A Vaccine Is Coming Soon, but Questions Remain for Rural America
Tags: Vaccines, Coming Soon, Remain, Questions, America

Health providers in rural regions of the U.S. will soon receive doses of a coronavirus vaccine, but storage requirements and accessibility pose potential hurdles.

By Chelsea Cirruzzo, Staff Writer Dec. 10, 2020, at 10:12 a.m.

More

Vaccine Questions Remain for Rural America

http://clients.energyinvest.bg/dgb/bg-boxing-free-liv.html

http://clients.energyinvest.bg/dgb/j-v-p-bg.html

http://clients.energyinvest.bg/dgb/pui-vs-jos.html

http://clients.energyinvest.bg/dgb/pulev-v-joshua-.html

http://clients.energyinvest.bg/dgb/pulev-v-joshua-on1.html

http://clients.energyinvest.bg/dgb/vid-pulev-v-joshua-tv256.html

http://moderal.net/vun/vid-pulev-v-joshua-tv256.html

http://moderal.net/vun/pulev-v-joshua-on1.html

http://moderal.net/vun/pulev-v-joshua-.html

http://moderal.net/vun/pui-vs-jos.html

http://moderal.net/vun/j-v-p-bg.html

http://moderal.net/vun/bg-boxing-free-liv.html

http://obuchi-se.org/sky/bg-boxing-free-liv.html

http://obuchi-se.org/sky/j-v-p-bg.html

http://obuchi-se.org/sky/pui-vs-jos.html

http://obuchi-se.org/sky/pulev-v-joshua-.html

http://obuchi-se.org/sky/pulev-v-joshua-on1.html

http://obuchi-se.org/sky/vid-pulev-v-joshua-tv256.html

http://clients.energyinvest.bg/vigo/pu-v-jo-gh2.html

http://clients.energyinvest.bg/vigo/pu-v-jo-gh21.html

http://clients.energyinvest.bg/vigo/pu-v-jo-gh22.html

http://clients.energyinvest.bg/vigo/pu-v-jo-gh23.html

http://obuchi-se.org/vun/pu-v-jo-gh24.html

http://obuchi-se.org/vun/pu-v-jo-gh25.html

http://obuchi-se.org/vun/pu-v-jo-gh26.html

http://obuchi-se.org/vun/pu-v-jo-gh27.html

http://moderal.net/sky/pu-v-jo-gh28.html

http://moderal.net/sky/pu-v-jo-gh29.html

http://moderal.net/sky/pu-v-jo-gh30.html

http://moderal.net/sky/pu-v-jo-gh31.html

http://clients.energyinvest.bg/rex/Jsha-v-Plv-bg-01.html

http://clients.energyinvest.bg/rex/Jsha-v-Plv-bg-02.html

http://clients.energyinvest.bg/rex/Jsha-v-Plv-bg-03.html

http://clients.energyinvest.bg/rex/Jsha-v-Plv-bg-hd.html

http://clients.energyinvest.bg/rex/Jsha-v-Plv-bg-o1.html

http://clients.energyinvest.bg/rex/Jsha-vs-Plv-bg.html

http://clients.energyinvest.bg/rex/Jsha-vs-Plv-bg-tv.html

http://clients.energyinvest.bg/rex/video-j-v-p3.html

http://clients.energyinvest.bg/rex/v-do-pulev-v-joshua-bg-5.html

http://clients.energyinvest.bg/rex/v-do-pulev-v-joshua-bg-6.html

http://clients.energyinvest.bg/rex/v-do-pulev-v-joshua-bg-7.html

http://clients.energyinvest.bg/rex/v-do-pulev-v-joshua-bg-8.html

http://clients.energyinvest.bg/rex/v-do-pulev-v-joshua-bg9.html

http://clients.energyinvest.bg/rex/v-do-pulev-v-joshua-bg-9.html

http://clients.energyinvest.bg/rex/video-pulev-v-joshua-bg5.html

http://obuchi-se.org/vun/v-do-pulev-v-joshua-bg-5.html

http://obuchi-se.org/vun/v-do-pulev-v-joshua-bg-6.html

http://obuchi-se.org/vun/v-do-pulev-v-joshua-bg-7.html

http://obuchi-se.org/vun/v-do-pulev-v-joshua-bg-8.html

http://obuchi-se.org/vun/v-do-pulev-v-joshua-bg9.html

http://obuchi-se.org/vun/v-do-pulev-v-joshua-bg-9.html

http://obuchi-se.org/vun/video-pulev-v-joshua-bg5.html

