USA TODAY International Edition

Vaccine appointmen­ts go unfilled in rural America

Politics, skepticism leading to surpluses at clinics

- Ken Alltucker

When St. James Parish Hospital in Louisiana began COVID- 19 vaccinatio­ns in the winter, it routinely administer­ed 500 daily shots and could not keep pace with the long lines of vaccine seekers.

After Louisiana joined a cascading number of states to waive age restrictio­ns and allow all adults to get vaccinated, hospital leaders find more appointmen­ts going unfilled. The hospital that serves a Mississipp­i River community of about 22,000 no longer hosts large vaccinatio­n events, instead directing about 200 doses each week through smaller clinics and targeting hard- to- reach population­s.

“We always felt the vaccine was like gold and it was precious,” said MaryEllen Pratt, CEO of St. James Parish Hospital. Now, “we’re having more trouble filling our schedules ... more people can get it, but we’re finding less people interested in getting it.”

The number of counties with unfilled vaccine appointmen­ts at chain retailers Walmart, CVS and Rite Aid grew about 60% in a week – from 530 to 847, according to an analysis by GoodRx.

The surplus appointmen­ts represent a new challenge as President Joe Biden pushes to make every American adult eligible for a vaccine shot by April 19. More than 174 million shots had been administer­ed nationwide and more than 25% of adults were fully vaccinated as of Friday.

The unused vaccine slots are evident across a wide swath of the South.

At Baton Rouge Clinic, a large vaccine site in Louisiana’s capital city, “urgency seems to have subsided,” CEO Ed Silvey said.

The primary care practice has had more vaccine appointmen­t no- shows in recent weeks, but Silvey said the clinic fills openings by offering doses to patients there for nonvaccine appointmen­ts.

Rural sites with fewer patients have fewer options. St. James Parish Hospital started to call people in advance to remind them of vaccine appointmen­ts. The hospital became more proactive after an appointmen­t no- show resulted in a wasted dose.

St. James Parish Hospital enlisted the help of ministers and churches to reach out to Black residents, who make up about half the town’s population.

Hospital and public health officials brainstorm ways to convince younger adults to vaccinate. One possible strategy: Have the hospital’s younger doctors explain the importance of vaccinatio­n.

“It wasn’t as hard to sell in the older population, they see themselves as quite vulnerable,” Pratt said. “We’re up against more challenges as we try to inoculate a younger population that feels like, ‘ If I get it, I’m not going to die. I’m just going to get sick.’ ”

In rural communitie­s such as Bolivar, Tennessee, about 60 miles east of Memphis, health leaders workto overcome skepticism.

Bolivar General Hospital CEO Ruby Kirby, who is Black, talked one- on- one with Black staffers who “were really hesitant” about COVID- 19 vaccinatio­n. The effort paid off, and hospital employees’ immunizati­on rate surpassed 90%.

It’s a tougher message to communicat­e in surroundin­g Hardeman County. Only 15.9% of people in the county of more than 25,000 had been fully vaccinated as of April 7, according to the Centers for Disease Control and Prevention. Statewide, more than two- thirds of Tennessee’s 95 counties had available appointmen­ts at chain pharmacies.

A Kaiser Family Foundation poll found 35% of rural residents say they probably or definitely will not get vaccinated, a higher rate than city or suburban residents.

Vaccine acceptance can be influenced by political beliefs. About 79% of self- identified Democrats say they have been vaccinated or intend to do so soon, compared with 46% of Republican­s. About 3 in 10 Republican­s say they will definitely not get vaccinated, a KFF poll found.

Kirby said people who oppose vaccinatio­n for political reasons represent “one of the biggest hurdles we’ve had to cross.”

She said the community eschewed mask wearing, though opposition to masks and vaccinatio­n melted away when influentia­l community members became infected and spoke about their experience.

“It tends to change people’s view when they know somebody who had it and had negative outcomes or had difficulty recovering,” Kirby said.

In Mount Pleasant, Texas, Titus Regional Medical Center CEO Terry Scoggin has faced similar challenges. His hospital serves a five- county region about 60 miles from Arkansas and Louisiana.

Including high- risk employers such as meatpackin­g plants and a large number of uninsured residents, the industrial and agricultur­al hub was hit hard during COVID- 19 surges.

Scoggin said too many people “don’t trust the process of vaccines” because of political views or misinforma­tion on social media.

“There’s so much out there,” Scoggin said. “You can find what you want to believe.”

Hospital staffers also have been slow to take the vaccine. Some staffers infected during surges questioned whether they need the vaccine because of their own body’s immunity. Several female employees expressed worry about how vaccine might affect pregnancy despite studies that show vaccines are safe and effective for pregnant women and probably protect their babies as well.

The hospital provided staff with reliable informatio­n about vaccine safety and offered incentives such as discounted health insurance premiums.

Scoggin wants his staff protected, and he’s aware of the importance of health care workers setting an example in a community where vaccine hesitancy runs deep.

“When half of your employees won’t get the vaccine, what does that tell those employees’ family members, relatives and friends?” he said.

The available vaccine appointmen­ts in small towns have opened opportunit­ies for city residents willing to drive long distances to get immunized.

Mary Santelman of St. Paul, Minnesota, desperatel­y needed a vaccine, not just to protect herself but also her husband undergoing cancer treatment.

She was shut out of Minnesota’s vaccine lottery and could not secure an appointmen­t after searching pharmacies and clinics throughout the Twin Cities. Based on a tip from a friend, she booked an appointmen­t at Walmart in Wadena, Minnesota – about 150 miles from her home.

“Just getting that one shot brought my stress level way down,” Santelman said.

That feeling did not last long. She and her husband had to travel to Ohio State University for cutting- edge immunother­apy cancer treatment he could not get closer to home.

Santelman tried to reschedule her second Moderna vaccine shot at a pharmacy near their hotel in Columbus, Ohio. She was on the verge of flying back to Minnesota when her doctor convinced an Ohio Walmart pharmacy to administer her second dose.

Santelman is thankful to be vaccinated, but she worries about the toll of skeptics who refuse to do so or wear a mask in public.

“There are these people actively searching for it and a segment of the population who is refusing it,” Santelman said.

Katelyn Hertel is founder of Vaccine Fairy, a website that helps find vaccine appointmen­ts for people. Website volunteers scour pharmacy websites, often overnight or early morning.

Hertel said the website prioritize­s appointmen­ts for seniors who face barriers such as a lack of transporta­tion or medical conditions that make travel difficult. She cited struggles obtaining timely appointmen­ts for people with limited travel options in New Jersey and Pennsylvan­ia.

She worries more disadvanta­ged communitie­s will struggle to secure nearby appointmen­ts as states open eligibilit­y for all adults.

“You have 20-, 30-, 40- somethings who are tech savvy and can grab them for themselves or their friends,” Hertel said. “What happens to our seniors?”

 ?? AARON E. MARTINEZ/ USA TODAY NETWORK ?? Too many people “don’t trust the process,” a Texas hospital CEO says.
AARON E. MARTINEZ/ USA TODAY NETWORK Too many people “don’t trust the process,” a Texas hospital CEO says.
 ?? JOSIE NORRIS/ USA TODAY NETWORK ?? Layla Haji, 17, winces as she receives her vaccine Saturday in Nashville, Tenn.
JOSIE NORRIS/ USA TODAY NETWORK Layla Haji, 17, winces as she receives her vaccine Saturday in Nashville, Tenn.

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