NASHVILLE, Tennessee – Rita Fentress was worried she would get lost if she walked down the unknown wooded one-way 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 there were so many health workers to be vaccinated there. But a neighbor told her that the rural provinces had already moved to younger age groups, and she found an appointment 60 km away.
“I felt so guilty,” she said. “I thought maybe I’m taking it from someone else.” But late that February day, she said there were five more openings for the next morning.
The U.S. vaccine campaign has heightened tensions between rural and urban America, where from Oregon to Tennessee to New York State, complaints have surfaced about a real – or alleged – inequality in the allocation of vaccines.
In some cases, accusations of how rare vaccines are distributed have been biased, while rural Republican lawmakers in democracies have complained that they ‘pick winners and losers’, and urbanites travel to rural GOP-leaning communities to get COVID-19 shots if there is no one in their city.
In Oregon, state GOP lawmakers walked out of a legislative session last week on the Democratic governor’s vaccine plans, citing the distribution of rural vaccines among their concerns. In New York State, public health officials in rural counties have complained about differences in vaccine allocation, and in North Carolina, rural lawmakers are saying that too many doses of mass vaccines are going to work in big cities.
In Tennessee, Missouri, and Alabama, a lack of shots in urban areas with most health care workers resulted in senior citizens having to take appointments hours away from their homes. The result is a jumble of approaches that may look exactly the opposite of equity, where those likely to be vaccinated are people with a mind and looking for a shot and wherever it goes.
“It’s really, really flawed,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Safety. There are even vaccine hunters who will get a dose for money. “Ideally, allocations would meet the needs of the population.”
With little more than general leadership 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, distributed doses based primarily on provincial populations, not on how many residents belong to qualifying groups – such as health workers. The Tennessee health commissioner defended the award as the “fairest”, but the approach also exposed another layer of haves and not-nots as the vaccine exploded.
In Oregon, the case led to government officials interrupting dose deliveries in some rural areas that have already vaccinated their health workers while catching up with clinics elsewhere, including the Portland metro area. The riots last month sparked a furious response, with some GOP lawmakers accusing the Democratic governor to play favorites with the urban residents who preferred her.
Public health leaders in Morrow County, a farming area in northeastern Oregon with one of the highest COVID-19 infection rates, said they had to postpone two vaccine clinics because of the state’s decision. Other rural provinces have delayed vaccines for the elderly.
States have many challenges. Rural provinces are less likely to have the freezing equipment needed to store Pfizer vaccines. Healthcare workers are often concentrated in large cities. And rural provinces have been hit hard by COVID-19 in many countries in particular, but according to a recent poll by the Kaiser Family Foundation, COVID-19 will say in most countries that they are definitely not going to be vaccinated.
Adalja said that most of these complications were foreseeable and that they could be avoided with the right planning and financing.
“There are people who know how to do it,” he said. “They just are not in control of it.”
In Missouri, where Facebook groups have come forward with posts about the availability of appointments in rural areas, state Senate Minority Leader John Rizzo, a Democrat from the suburb of Independence in Kansas City, mentioned the need for more vaccination after to lead urban areas.
The criticism sparked a furious reprimand from Republican Gov. Mike Parson, who said the distribution of vaccines was proportionate to the population and that critics “chose cherries.”
“There is no division between rural and urban Missouri,” Parson said during his weekly update of COVID-19 last week.
In Republican-led Tennessee, Health Commissioner Lisa Piercey notes that the Trump administration considers the state’s plan to be the fairest in the country. Extra doses go to 35 counties with a high social vulnerability index – very small and rural, but also Shelby County, which includes Memphis, with a large black population.
Last week, government officials revealed that about 2,400 doses had been wasted in Shelby County. the past month due to incorrect communication and insufficient record keeping. The country has also built up nearly 30,000 excessive doses in its stock. The situation caused the Centers for Disease Control and Prevention to investigate and the director of the province’s health to resign.
Democratic Mayor John Cooper says in Nashville that the fact that city residents can shoot elsewhere is positive, even if it’s a bit of a pain.
“I’m thankful that other provinces didn’t say, ‘Oh, you always have to be a resident of this country to get the vaccine,'” Cooper said.
Jennifer Simon and Jessica Morris, educators from Nashville, took sick days last week to make the four-hour round trip to the small Van Buren County, less than 6,000 residents.
They got their first shots there in January when Republican Gov. Bill Lee pushed the Nashville and Memphis neighborhood schools to return to personal classes. Republican lawmakers have even threatened to withdraw money from districts that have stayed online.
Personal classes started a few weeks ago, but the city only started vaccinating teachers last week.
“It was scary, frustrating and to feel really betrayed,” Simon said.
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Flaccus reported from Portland, Oregon. Jim Salter in O’Fallon, Missouri; Bryan Anderson in Raleigh, NC, and Carla Johnson in Washington State contributed.