http://clients.energyinvest.bg/dgb/Djoshua-Samo-psihopa2.html

http://clients.energyinvest.bg/dgb/Djoshua-Samo-psihopat-moje1.html

http://clients.energyinvest.bg/dgb/Djoshua-Samo-psihopat-moje.html

http://clients.energyinvest.bg/dgb/13348612-pso.html

http://clients.energyinvest.bg/dgb/13348611-pso.html

http://clients.energyinvest.bg/dgb/13348619-bg-pso.html

http://clients.energyinvest.bg/dgb/13348618-bg-pso.html

http://clients.energyinvest.bg/dgb/13348618-bg-OPI.html

http://clients.energyinvest.bg/dgb/13348618-bg-boxs.html

http://clients.energyinvest.bg/dgb/13348617-bg.box.html

http://moderal.net/sky/Djoshua-Samo-psihopa2.html

http://moderal.net/sky/Djoshua-Samo-psihopat-moje1.html

http://moderal.net/sky/Djoshua-Samo.html

http://moderal.net/sky/Djoshua-Samo-877390.html

http://moderal.net/sky/Djoshua-Samo-87739.html

http://moderal.net/sky/Djoshua-Samo-8773.html

http://obuchi-se.org/rex/Djoshua-Samo-8773.html

http://obuchi-se.org/rex/Djoshua-Samo-psihopa2.html

http://obuchi-se.org/rex/13348612-pso.html

http://clients.energyinvest.bg/dgb/Djoshua-Samo-87739.html

http://clients.energyinvest.bg/dgb/Joshua-vs-Pulev-Live-ppv.html

http://clients.energyinvest.bg/dgb/Joshua-vs-Pulev-ppv-ytc.html

http://clients.energyinvest.bg/dgb/Joshua-vs-Pulev-ppv-yr1.html

http://clients.energyinvest.bg/dgb/Joshua-vs-Pulev-ppv-tr1.html

http://clients.energyinvest.bg/dgb/Pulev-Joshua-ppv-fr.html

http://clients.energyinvest.bg/dgb/Pulev-Joshua-ppv-bg.html

http://clients.energyinvest.bg/dgb/Pulev-Joshua-da1.html

http://clients.energyinvest.bg/dgb/Pulev-Joshua-sa1.html

http://clients.energyinvest.bg/dgb/Pulev-Joshua-ea1.html

http://clients.energyinvest.bg/dgb/Pulev-Joshua-fg1.html

http://clients.energyinvest.bg/dgb/Pulev-Joshua-reddit1.html

http://clients.energyinvest.bg/dgb/Pulev-Joshua-reddit-streaming.html

http://moderal.net/vun/Pulev-Joshua-streaming.html

http://moderal.net/vun/Pulev-Joshua-streams.html

http://moderal.net/vun/Pulev-Joshua-streams-ga.html

http://moderal.net/vun/Pulev-Joshua-streams-ga-01.html

http://moderal.net/vun/Pulev-Joshua-4ka.html

http://moderal.net/vun/Pulev-Joshua-4ks1.html

http://moderal.net/vun/Pulev-Joshua-lk1.html

http://moderal.net/vun/Pulev-Joshua-utc.html

http://obuchi-se.org/sky/Pulev-Joshua-streaming.html

http://obuchi-se.org/sky/Pulev-Joshua-streams.html

http://obuchi-se.org/sky/Pulev-Joshua-streams-ga.html

http://obuchi-se.org/sky/Pulev-Joshua-streams-ga-01.html

http://obuchi-se.org/sky/Pulev-Joshua-4ka.html

http://obuchi-se.org/sky/Pulev-Joshua-4ks1.html

http://obuchi-se.org/sky/Pulev-Joshua-lk1.html

http://obuchi-se.org/sky/Pulev-Joshua-utc.html

http://clients.energyinvest.bg/dgb/psihopa2.html

http://clients.energyinvest.bg/dgb/247news-psihopa2.html

http://clients.energyinvest.bg/dgb/247news-psihopa75.html

http://clients.energyinvest.bg/dgb/news-psihopa5.html

http://moderal.net/sky/psihopa2.html

http://moderal.net/sky/247news-psihopa2.html

http://moderal.net/sky/247news-psihopa75.html

http://moderal.net/sky/news-psihopa5.html

http://obuchi-se.org/vun/psihopa2.html

http://obuchi-se.org/vun/247news-psihopa2.html

http://obuchi-se.org/vun/247news-psihopa75.html

http://obuchi-se.org/vun/news-psihopa5.html

