{"id":95869,"date":"2021-04-13T14:37:39","date_gmt":"2021-04-13T19:37:39","guid":{"rendered":"https:\/\/news.medill.northwestern.edu\/chicago\/?p=95869"},"modified":"2021-04-14T10:19:32","modified_gmt":"2021-04-14T15:19:32","slug":"vaccine-allocation-detours-many-of-americas-small-towns","status":"publish","type":"post","link":"https:\/\/news.medill.northwestern.edu\/chicago\/vaccine-allocation-detours-many-of-americas-small-towns\/","title":{"rendered":"Vaccine allocation detours many of America\u2019s small towns"},"content":{"rendered":"

By Natalie Eilbert<\/strong>
\nMedill Reports<\/em><\/p>\n

From above, the roads in Walnut, Kansas, intersect into the green and gray geometry typical of so many rural towns in Middle America. Main Street, the major town artery, offers a bar, a bank, the fire department and a post office.<\/p>\n

In January, the Crawford County Health Department announced on its Facebook page that a mobile COVID-19 testing unit would be parked in front of His and Hers Bar to administer testing between 9:30 a.m. and 11:30 a.m. the next day.<\/p>\n

This was the last direct contact the County Health Department has made with Walnut, at least through Facebook \u2014 although a contact phone number exists on the page for health-related inquiries. With a population of just 186 people in Walnut and equally tiny populations in other small towns in the area, the county health department must triage the frequency of where their testing units go. For the people of Walnut and other poor, rural communities, this means that, when it comes to vaccine distribution, residents face more steps and many additional challenges to get vaccinated.<\/p>\n

The sprawling farmlands of America hit several roadblocks in the race to the vaccine. Unprecedented winter storms halted vaccine delivery in even the bigger Midwestern cities such as Chicago and Minneapolis. But climate change-driven weather patterns only paint some of the picture in the story of vaccine distribution. A recent lack of vaccine supply and a dearth of vaccine education for the people living in poor and rural communities, compounded by bitter partisan sentiments, have emphasized the sense of being abandoned by the country at large.<\/p>\n

A lack of coordination<\/strong><\/p>\n

Canese Jarboe, 30, returned to their hometown of Walnut, Kansas, to assist on their parents\u2019 family farm and help with general upkeep in anticipation of their father\u2019s upcoming back surgery. A year into pursuing a Ph.D. in English and creative writing at the University of Wisconsin\u2013Milwaukee, they straddled polar opposite attitudes about the pandemic. In Milwaukee, a rich community spirit buoyed their sense of safety and protection. People, for the most part, wore masks and social distanced. They posted flyers about carpooling to COVID-19 testing centers.<\/p>\n

\u201cThere was more of a community effort to keep people safe,\u201d Jarboe said.<\/p>\n

When they came back to Walnut, wearing a mask became an affront to other residents, even people who had known Jarboe since they were an infant. In Milwaukee, community members would request someone without a mask to don one in public. Such an ask is unthinkable in Walnut.<\/p>\n

\u201cI would not do that out of fear, and I\u2019ve been harassed for wearing a mask,\u201d they said.<\/p>\n

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Jarboe\u2019s father, Kelly, cuts bale netting to feed to his cattle. (Canese Jarboe)<\/figcaption><\/figure>\n

Jarboe attributes the hostility they experience in their town to the consequences of divisive rhetoric surrounding COVID-19 and masks. But more than that is the sheer isolation within which a town such as Walnut exists. For the most part, people in Walnut haven\u2019t stopped working, and there\u2019s been no hazard pay since the start of the pandemic, Jarboe said.<\/p>\n

\u201cA lot of people don\u2019t want the vaccine. They\u2019re not saying they\u2019ll never get it. They just want to wait and see what happens to other people because they distrust it,\u201d Jarboe said. \u201cThe attitude is more like, \u2018I\u2019m not scared of it,\u2019 which is kind of fatalistic in a way and I can understand to some extent. But it\u2019s created a lot of harm.\u201d<\/p>\n

The primary means of public health communication for many residents in Walnut has been the Crawford County Health Department Facebook page, Jarboe said. For most of the year, people have relied on the Facebook page for mobile testing announcements, but vaccine rollouts make fraught an already tense waiting game.<\/p>\n

