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Experts say supply and logistics are two barriers in administering COVID-19 vaccines in rural areas. Michael Clevenger – Pool/Getty Images
  • Despite an increase in COVID-19 vaccine distribution, officials say there are a number of obstacles to administering vaccinations in rural areas.
  • Among the issues are a lack of supply and cold storage facilities, as well as sites to administer the shots.
  • In addition, many rural residents are hesitant about the vaccine and others need to travel long distances to reach a health center.

The United States is in the midst of a massive vaccination campaign that hasn’t been seen in decades.

More than 1.5 million COVID-19 vaccinations are currently being administered per day.

While the fact that these long-awaited COVID-19 vaccines are now available comes as a relief, there are numerous and significant logistical challenges to overcome before a majority of the country’s 328 million people are immunized.

Dr. Javeed Siddiqui, an infectious disease specialist and chief medical officer at TeleMed2U, outlined some of these challenges.

“In order to effectively deliver vaccine to the United States population, we must have a coordinated effort. This requires coordination among production, transportation, storage, and delivery sites,” he told Healthline.

“To make this issue more complex, maintaining and assuring the cold chain is vital with the currently available vaccines,” he added.

In a country as large, diverse, and spread out as the United States, a one-size-fits-all approach doesn’t work well.

While clinics in a densely populated urban setting might be accessible to millions of people, administering vaccines in the more sparsely populated rural parts of the country is another challenge.

“In the rural setting, there are limited resources to maintain cold chain of the vaccine and for vaccine administration,” said Siddiqui. “In addition, the rural residents may need to travel distances to a centralized vaccine administration site, which may be affected by weather conditions and further complicates care coordination.”

To better understand how different parts of the country are doing with their COVID-19 vaccine rollout, Healthline spoke to experts in three different regions.

Jeff James, chief executive officer of Wilmington Health, is involved in coordinating vaccinations in Wilmington, North Carolina.

He told Healthline that while his practice has received vaccines from the local health department, they still have yet to receive an allocation from the state.

“While our state and local officials have been incredibly responsive to our questions and requests, one of our challenges has included accessing and entering data related to administered vaccines into the statewide COVID-19 Vaccine Management System (CVMS),” said James.

“The CVMS is a cloud-based, secure management system that allows state officials to identify areas that need more vaccine,” he said. “Many counties in the state reported difficulty in using the new system, and it’s worth noting North Carolina continues to improve the CVMS and deploy assistance related to the administrative barriers to using the system.”

James also pointed to vaccine hesitancy and common misconceptions about the efficacy of vaccines as additional challenges to getting shots in arms.

To help educate the public, he pointed to rollupyoursleeves.us, a site that provides information on the various COVID-19 vaccines in a reader-friendly way.

“We have also proactively reached out to partner with community organizations that serve historically marginalized populations to ensure every eligible patient has access to the vaccine,” he said.

Wilmington Health is only authorized to administer vaccines in New Hanover County, one of the more densely populated areas in the state. Vaccines will be accessible for those within the county, but it’s likely to be more difficult for those in rural areas.

“If individuals who live far away from a vaccine site do not have transportation, that is a significant barrier,” said James. “Inside our county, public transportation is provided free of charge for anyone going to a vaccine appointment.”

Dr. Patrick Goggin, the medical director of Trusted Senior Care Advantage, operates out of Cambridge, Ohio, a small city in the Appalachian foothills.

He told Healthline that his practice, Medical Associates of Cambridge, has been authorized to administer vaccines. However, to date he has yet to receive a single dose.

Goggin also pointed out that the local hospital and health department are administering vaccines but haven’t received enough to meet demand.

“The issue of travel to a centralized site such as a hospital or health department for those living in our rural counties in southeast Ohio present an added challenge to widespread vaccination,” he told Healthline.

“The recent severe winter weather has also compounded this,” he added. “But our people are used to the drive and don’t typically get skittish about snow and ice, so I think the real challenge has been supply of the vaccine. Has more vaccine gone to urban communities than ours? I don’t know the answer to that.”

Erin Fabian, PharmD, a pharmacotherapy specialist and senior content management consultant at Wolters Kluwer Health, has been administering vaccines since last December.

She’s located in North Madison, Ohio, not far from Cleveland.

Fabian told Healthline that the vaccine rollout has been an all-hands-on-deck approach, and that finding appropriate sites for administering doses has been a challenge.

She also spoke about the challenges of vaccinating in urban versus rural areas.

“Vaccinators as well as vaccination sites are more readily available in more populated areas. Quickly increasing the number of people eligible to vaccinate others and utilizing them at vaccine clinics is critical for rural areas,” Fabian said.

“Efforts to improve this in Ohio have included expanding eligibility to include pharmacy technicians and EMS certificate holders,” she added. “In Ohio, we have just begun to see local pharmacies opening their doors to schedule vaccine appointments.”

“Having both pharmacy technicians and pharmacists administering vaccine at multiple locations through a community improves accessibility,” she said.

One of the more intriguing case studies when it comes to COVID-19 in the United States is the Navajo Nation.

The largest Native American reservation in the country, the Navajo Nation comprises more than 27,000 square miles across Arizona, Utah, and New Mexico.

At one time, the Navajo Nation had the highest COVID-19 case rate in the United States, but a series of aggressive measures to curb the spread of the virus has helped to bring numbers down.

Last September, Dr. Anthony Fauci, the nation’s leading infectious disease specialist, praised the Navajo Nation for its containment efforts.

Since the pandemic began, there have been nearly 30,000 confirmed COVID-19 cases and more than 1,000 COVID-related deaths in the nation.

With the transmission of the virus slowing down in recent months, efforts have shifted to administering vaccines to the 175,000 members of the sparsely populated nation.

Harley Jones, the domestic COVID-19 response lead of international health and humanitarian NGO Project HOPE, has helped coordinate the response to COVID-19 in various states by supporting frontline workers and providing additional staff to handle the surge of COVID-19 patients in hospitals and clinics.

His organization has been helping with pandemic mitigation and vaccination efforts in the Navajo Nation since last summer.

“Regardless of where you’re at, communication and access are key, and these are a little bit different in rural areas versus urban areas,” said Jones. “You want to make it as simple for people as you can, but then you also need to know and understand the limitations that people are going to have.”

“For instance, in the Navajo Nation, internet access is not something that’s proliferated across the reservation, and so oftentimes, electronic methodologies of engaging people aren’t always the best outlet in a rural area like that,” he said.

To that end, reaching the people of the Navajo Nation isn’t as simple as telling them to go to a website and make an appointment.

“In that kind of rural area, they brought the vaccine to the natural gathering places for the Navajo Nation,” Jones said. “Their communities meet, network, and have fellowship at what’s called a chapter house.”

“In different parts around the reservation those are natural gathering spots, so they’ve done a really great job of setting up their mobile clinics at the places that are already trusted locations,” he added.

Now that vaccination efforts are in full swing, Jones is hopeful that the rollout will continue to gather momentum.

“Probably a third to half of the staff I’m sending to the Navajo Nation right now would have been at COVID-19 testing clinics 3 months ago. Now they’re starting to give out vaccines,” he said. “I think that’s going to be the story of the next few months: Getting the vaccine out to as many people as possible, and providing support to clinics and healthcare systems that are focused on vulnerable populations.”