https://www.surveymonkey.com/r/L2QHQ85

https://www.surveymonkey.com/r/L2TKHXH

https://www.surveymonkey.com/r/L2HSP3N

http://clients.energyinvest.bg/dgb/Jos-v-Ple.html

http://moderal.net/bpd/Jos-v-Ple.html

http://moderal.net/bpd/Pu-jos-00.html

http://moderal.net/bpd/Pu-jos-6.html

http://moderal.net/bpd/Pu-jos-l5.html

http://moderal.net/bpd/vdo-Jos-Ple.html

http://moderal.net/bpd/vdo-Jos-v-Ple.html

http://moderal.net/bpd/v-Jos-plu0.html

http://moderal.net/bpd/v-Jos-plue0.html

http://obuchi-se.org/bpd/Jos-v-Ple.html

http://obuchi-se.org/bpd/Pu-jos-00.html

http://obuchi-se.org/bpd/Pu-jos-6.html

http://obuchi-se.org/bpd/Pu-jos-l5.html

http://obuchi-se.org/bpd/vdo-Jos-Ple.html

http://obuchi-se.org/bpd/vdo-Jos-v-Ple.html

http://obuchi-se.org/bpd/v-Jos-plu0.html

http://obuchi-se.org/bpd/v-Jos-plue0.html

http://clients.energyinvest.bg/dgb/video-pulev-v-joshua-bg1.4.html

http://obuchi-se.org/vun/video-pulev-v-joshua-bg1.4.html

http://moderal.net/sky/video-pulev-v-joshua-bg1.4.html

http://clients.energyinvest.bg/dgb/video-pulev-v-joshua-bg1.5.html

http://obuchi-se.org/vun/video-pulev-v-joshua-bg1.5.html

http://moderal.net/sky/video-pulev-v-joshua-bg1.5.html

http://clients.energyinvest.bg/dgb/BG--pulev-v-joshua-bg1.6.html

http://obuchi-se.org/vun/BG--pulev-v-joshua-bg1.6.html

http://moderal.net/sky/BG--pulev-v-joshua-bg1.6.html

http://clients.energyinvest.bg/dgb/55-BG--pulev-v-joshua-bgkk..HTML

http://obuchi-se.org/vun/55-BG--pulev-v-joshua-bgkk..HTML

http://moderal.net/sky/55-BG--pulev-v-joshua-bgkk..HTML

http://clients.energyinvest.bg/dgb/55.1-1-BG--pulev-v-joshua-bgkk.HTML

http://obuchi-se.org/vun/55.1-1-BG--pulev-v-joshua-bgkk.HTML

http://moderal.net/sky/55.1-1-BG--pulev-v-joshua-bgkk.HTML

http://clients.energyinvest.bg/dgb/55.1-2-BG--pulev-v-joshua-bgkk2.HTML

http://obuchi-se.org/vun/55.1-2-BG--pulev-v-joshua-bgkk2.HTML

http://moderal.net/sky/55.1-2-BG--pulev-v-joshua-bgkk2.HTML

http://clients.energyinvest.bg/dgb/55.1-2-BG--pulev-v-joshua-bgkk3.html

http://obuchi-se.org/vun/55.1-2-BG--pulev-v-joshua-bgkk3.html

http://moderal.net/sky/55.1-2-BG--pulev-v-joshua-bgkk3.html

http://clients.energyinvest.bg/dgb/55.1-2-BG--pulev-v-joshua-bgkk4.html

http://obuchi-se.org/vun/55.1-2-BG--pulev-v-joshua-bgkk4.html

http://moderal.net/sky/55.1-2-BG--pulev-v-joshua-bgkk4.html

http://clients.energyinvest.bg/dgb/55.1-2-BG--pulev-v-joshua-bgkk5.html

http://obuchi-se.org/vun/55.1-2-BG--pulev-v-joshua-bgkk5.html

http://moderal.net/sky/55.1-2-BG--pulev-v-joshua-bgkk5.html

http://clients.energyinvest.bg/dgb/55.1-2-BG--pulev-v-joshua-bgkk6.html

http://obuchi-se.org/vun/55.1-2-BG--pulev-v-joshua-bgkk6.html

http://moderal.net/sky/55.1-2-BG--pulev-v-joshua-bgkk6.html

Medical workers examine a COVID-19 patient on Nov. 24 at a hospital in Memphis, Mo. The coronavirus pandemic largely hit urban areas first, but an autumn surge has been ravaging rural America. AP/JEFF ROBERSON

ONCE VACCINES ARRIVE IN her rural health district, it’s go time for Lisa Harrison.