Their parents are both essential workers and eligible for the vaccine. Jarboe\u2019s mother, Vicki, is a postal worker, and their father, Kelly, delivers dairy as a truck driver in addition to his long hours as a rancher on his own property. But the paradox of vaccinating essential workers has been present since the early days of the pandemic. They have to work and expose themselves on a nearly daily basis, and they don\u2019t have the luxury of time to prioritize their health. And certainly, they don\u2019t have time to scroll Facebook for updates and endless websites for potential vaccine appointments, Jarboe said.<\/p>\n

In their free time between university Zoom classes, Jarboe checks the Facebook page for vaccine updates in the hopes of signing their parents up. Jarboe acknowledged their position is unique: They\u2019re one of the few nonessential workers in town.<\/p>\n

Public health experts have emphasized a need for nuanced coordination efforts in streamlining vaccine allocation. Dr. Rupali Limaye, an associate scientist at the Johns Hopkins Bloomberg School of Public Health, thinks aligning outreach to reflect the community is imperative.<\/p>\n

\u201cThe outreach has to match the target demographic, and if that target demographic is not really online, how do we communicate to people? How do we make sure that people know that, one, they’re eligible for it, that they can have access to it, and that it’s not going to be essentially punitive for them to try to get access to it, i.e. it’s not going to take them four hours to get to a place where they can have it,\u201d Limaye said.<\/p>\n

Even as experts stress creative outreach strategies, those can all fall short if a public health department\u2019s administration officers are in constant flux. That\u2019s been the ongoing situation in Crawford County, where the positions within the Crawford County Health Department have changed in major ways since the pandemic began.<\/p>\n

First, in June 2020, County Health Officer Rebecca Adamson resigned from her post following a coronavirus outbreak at the SugarCreek bacon plant in Frontenac. The county replaced her position with two positions. The Crawford County Health Commission appointed Dr. Timothy Stebbins as the county\u2019s new public health officer and Dr. Linda Bean deputy public health officer. Then, in January, Teddi Van Kam was appointed the new Crawford County Health Department director, which reframed Bean\u2019s role as a consultant to the department and puts an expiration date of June 2021 on Stebbins\u2019 public health officer appointment.<\/p>\n

What comes next? The Crawford County Health Department declined to comment.<\/p>\n

For people like Jarboe, the county\u2019s departmental scramble meant a continued lack of communication. Rumors about weekly dose amounts at the county level started to concern Jarboe, whose only real connection to the health department was through the Crawford County Facebook page. Meanwhile, their father continued to be exposed to COVID-19-positive truck drivers, which ratcheted up their anxieties.<\/p>\n

Just how hard is it to distribute the different vaccines to rural America?<\/p>\n

Dr. Glen Nowak, the director of Center for Health & Risk Communication at the Grady College of Journalism and Mass Communication at University of Georgia, said health departments need better vaccine coordination. While the Johnson & Johnson vaccine doesn\u2019t need frigid temperatures maintained like the Pfizer and Moderna vaccines, that vaccine, only recently approved for emergency use, began shipments only at the end of February.<\/p>\n

\u201cIn a rural area, if you get a cooler of 975 doses, you\u2019re now on the clock to be able to use it. And then each of those vials is on a clock. And so, when you take out a vial, which has 10 doses, and you mix it, you now have six hours to use those 10 doses \u2014 because then, at that point, they expire. So shipping Pfizer vaccine to a rural health care provider who has, say, 45 patients in a long-term care facility and 25 workers \u2014 what do you do with the other 900 doses?\u201d Nowak said.<\/p>\n

While the Pfizer vaccine is less stable, the Moderna vaccine, a more forgiving and user-friendly vaccine, has delivered fewer doses in the Midwest as a result of winter storm Uri\u2019s devastating aftermath in February. Unforeseen weather conditions play a critical and frightening role in vaccine allocation efforts, and this affects how the county responds to registering patients.<\/p>\n

Such instability at the county level adds additional chaos to what is already an overburdened time for local health departments across the country. Limaye said the key trait of a successful health department is coordination. In rural areas, communication and coordination among several communities and even whole counties becomes essential.<\/p>\n

\u201cCoordination, coordination, coordination. States needs to determine this, and they need to make sure that they’re communicating with every other actor within their state that could be administering the vaccine, to ensure that we have as smooth of a rollout as possible. I mean, that’s really going to be critical. And it’s going to be hard because most public health departments I know at the state level are really already overwhelmed,\u201d Limaye said.<\/p>\n

