Rural clinics, pharmacies seek to fill open vaccine slots as hesitancy looms

When St. James Parish Hospital in Louisiana began COVID-19 vaccinations this winter, it routinely would administer 500 daily shots and could not keep pace with the long lines of vaccine seekers. 

But as Louisiana joined a cascading number of states to waive age restrictions and allow all adults to get vaccinated, hospital leaders are finding more appointments going unfilled. The hospital that serves a Mississippi River community of about 22,000 no longer hosts the large vaccination events, instead directing about 200 doses each week through smaller clinics and targeting hard-to-reach populations.

It's a fast-changing scenario hospital leaders did not imagine would happen so quickly. 

"We always felt the vaccine was like gold and it was precious," said MaryEllen Pratt, CEO, St. James Parish Hospital, Louisiana. Now, “we’re having more trouble filling our schedules ... more people can get it but we’re finding less people interested in getting it.”

These volunteers are scouring the internet to book vaccine appointments for people across the country.
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St. James Parish is among a growing number of U.S. communities with more vaccine slots than people willing to take them. The number of counties with unfilled vaccine appointments at chain retailers Walmart, CVS and Rite Aid grew about 60% in a week – from 530 last week to 847 this week, according to an analysis by GoodRx.

The surplus appointments represent a new challenge as President Joe Biden pushes to make every American adult eligible for a vaccine shot by April 19.  With more than 174 million shots administered nationwide and more than 25% of adults fully vaccinated as of Friday, public health experts warn of hard work ahead to immunize enough Americans to slow the spread of COVID-19.

The unused vaccine slots are especially evident across a wide swath of the South, a possible sign regional demand is slowing as clinics targeting health care workers and seniors now court younger adults and other harder-to-reach populations.

In Louisiana, 48 out of 64 parishes – the equivalent of counties – had available vaccine appointments at the three chain retailers as of Monday, according to GoodRx.  Even non-pharmacy clinics say with three Food and Drug Administration authorized vaccines flowing to communities, the public does not seem as desperate to get immunized.

At Baton Rouge Clinic, a large vaccine site in Louisiana's capitol city, “urgency seems to have subsided,” said CEO Edgar Silvey.

The primary-care practice has had more vaccine appointment no-shows in recent weeks, but Silvey said the clinic fills openings by offering doses to patients there for non-vaccine appointments.

Rural sites with fewer patients have fewer options. St. James Parish Hospital has started to call people in advance to remind them of vaccine appointments. The hospital became more proactive after an appointment no-show resulted in a wasted dose.

Hospital and public health officials are brainstorming ways to convince younger adults to vaccinate. St. James Parish Hospital enlisted the help of ministers and churches to reach out to Black residents, who make up about half the town's population. 

Now, the hospital is attempting to convince younger residents to vaccinate. One possible strategy: Have the hospital's younger doctors explain the importance of vaccination. 

"It wasn’t as hard to sell in the older population, they see themselves as quite vulnerable," Pratt said. "We’re up against more challenges as we try to inoculate a younger population that feels like, 'If I get it, I’m not going to die. I’m just going to get sick.'"

In rural communities such as Bolivar, Tennessee, located about 60 miles east of Memphis, health leaders have worked tirelessly to overcome skepticism.

Bolivar General Hospital CEO Ruby Kirby said the effort started with her nurses and other hospital employees.  Kirby, who is Black, has talked one-on-one with Black staffers who “were really hesitant” about COVID vaccination.  The effort paid off and hospital employees immunization rate surpassed 90%.

But it's a tougher message to communicate in surrounding Hardeman County. Only 15.9% of people in the county of more than 25,000 had been fully vaccinated as of Wednesday, according to the Centers for Disease Control and Prevention. Statewide, more than two-thirds of Tennessee's 95 counties had available appointments at chain pharmacies this week. 

National polls show residents of rural communities are less likely to commit to vaccination. A Kaiser Family Foundation poll found 35% of rural residents said they probably or definitely would not get vaccinated, a higher rate than city or suburban residents.

Vaccine acceptance also is influenced by political beliefs. About 79% of self-identified Democrats said they have been vaccinated or intend to do so soon, compared to 46% of Republicans. About 3 in 10 Republicans say they will definitely not get vaccinated, a KFF poll found. 

Kirby said people who oppose vaccination for political reasons represent “one of the biggest hurdles we’ve had to cross.”

She said the community also eschewed mask wearing as a tool to mitigate spread of coronavirus. But she said opposition to both mask wearing and vaccination melt away when influential community members become infected and speak about their experience.

"It tends to change people's view when they know somebody who had it and had negative outcomes or had difficulty recovering," Kirby said. 

In Mount Pleasant, Texas, Titus Regional Medical Center CEO Terry Scoggin has faced similar challenges. His hospital serves a five-county region about 60 miles from Arkansas and Louisiana. With high-risk employers such as meatpacking plants and a large number of uninsured residents, the industrial and agricultural hub has been hit hard during previous COVID surges.

He said too many people "don’t trust the process of vaccines," whether because of political views or misinformation on social media. "There’s so much out there," Scoggin said. "You can find what you want to believe."

Hospital staffers also have been slow to take the vaccine. Fewer than half of hospital employees had been vaccinated as of last week. Some staffers infected during earlier surges question whether they need the vaccine because of their own body's immunity.  Several female employees worry about how the vaccine might affect pregnancy despite studies that show vaccines are safe and effective for pregnant women and likely protect their babies as well. 

The hospital has provided staff with reliable information about vaccine safety and also offered incentives such as discounted health insurance premiums. 

Scoggin wants his staff protected, but he's also aware of the importance of health care workers setting an example in a community where vaccine hesitancy runs deep.

"When half of your employees won’t get the vaccine, what does that tell those employees’ family members, relatives and friends?" he said. 

Many rural communities are battling vaccine hesitancy, said Alan Morgan, CEO of National Rural Health Association.

"It is an issue nationwide," Morgan said. "What makes it challenging is you’ve got a population that’s at most risk and has limited health care options. When you throw vaccine hesitancy on top of those other barriers, it makes it much more problematic." 

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