Rita Fentress feared she might get lost while driving down the unknown wooded, single-lane road in rural Tennessee in search of a coronavirus vaccine. Then the trees were cleared and the Hickman County Agricultural Pavilion appeared.
The 74-year-old woman could not be vaccinated in Nashville, where she lives because so many health care workers have had to be vaccinated there. But a neighbor told her that the state’s rural counties had already moved into younger age groups and that she had found an appointment 60 miles away.
“I felt kind of guilty,” she said. “I thought maybe I would take it from someone else.” But in late February she said there were five more openings for the next morning.
The US vaccination campaign has exacerbated tensions between rural and urban America, where from Oregon to Tennessee to New York complaints emerge of real or perceived inequality in vaccine allocation.
In some cases, accusations of how scarce vaccines are being distributed have taken partisan tones, with rural Republican lawmakers in democratic-led states complaining about “picking winners and losers,” and city dwellers traveling for hours to rural GOP communities to fight COVID-19 get shots when there aren’t any in their city.
In Oregon, state GOP lawmakers left a legislative session last week on the Democratic governor’s vaccination plans, citing rural vaccine distribution. In New York state, public health officials in rural counties have complained about differences in vaccine allocation, and in North Carolina, according to rural lawmakers, too many doses go to mass vaccination centers in large cities.
In Tennessee, Missouri, and Alabama, a lack of recording in urban areas with the largest numbers of healthcare workers has resulted in seniors having to schedule hours outside their homes. The result is a myriad of approaches that can look exactly like the opposite of justice, the most likely of which is to skillfully vaccinate people and give them the opportunity to seek a shot and travel to where it is.
“It’s really, really flawed,” said Amesh Adalja, a senior scientist at the Johns Hopkins Center for Health Security, who found that there are even vaccine hunters out there who can find a dose for money. “Ideally, the allocations would meet the needs of the population.”
With little more than general instructions from the federal government, states have made it their business to decide what it means to distribute the vaccine fairly and to reach vulnerable populations.
Tennessee, like many states, has broken down doses based primarily on the county’s population, not the number of residents belonging to eligible groups – such as: B. Healthcare Workers. The Tennessee Health Commissioner has defended the allotment as the “fairest” one, but the approach has also exposed another layer of belongings as the vaccine rollout accelerates.
In Oregon, the problem caused state officials in some rural areas where their healthcare workers had completed their vaccination to pause dose delivery while clinics in other regions, including the Portland metropolitan area, caught up. The cloud of dust last month caused an angry reaction. Some state GOP lawmakers accused the Democratic governor of playing favorites with the townspeople they voted for.
Public health executives in Morrow County, an agricultural region in northeast Oregon with one of the highest COVID-19 infection rates, said they had to move two vaccination clinics because of the state’s decision. Other rural counties delayed vaccinations for seniors.
States face many challenges. In rural areas, the freezers needed to store Pfizer vaccines are less likely to be available. Healthcare workers are often concentrated in large cities. And rural counties in many states have been particularly hard hit by COVID-19, but their residents are the most likely to say they “definitely won’t” be vaccinated, according to recent surveys by the Kaiser Family Foundation.
Adalja said most of these complications were predictable and could have been avoided with proper planning and funding.
“There are people who know how to do that,” he said. “You’re just not responsible for it.”
In Missouri, where Facebook groups have popped up to post about the availability of appointments in rural areas, Senate minority leader John Rizzo, a Democrat from the suburb of Independence, Kansas City, pointed out the need to get more vaccines into urban areas .
The criticism drew a furious reprimand from Republican Governor Mike Parson, who said the vaccine distribution was proportional to the population, and critics use “cherry-picked” data.
“There’s no division between rural and urban Missouri,” Parson said during his weekly COVID-19 update last week.
In Republican-led Tennessee, Health Commissioner Lisa Piercey notes that the Trump administration viewed the state’s plan as one of the most equitable in the nation. Additional doses go to 35 counties with a high social vulnerability index – many small and rural, but also Shelby County, which includes Memphis, with a large black population.
Last week, state officials announced that around 2,400 cans had been wasted in Shelby County over the past month due to misunderstandings and inadequate records. The county also has nearly 30,000 excessive doses in its inventory. The situation led the Centers for Disease Control and Prevention to investigate and the county health director resigned.
In Nashville, Democratic Mayor John Cooper says the fact that city dwellers can take pictures elsewhere is positive, even if the road trips are “a bit painful.”
“I’m grateful that other counties didn’t say, ‘Oh my god, you always have to live in this county to get the vaccine,’ said Cooper.
Nashville educators Jennifer Nashville and Jessica Morris took sick leave last week to take the four-hour round trip to tiny Van Buren County of fewer than 6,000 residents.
They made their first recordings there in January when Republican Governor Bill Lee urged Nashville and Memphis schools to return to face-to-face teaching. Republican lawmakers even threatened to pull funds from districts that stayed online.
Personal lessons started a few weeks ago, but the city only started vaccinating teachers last week.
“It was scary, frustrating and felt really betrayed,” said Simon.
Flaccus reports from Portland, Oregon. Jim Salter of O’Fallon, Missouri; Bryan Anderson in Raleigh, NC and Carla Johnson in Washington state contributed.