\u201cA different kind of rural\u201d<\/strong><\/p>\n

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Vicki Jarboe cuts bale twine to prepare hay feed for the family\u2019s cattle. (Canese Jarboe)<\/figcaption><\/figure>\n

Public health experts have been wringing their hands over how to gain the trust of various communities. Dr. Lawrence Gostin, a professor of global health law and faculty director of the O\u2019Neill Institute for National & Global Law at Georgetown University, said he thinks that creating community trust requires information campaigns designed from the bottom up.<\/p>\n

\u201cScientists are often remote and detached from the lived experiences of many people of color and the poor. These communities often look to local civic and religious leaders for information,\u201d Gostin said in an email.<\/p>\n

Establishing trust in poor, rural, and Black, Indigenous and other communities of color can be exceedingly challenging when towns feel abandoned even by neighboring cities. Dr. Harald Schmidt, assistant professor of Medical Ethics and Health Policy at University of Pennsylvania\u2019s Perelman School of Medicine, said the metrics for establishing trust are not one-size-fits-all. \u201cNon-traditional models\u201d such as a mobile testing unit in front of one town\u2019s barbershop will be less relevant for the next town over, he said.<\/p>\n

For Walnut residents, even community leaders from nearby Pittsburg, home to 19,918 according to the 2020 U.S. census, are considered elite and untrustworthy by many. Much of this outsider mentality can be ascribed to Pittsburg\u2019s industries, which tend to lack manual labor. Crawford County, Kansas, made up of 12 towns, has a population of 38,818, with Pittsburg representing the most populated city. Walnut, with a population of 186, makes up about 0.5% of the overall population.<\/p>\n

From the vantage point of Walnut residents, Pittsburg is the hotshot city of Crawford County, teeming with elite infrastructure and resources such as a city government, multiple public safety departments and community services. Advice from outsiders in the big town \u2014 even if they were born and raised within Crawford County \u2014 can feel insulting in Walnut.<\/p>\n

\u201cIt sounds silly, but [some] people here see someone from a town of, say, 30,000 as a city slicker who doesn\u2019t understand what it’s like to be working and living here. You know, someone who doesn’t have to risk their lives every day working. People here work dangerous jobs,\u201d Jarboe said. \u201cIt\u2019s just a different kind of rural.\u201d<\/p>\n

According to Data USA, the largest industries in Walnut are construction, transportation and warehousing, and health care and social assistance. But, as a farming area, nearly every household undertakes the physical labor of farm upkeep in addition to full-time jobs. The median household income is $23,542, not quite one-third of the national average.<\/p>\n

The disconnect doesn\u2019t end with recent public health communications, either. Some households aren\u2019t on Pittsburg\u2019s water system, which only adds to the isolation mentality and distrust at the county level. And installing water lines to be on rural water can cost upward of $4,000 per household. Just 15 years ago, Jarboe\u2019s family had to drive to an abandoned fire station with a quarter in hand to fill their water tank, an activity they\u2019ll still do for their cattle in the summer when droughts dry out drinking ponds. And it remains this way for certain families just a mile away. It still costs a quarter.<\/p>\n

\u201cThe county hasn\u2019t made a real effort here anyway to help people out,\u201d Jarboe said. \u201cThere isn\u2019t a safety net.\u201d<\/p>\n

Health at a distance<\/strong><\/p>\n

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Residents like the Jarboes are more willing to drive farther for healthcare. In the past, Canese and their family have driven to cities such as Kansas City, Wichita, Tulsa, Oklahoma, and even Joplin, Missouri, if they needed a hospital. (Canese Jarboe)<\/figcaption><\/figure>\n

Of the resources from which Walnut is out of reach \u2014 Jarboe said it takes 30 miles to get to the nearest Walmart for access to fruits and vegetables \u2014 a decent health care provider can be as far as a two-and-half-hour ambulance ride away.<\/p>\n

Growing up, Jarboe saw a physician\u2019s assistant in a neighboring town only when they needed a physical to play a sport. A more comprehensive doctor\u2019s appointment, which for Jarboe meant a colonoscopy and endoscopy at 15, meant a ride to Kansas City.<\/p>\n

Because Jarboe and their parents prefer not to rely on local hospitals and medical centers, they will travel either to Kansas City, Kansas, or Tulsa, Oklahoma, both of which are over 100 miles away for the major medical facilities there. Determining what constitutes a serious medical need, however, only adds to the sense of anxiety and isolation.<\/p>\n