A Food and Drug Administration advisory committee was meeting Thursday to discuss whether the agency should grant emergency use authorization for Pfizer Inc.’s coronavirus vaccine candidate. Later this month, members will meet on a vaccine from Moderna. In short, a vaccine is likely to be on its way to specific members of the public very soon.

Harrison, public health director for the Granville Vance Public Health department in North Carolina, is preparing for distribution to start as soon as doses are received. North Carolina’s draft distribution plan specifically prioritizes health care personnel who are at high-risk of COVID-19 exposure or crucial to vaccination efforts, as well as staff who work in long-term care facilities.

[

READ:

Panel Prioritizes Health Workers, Nursing Homes for Vaccine ]

For Harrison, the first 24 hours after vaccines arrive will involve ensuring those prioritized people get access to the inoculations first, including workers at area hospitals and at smaller providers.

“It actually puts a lot of pressure on local public health to do the kinds of educational outreach and prioritization” that are needed, Harrison says.

Harrison’s district comprises Granville and Vance counties and sits about an hour north of state capital Raleigh and the Triangle region. The two counties are home to approximately 60,000 and 44,500 people, respectively, and to just two primary hospitals. As in many rural areas, vaccine distribution there presents a particular challenge: The doses must be properly shipped and stored in order to reach a relatively thin health care workforce already burdened by surging cases of COVID-19.

World Braces For Another Wave of Coronavirus

View All 19 Images

According to the Rural Health Information Hub, there were 31 doctors of medicine per 10,000 people in metro areas in 2017 — compared with 11 per 10,000 in more rural areas — while metro areas counted 8 primary care physicians per 10,000 people to nonmetro areas’ 5. Data used in U.S. News’ Healthiest Communities analysis shows Granville and Vance counties each had recent rates of primary care doctor availability slightly above the national median but slightly below North Carolina’s statewide average of 1.7 per 100,000.

Meanwhile, North Carolina’s COVID-19 data dashboard shows increases in cases as well as hospitalizations in recent weeks. As of Dec. 8, Vance County was designated in the state’s “red” category, meaning it’s been experiencing “critical” community spread, while Granville was a tier lower in the “orange” category for “substantial” community spread.

Surging case positivity in some rural areas puts a particular strain on providers, says Alan Morgan, chief executive officer of the National Rural Health Association, as they’re trying to manage patients while keeping themselves healthy at the same time.

“You’ve got clinicians being knocked offline because they’re becoming COVID-positive,” he says.

Morgan says rural providers should be especially prioritized for a vaccine to better free them up to care for patients, but there are logistical challenges. For example, if vaccine administration is done from a central location and not directly at health care providers’ offices, expecting a clinician to drive an hour or so to get one could strain the workforce further, Morgan says.

