When St. James Parish Hospital in Louisiana began COVID-19 vaccinations in the winter, it routinely administered 500 daily shots and could not keep pace with the long lines of vaccine seekers.
After Louisiana joined a cascading number of states to waive age restrictions and allow all adults to get vaccinated, hospital leaders find 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 of St. James Parish Hospital. Now, “we’re having more trouble filling our schedules ... more people can get it, but we’re finding less people interested in getting it.”
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. More than 174 million shots had been administered nationwide and more than 25% of adults were fully vaccinated as of Friday. Public health experts warned of hard work ahead to immunize enough Americans to slow the spread of COVID-19.
The unused vaccine slots are evident across a wide swath of the South, a possible sign regional demand is slowing as clinics targeting health care workers and seniors 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 nonpharmacy clinics said that even though three vaccines authorized by the Food and Drug Administration vaccines are flowing to communities, the public does not seem as desperate to get immunized.
At Baton Rouge Clinic, a large vaccine site in Louisiana's capital city, “urgency seems to have subsided,” CEO Ed Silvey said.
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 nonvaccine appointments.
Rural sites with fewer patients have fewer options. St. James Parish Hospital 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.
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.
Hospital and public health officials brainstorm ways to convince younger adults 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.’”
More than one-third of rural residents say they won’t get vaccinated
In rural communities such as Bolivar, Tennessee, about 60 miles east of Memphis, health leaders work to overcome skepticism.
Bolivar General Hospital CEO Ruby Kirby said the effort started with her nurses and other hospital employees. Kirby, who is Black, talked one-on-one with Black staffers who “were really hesitant” about COVID-19 vaccination. The effort paid off, and hospital employees' immunization rate surpassed 90%.
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 April 7, 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 say they probably or definitely will not get vaccinated, a higher rate than city or suburban residents.
Vaccine acceptance can be influenced by political beliefs. About 79% of self-identified Democrats say they have been vaccinated or intend to do so soon, compared with 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 eschewed mask wearing as a tool to mitigate spread of coronavirus, though opposition to masks and vaccination melted away when influential community members became infected and spoke 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. Including high-risk employers such as meatpacking plants and a large number of uninsured residents, the industrial and agricultural hub was hit hard during COVID-19 surges.
Scoggin said too many people "don’t trust the process of vaccines" 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 surges questioned whether they need the vaccine because of their own body's immunity. Several female employees expressed worry about how vaccine might affect pregnancy despite studies that show vaccines are safe and effective for pregnant women and probably protect their babies as well.
The hospital provided staff with reliable information about vaccine safety and offered incentives such as discounted health insurance premiums.
Scoggin wants his staff protected, and he's 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."
‘Getting that one shot’
The available vaccine appointments in small towns have opened opportunities for city residents willing to drive long distances to get immunized.
Mary Santelman of St. Paul, Minnesota, desperately needed a vaccine, not just to protect herself but also her husband undergoing cancer treatment.
She was shut out of Minnesota’s vaccine lottery and could not secure an appointment after searching pharmacies and clinics throughout the Twin Cities. Based on a tip from a friend, she booked an appointment at Walmart in Wadena, Minnesota – about 150 miles from her home.
“Just getting that one shot brought my stress level way down,” Santelman said.
That feeling did not last long.
She and her husband had to travel to Ohio State University for cutting-edge immunotherapy cancer treatment he could not get closer to home. Santelman tried to reschedule her second Moderna vaccine shot at a pharmacy near their hotel in Columbus, Ohio. She was on the verge of flying back to Minnesota when her doctor convinced an Ohio Walmart pharmacy to administer her second dose.
Santelman is thankful to be vaccinated, but she worries about the toll of skeptics who refuse to do so or wear a mask in public.
“There are these people actively searching for it and a segment of the population who is refusing it,” Santelman said.
Although vaccine opportunities are expanding in several states, some said barriers persist.
Katelyn Hertel is founder of Vaccine Fairy, a website that helps find vaccine appointments for people. Website volunteers scour pharmacy websites, often overnight or early morning.
Hertel said the website prioritizes appointments for seniors who face barriers such as a lack of transportation or medical conditions that make travel difficult. She cited struggles obtaining timely appointments for people with limited travel options in states such as New Jersey and Pennsylvania.
She worries more disadvantaged communities will struggle to secure nearby appointments as states open eligibility for all adults.
"You have 20-, 30-, 40-somethings who are tech savvy and can grab them for themselves or their friends," Hertel said. "What happens to our seniors?"
Ken Alltucker is on Twitter as @kalltucker or can be emailed at email@example.com
This article originally appeared on USA TODAY: Clinics, hospitals seek to bolster COVID-19 vaccination in rural areas