In the rural race to distribute COVID vaccines, a piecemeal approach - North Carolina Health News
By Liora Engel-Smith
For the first time in a long time last summer, the Madison County fairgrounds were empty. As with many other events across the state, the pandemic sidelined this annual celebration of all things agriculture.
But last month, cars carrying seniors flocked to the empty fairgrounds once again, this time not in search of blue ribbon accolades and fried food, but to get vaccinated. Cars circled the fairground rodeo arena, moving from station to station — registration, consultation with a provider, followed by a quick jab, and then, finally to a 15-minutes observation station.
That day, roughly 15 volunteers corralled through the Asheville-based Mountain Area Health Education Center vaccinated 250 seniors in what would become the first in a series of drive-thru vaccine clinics in rural western North Carolina. On that same day, by comparison, Madison County Health Department staff vaccinated roughly 50 residents.
A county of more than 22,000 — nearly 4,700 of them seniors — Madison has many of the challenges other rural locales in the state face when it comes to vaccinating people. At almost 450 square miles of dirt roads, hollers and remote homes, finding a central location that reaches as many people as possible is a challenge.
In the initial stages of the vaccination effort, that task fell on the handful of employees at the county health department. The same employees were already inundated with answering the phones, testing residents for COVID-19 and responding to the community’s other ongoing health needs.
At just over 2,300 people vaccinated in Madison County, with roughly 200 of those getting their second dose, the effort to reach seniors is slow-going. Unlike the more populated areas in the state, where one event can reach thousands of residents the rural race to vaccinate people has come in dribs and drabs.
That is, in part, a reality of rural life. But it’s also a function of vaccine availability, said Bryan McClure, a MAHEC employee who oversees the volunteer clinic effort.
“I think supply of vaccinations is the biggest limiting factor,” he said. “Of course, if we had the vaccine, you know, we can hold these events every day.”
The other piece of the puzzle, rural providers said, is finding ways to reach seniors who can’t necessarily make it to vaccine clinics for lack of transportation or because of poor health. With the highly contagious virus spreading through droplets, approaches such as busing groups of seniors to a particular location may not be wise.
The needs generated by keeping the vaccines super-cold, not to mention staffing constraints are also hampering that effort.
“You can’t be in every neighborhood on every street corner, allowing people to just be able to walk in,” said Tamara Dunn, chief operating officer at CommWell Health, a community health center that cares for thousands of residents in six rural counties out east. “We just don’t have that sort of resources.”
A phone tree 200 strong
Carl Parker got the call sometime on Tuesday. The president of the NAACP Brunswick county branch sprang into action as soon as the details were firm: CommWell Health had 200 vaccine doses. They planned on showing up at the local middle school in the community of Supply, an unincorporated crossroads that’s roughly a 10-minute drive from the beach. Supply’s 12,000 or so residents are mostly white, but roughly one in 10 residents identify as people of color.
The CommWell event was a golden opportunity to make sure some residents got their first shot.
Parker got to work.
He called one member of his organization, who, in turn, called another member, and then another. The phone tree proved remarkably successful.
“We kept on linking that thing together until we had more than 200 there by the next morning,” he said.
This kind of communication, Parker said, is an important part of reaching remote residents who may not know a vaccination event is happening, particularly as the pandemic cut them off from their usual sources of information, such as the grocery store, the senior center or a church visit.
Though Parker is proud of the turnout, he knows that more people will need to get vaccinated.
“Two hundred was a small challenge,” he said. “If they needed more, we would have gotten them more.”
Dunn, the CommWell employee who helped organize the event, said these kinds of local partnerships are crucial to reaching rural residents.
“It’s something that’s brand new,” she said. “I’ve not been part of a pandemic before. And so, you can’t just pop up and all of a sudden you’re an expert at doing testing and giving vaccines.”
Events like the one in Brunswick County, she added, are crucial because not everyone can drive to locations outside of their communities. Though perhaps more time-consuming than holding a mass vaccination site in a city, these events have proven to be a successful outreach approach, along with fixed vaccine clinic sites. Between these two approaches, CommWell has been able to vaccinate more than 1,000 people in its six-county region.
Outreach is slow and labor-intensive, Dunn added, and the team at CommWell gets help where they can. Support staff and CommWell’s senior management team have been helping with patient registration events, and at the Brunswick County vaccine clinic this week, staff called on the National Guard to direct traffic to the middle school.
“We serve the underserved areas,” she said. “That’s where our clinics are and we know what to do. … We are a big piece of the [vaccination] pie.”
Remote group home by remote group home
As North Carolina passes the 1.5 million vaccines mark, some residents, particularly those who are homebound, may be left behind. Paul Shackelford, a professor of obstetrics at the East Carolina University Brody School of Medicine, says he wants to narrow that access gap.
Since January, he and a team of volunteers have vaccinated eight of the most remote group homes in Pitt County. A collaboration between the Centers for Disease Control and Prevention and pharmacy companies CVS and Walgreens have been administering vaccines in some of the larger assisted living facilities, Shackelford said, but smaller providers have been left behind.
The painstaking process has led to 75 vaccinations to date, he added, with the goal of vaccinating roughly 300 of the most vulnerable residents — often poorer nursing home residents in the county.
The same approach could perhaps work for seniors who live alone and can’t go out, Shackelford said, but the approach is limited by staff and time constraints.
“If their health care is compromised by their movement, then we have a public health need to go to them,” he said. “ … But we have a substantial effort in delivering it so it’s not something we can do for everybody, but we have to learn how to do it.”
The local becomes regional
Almost 400 miles west, in Jackson County, physical access to vaccines is also a challenge, said Melissa McKnight, the county health department’s deputy health director. The health department has administered more than half of the vaccines in the county to date, reaching roughly 1,600 of the more than 3,500 vaccinations in the county, she said, out of a list of roughly 7,000 eligible residents.
Even with additional doses, the health department has been able to secure from Harris Regional and with additional vaccinating agencies in the county, that vaccination effort remains slow, since the county health department receives roughly 200 doses a week.
“We could do those giant events,” she said. “Our clinics are set up to do about 100 to 125 vaccines an hour. We calculated that in that way we could do 750 to 1,000 vaccinations a day. We’re just truly waiting for the supply.”
The vaccine effort in the county is fought on many fronts at once, McKnight said. Health department staff are getting help from the National Guard, the local emergency management system and from the department’s animal control staff.
Jackson County’s regional transit system has also joined the effort, transporting a small number of seniors who can’t otherwise make it to a vaccination site free of charge. The county’s vans and small buses are as COVID-proof as can be. Only a few passengers get on the van at a time and each of them is protected by plexiglass to minimize air droplet transmission.
But the effort of putting up a complex vaccination campaign in the middle of a pandemic is taking its toll, McKnight said.
“It is an incredibly heavy lift,” she said. “It has been a year of response now with COVID and I think the task gets bigger every day.”
Elsewhere in the mountain region, a consensus has emerged that the solution to these vaccine allocation challenges is regional, not local.
The Dogwood Health Trust, a regional nonprofit created after the recent sale of Mission Health, has convened an informal group of vaccinating agencies who not only share resources and best practices but also advocate as a collective for more vaccine allocations to the region.
“We know that every community has unique needs and challenges and we have to honor that,” said interim CEO Susan Mims. “And we know that there are efficiencies to be gained from working together. … That’s exactly what the consortium is about.”