Rural Areas Face Challenges In COVID Vaccine Rollout

Feb 9, 2021

Across the Midwest, the rollout of COVID vaccines has been spotty. Lots of people are having a trouble with online signups. And vaccine demand far exceeds supply. That’s made the process challenging, especially in rural areas. 

For years, the Girls State Training School in central Iowa has sat mostly empty. But on this day, the main building is buzzing as a local vaccination clinic opens.

Rooms labeled for social workers, psychologists and others who once helped delinquent girls are filled with health care workers and elderly residents from the rural area.

"It's zooming today. We've noticed that despite our best efforts to say come at your scheduled time, people are coming 10, 15 minutes early," says Shannon Zoffka, executive director of the Tama County Public Health Department.

Zoffka says the clinic scheduled 110 people for their first doses. They were selected from a waiting list her department started last month.

But aside from the excitement in the air, Zoffka says her small staff is stressed. They have to maintain the waiting list while making appointments to dispense a limited number of doses.

Tama County Health Department Executive Director Shannon Zoffka says her department started a COVID-19 vaccine waiting list in late January.
Credit Natalie Krebs / Side Effects Public Media

"And there's just a lot of unknowns too, with how many doses are we getting? How many people can we actually vaccinate?" she says.

Zoffka isn’t the only rural health official feeling overwhelmed.

Chris Estle runs the department in Jefferson County. When word got out they were scheduling appointments, 180 slots were filled in about three hours. 

"We never could get all the voicemails called back because we could hold 100 voicemails, we couldn't even get through all the voicemails," she says.

Estle says about a quarter of county residents are 65 or older. Like many rural counties, that’s higher than the statewide average.

But her department isn't keeping a waiting list. She says it’s too complicated with rapidly changing information coming in. 

Estle says they’re scheduling first-come, first-served appointments as doses come in. Still, high demand has pushed some to call or contact her through her personal Facebook account.

"Nope, not gonna — not even starting that. Not, not even going to go down that road," she says. "So you have to set professional boundaries. And that's very, very difficult in a small rural community."

Tinglong Dai, a professor of operations management at Johns Hopkins University, says rural areas have additional obstacles. 

For example, most just don’t have the ultra-cold storage needed for the Pfizer vaccine, which accounts for just under half the doses administered in Iowa so far.

"I think we need to really think carefully about equity," Dai says. "So equity does not just mean the quantity of vaccines allocated to each area, it also means what kind of vaccines people are getting."

To address supply problems, Dai says Iowa should follow the lead from another rural state: West Virginia. It registers qualified residents at the state level and gives them a place in line to avoid overwhelming small local departments. Gov. Kim Reynolds says Iowa is working on it.

"I don't think people really want to get vaccines, like, the next day, the next hour. People just want to get that kind of assurance," Dai says.

That assurance is what Linda Robbins wants. She’s 69 and lives in Epworth, a town of about 2,000.

Robbins hasn’t heard anything from her county about how to get vaccinated, but she says several friends in Des Moines have gotten appointments at places like the Hy-Vee grocery store.

Toledo is the county seat of Tama County. The rural county of about 18,000 is one of the few counties in Iowa that does not have a hospital and does not have the ultracold storage needed for the Pfizer vaccine.
Credit Natalie Krebs / Side Effects Public Media

"Tell us something," she says. "You know, just let me know. I mean, I know there's a shortage. And I know I'm probably not going to be first, but just tell us what the plan is."

Back at the Girls State Training School, 67-year-old Debra Behounek is getting her first dose of the Moderna vaccine along with her husband and aunt.

Behounek feels incredibly fortunate to get her family vaccinated this quickly. She just happened to notice a Facebook post from the health department.

"You know, when you watch across the country, everybody, waiting and waiting," she says. "And then it's just — this is a miracle. We got the first day."

Behounek says she would have been happy if her family got vaccinated by June.

This story was produced by Side Effects Public Media, a news collaborative covering public health.