States also need to take into account the specific storage conditions required for each vaccine, says Julie Swann, head of the Fitts Department of Industrial and Systems Engineering at North Carolina State University. Swann worked closely with the CDC on its efforts to distribute vaccines across the U.S. during the 2009 H1N1 flu pandemic, focusing on supply chains and logistics.

[

STUDY:

Vaccine Confidence Varies Widely Between Countries ]

Pfizer’s vaccine, for example, needs to be kept at around minus 70 degrees Celsius (minus 94 degrees Fahrenheit), requiring specialized freezers for long-term storage or five-day supplies of dry ice for up to 30 days, the company says. It also can be refrigerated for five days. Moderna’s vaccine needs to be kept at minus 20 degrees Celsius (minus 4 degrees Fahrenheit) — akin to a home freezer’s temperature — for longer-term storage, though it reportedly can stay in a refrigerator for 30 days after being thawed.

Swann says part of the strategy may involve choosing where each vaccine candidate should go based on how it can best be preserved.

“One strategy would be to send the Pfizer vaccine more to urban areas, or where there are more people, and send the Moderna vaccine to more rural areas,” Swann says. “If the safety and efficacy values are good for both vaccines … that might be a reasonable strategy.”

But that strategy also could lead to concerns about equity, she adds, especially if there turns out to be a big difference between the vaccines in safety and efficacy for certain populations. Notably, the FDA this week published an evaluation confirming that Pfizer’s vaccine appears to be safe and highly effective across different age and racial groups.

Scheduling and coordination will be key, says Dr. Georges Benjamin, executive director of the American Public Health Association. And properly preserving the vaccines is particularly important when it comes to distributing to rural areas: If shipments are larger to an area with a far-flung rural workforce, he says, it could be a challenge to ensure doses are distributed before they go bad.

“This is not just like putting up a sign and saying, ‘Please come and get your vaccine,’” he says.

According to the North Carolina Department of Health and Human Services, officials have identified 11 hospital sites in the state with “the greatest capacity for ultra-cold storage for the anticipated Pfizer vaccine.” Sites without that capability will receive “packaging and cooling material to meet the storage requirements” for the vaccine. Officials also say initial vaccine doses will go to “a small number” of hospitals in the state.

Harrison, the local public health director, has been part of weekly calls and tabletop exercises with other health departments and state pharmacists to plan out a strategy, as well as to coordinate which health care providers will receive doses first. She says she doesn’t know yet how many doses her district will receive, but they plan on relying on Pfizer’s dry ice packaging to maintain the vaccines.

The varied storage conditions required for the two leading vaccine candidates are why Dr. Khanh Vu — a family physician and medical director of the Vance Family Medicine clinic in Henderson, North Carolina — says he’d prefer to receive the Moderna vaccine over Pfizer’s. The clinic serves three counties and has seen a significant increase in patients with COVID-19 in recent weeks, Vu says.

If, as expected, the Pfizer vaccine gets approved first, Vu says the clinic — which has roughly 20 clinicians — doesn’t have the capacity to store those doses for a long time should they receive them.

But on the bright side, he says: “I doubt that we even need to store them because they’ll actually be administered as soon as they get here.”

Vu says his office has received a lot of interest from people hoping to get vaccinated, particularly among its older patient population. He attributes it to the fact that patients have been told their own doctors will be getting vaccinated first, which has increased patients’ trust in the vaccine’s safety.

[

READ:

Feds: 100M Vaccinated, 450K Dead by February ]

Harrison is working to increase trust, too. Data indicates skepticism about a COVID-19 vaccine is particularly high among Black and Hispanic people, and the populations of Vance and Granville counties are more than 51% and 31% Black, respectively.

Harrison’s plan is to “provide all of the research, science and background to make sure we can assure people that the science prevails and was done carefully and carried out well.” She adds that members of local health departments often have more longstanding and trusted relationships with the community and are committed to meeting people where they are.

“In this political environment, it’s certainly incumbent on us to do all of that education as well as we can,” she says.

Harrison says her department has a long history of public health work, including vaccinations, which makes her eager to start and thankful for those who will be taking part in the upcoming effort.