour
later, still limping from an apparent flare-up of sciatica nerve pain that makes walking difficult.
A religious official in Najaf called the 40-minute meeting “very positive.” He spoke on condition of anonymity because he was not authorized to brief media.
The official said al-Sistani, who normally remains seated for visitors, stood to greet Francis at the door of his room — a rare honor. The pope removed his shoes before entering alSistani’s room and was served tea and a plastic bottle of water.
Al-Sistani and Francis sat close to one another, without masks. Al-Sistani spoke for most of the meeting, the official said. AlSistani, who rarely appears in public or even on television, wore black robes and a black turban, in simple contrast to Francis’ allwhite cassock.
The official said there was some concern about the fact that the pope had met with so many people the day before. Francis has received the coronavirus vaccine but al-Sistani has not. The aging ayatollah, who underwent surgery for a fractured thigh last year, looked tired.
After the meeting ended, Francis paused before leaving the room to have a last look, the official said.
In a statement issued by his office afterward, alSistani
affirmed that Christians should “live like all Iraqis, in security and peace and with full constitutional rights.” He pointed out the “role that the religious authority plays in protecting them, and others
who have also suffered injustice and harm in the events of past years.”
Al-Sistani wished Francis and the followers of the Catholic Church happiness and thanked him for taking the trouble to visit
him in Najaf, the statement said.
Iraqis cheered the meeting, and the prime minister responded to it by declaring March 6 a National Day of Tolerance and Cooexistence in Iraq.
”We welcome the pope’s visit to Iraq and especially to the holy city of Najaf and his meeting with Grand Ayatollah Ali al-Sistani,” said Najaf resident Haidar Al-Ilyawi. “It is a historic visit and hope it will be good for Iraq and the Iraqi people.”
Iraq’s Christians, battered by violence and discrimination, hope a show of solidarity from al-Sistani will help secure their place in Iraq and ease intimidation from Shiite militiamen against their community.
Al-Sistani’s voice is a powerful one, often for moderation.
After the 2003 U.S.-led invasion, his opinions forced American administrators to alter their transition plans, and his approval opened the way for Iraq’s Shiites to participate in force in post-Saddam Hussein elections. In 2019, as anti-government demonstrations gripped the country, his sermon led to the resignation of then-prime minister Adil Abdul-Mahdi.
But his word is not law. After 2003, he repeatedly preached calm and restraint as the Shiite majority
came under attack by Sunni extremists. Yet brutal Shiite reprisals against Sunni civilians fed a yearslong cycle of sectarian violence.
His 2014 fatwa, or religious edict, calling on ablebodied men to join the security forces in fighting the Islamic State group helped ensure the extremists’ defeat. But it also swelled the ranks of Shiite militias, many closely tied to Iran and now blamed for discrimination against Sunnis and Christians.
Later, Pope Francis evoked the common reverence for Abraham to speak against religious violence at the inter-faith gathering at the Plains of Ur, near the southern city of Nasiriyah.
“From this place, where faith was born, from the land of our father Abraham, let us affirm that God is merciful and that the greatest blasphemy is to profane his name by hating our brothers and sisters,” Francis said. “Hostility, extremism and violence are not born of a religious heart: they are betrayals of religion.”
The Vatican said Iraqi Jews were invited to the event but did not attend, without providing further details. Iraq’s ancient Jewish community was decimated in the 20th century by violence and mass emigration fueled by the ArabIsraeli conflict, and only a handful remain.
Ali Thijeel, a Nasiriyah resident who attended the event, said he hoped the pope’s visit would encourage investment in the area to attract pilgrims and tourists. “This is what we were waiting for,” he said. “This is a message to the government and politicians. They should take care of this city and pay attention to our history.”
Francis’ visit — his first international trip since the start of the coronavirus pandemic — comes amid a surge in COVID-19 cases in Iraq. Despite concern about infections, Francis celebrated Mass in a packed, stuffy Chaldean Catholic Cathedral later Saturday in Baghdad that featured chanted Scripture readings and a maskless choir singing hymns.
“Love is our strength, the source of strength for those of our brothers and sisters who here too have suffered prejudice, indignities, mistreatment and persecutions for the name of Jesus,” Francis told the faithful, who did wear masks.