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Rural communities outside U.S. cities fall further behind in COVID-19 vaccination race as President Joe Biden’s July 4 target of 70% of U.S. adults looms on the horizon .
Alaska is the only state where average rural rates of fully immunized people have increased faster than urban rates since April 19, when every state opened up vaccines to anyone 16 years of age and older, according to the latest analysis from NPR county-level immunization data from the Centers for Disease Control and Prevention.
Everywhere else, rates in urban counties exceeded those in rural counties.
More than a dozen states where rural rates actually beat urban rates seven weeks ago have swung, so they are now following their urban counterparts. These include Oregon, where rural areas are now 9 percentage points behind urban areas, and Maine, where they are now 7 points behind.
Florida, Massachusetts and Nebraska show the greatest disparity, with rural counties lagging 14 percentage points behind. For Florida and Nebraska, these gaps are about double what they were in mid-April.
While glaring, these discrepancies may hide a more complex history of immunization rates, as data shows many well above average rural counties and urban areas lagging behind.
“There is a lot, let’s call it the judgment of rural communities and a lot of blame placed on them for the masks, for the vaccinations,” says Mark Holmes, professor at the Gillings School of Global Public Health at the University of Carolina. North. “There is a continuum overall, and it’s not that simple because all major areas are doing well and not all rural areas are.”
Indeed, a CDC report from mid-May included a detail that surprised Holmes: The suburban counties surrounding the largest cities in his state, Charlotte and Raleigh, North Carolina, had vaccination rates significantly lower than those of their urban cores.
Not only that, these suburbs were worse than even the rural counties scattered across the state. The counties surrounding Minneapolis, Birmingham, Alabama, Seattle, Denver and Portland, Oregon, all repeated this pattern, with the suburbs following both the urban and rural counties of their states, according to the CDC’s analysis.
Pockets of lower vaccination rates are a problem for people everywhere, experts say. If COVID-19 breaks out in an unvaccinated rural or suburban area, these outbreaks are likely to spill over into neighboring cities, according to Keith Mueller, director of the Rural Policy Research Institute at the University of Iowa.
“If we’ve learned anything from the 18 months of this pandemic, we’ve learned that it can spread from any place to any place. We are a far too mobile society,” Mueller said.
As COVID-19 restrictions relax and the summer travel season heats up, more Americans are likely to venture into national parks and other outdoor destinations in rural areas.
“You stop to fill up on gas, and all of a sudden it’s your contact,” Holmes says. “It is ineffective to look at our borders, whether national, state or departmental, and say it’s over there. It’s not coming here.”
Socio-economically vulnerable countries are more in difficulty
A second CDC report in early June sheds light on demographic and social factors linked to declining vaccination rates in all counties, whether rural or urban.
The CDC ranks more than 3,000 counties nationwide using a Social Vulnerability Index that measures 15 factors such as poverty, poor public transportation and overcrowded housing that weakens a community’s capacity. to respond to disasters.
The researchers divided the counties into four categories – large urban, suburban, small to medium urban, and rural – and looked for which demographic profiles were linked to lower vaccination rates. Across all of these categories, households with children, people with disabilities, and lone-parent households were more likely to experience lower immunization rates. And researchers say these gaps are especially pronounced in suburban and rural counties.
Counties with higher numbers of mobile home residents, as well as those with higher poverty and lower education rates, also lagged behind other counties in their rural-urban category, according to the report. of the CDC.
“Rural communities often have a higher proportion of residents over the age of 65, without health insurance, living with underlying medical conditions or disabilities, and with limited access to health care facilities with caring capacities. intensive, which can make them more likely to get sick. or die from COVID-19, ”says Vaughn Barry, CDC epidemiologist and one of the report’s lead authors.
Fighting against hesitation should be “hyperlocal”
CDC reports present vaccine reluctance as the main obstacle to reaching rural areas and call on public health leaders to do more to overcome it. According to a Kaiser Family Foundation poll released in April, one in five rural Americans said they “definitely” would not get vaccinated. He found the most resistance among Republicans, white evangelical Christians, essential workers in fields other than health care, and adults under the age of 50.
The strategies for overcoming this reluctance will be different for hundreds of rural counties across the country, says Marcella Nunez-Smith, White House President for COVID-19 Health Equity, but they will likely share a critical aspect.
“Partnering with trusted local community leaders is a must,” Nunez-Smith said at a press conference in May. “Equity work is always hyperlocal. Communities are the experts on what they need.”
Medics in the Navajo Nation, once among the hardest-hit areas in the country, say constant communication with their tribal members about the fight against the COVID-19 ‘monster’ has helped this remote region reach some of the Highest vaccination rates in New Mexico and Arizona.
Like most Native American tribes, the Navajo Nation has dozens of paid community health representatives who work with the Indian Health Service to reach rural areas and forge relationships.
“They know their area extremely well. They all speak the language,” said Dr. Loretta Christensen, Acting Chief Medical Officer of the Indian Health Service and member of the Navajo Nation. “They can take this one-on-one with people who can be hesitant, and sometimes it’s because they’re afraid to leave their house, by the way, but we went to the houses and did these vaccinations. “
Friends and family can be among the most influential in convincing a hesitant person, adds Dr. Chris Percy of Northern Navajo Medical Center in Shiprock, NM.
Patients frequently tell him what convinced them to show up to recent vaccination events: “They’ll just say voluntarily that ‘My mom and sisters have been … on my case to get in here,'” says Percy.
Christensen and Percy say they can’t beat anyone over their heads with data or force reluctant patients to take the vaccine, but what they can do is appear welcoming and lower all barriers.
“Our systems that we have in place on Navajo don’t have a pre-registration component or, you know, you have to do these five things before you can get an appointment,” says Percy. “If you have to come in on Tuesday, just introduce yourself. … When you’ve made your decision and you’re ready, we’ll be there. “
Barry’s report echoes Percy, suggesting walk-in clinics with flexible hours in the evenings and weekends to accommodate work schedules and reach people in socially vulnerable communities. CDC researchers also suggest that organizing immunization clinics near daycare centers and partnering with schools could improve the lower rates they’ve seen among lone-parent households in suburban and rural counties.