A month and several tweaks into Colorado's initial vaccine rollout, providers in rural parts of the state say things have gone as well as could be expected.
Though rural Colorado has some unique challenges that separate inoculation efforts there from Denver or Colorado Springs, many of the issues in the larger areas apply to the more sparsely populated counties. The limited supply of the vaccine, exacerbated by constant federal reshuffling, makes planning difficult. Repeated changes to the state's vaccine priority list, primarily the abrupt addition of those over 69 years old to the top tier, have caught providers off-guard. There are sure to be more obstacles as more and more people become eligible to receive their shot, but providers remain focused on the current, smaller groups.
"I can't believe how smooth it's been," said Justin Hanel, a pharmacist with Valley-Wide Health System, based in Alamosa and serving southern Colorado.
He said that his system was focused on avoiding the debacles at clinics elsewhere in America, with long lines and exhausted supplies. That type of negative publicity, or poor planning, would set back planning significantly.
Thus far, no such problems have arisen in Colorado's rural areas. Though a sizable minority in America has said they likely or definitely won't get vaccinated, and national research indicates rural residents are most likely to be skeptical or outright opposed, providers have seen little of that so far. Indeed, nearly all of the providers from across the state interviewed by The Gazette said they had encountered minimal or no hesitancy. Even if they had, they said, they're focused on vaccinating those who want it, rather than convincing those that don't.
That may be because the current population eligible to receive it — older Coloradans — are most at risk of serious illness or death, which may in turn provide motivation to get an inoculation. Relatedly, many in that age group have sought health care treatment already and have relationships with providers, a key piece in establishing trust in vaccines.
"I manage our social media channels, and I expected to see a lot of pushback when we started publishing stuff (about the vaccine)," said Evelyn Wiant, spokeswoman for Valley-Wide. "I don't know if it's because the situation has gotten so bad in the fall and winter or if people are just done — it's all people who are like, 'When can I get mine, when can I get mine?'"
"There hasn't been as much hesitancy as expected," she added.
"I think our patient population is a little different than average as far as vaccines in general because our patients tend to be more underserved and tend to just be very grateful for any health care they get," said Matt Percy, a family practice physician at Mountain Family Health Center's Rifle clinic. "I have very few vaccine-hesitant patients."
There are reasons to be concerned about uptake in rural Colorado: A Kaiser Family Foundation report found the highest levels of vaccine hesitancy in rural America. More than a third of rural residents say they probably or definitely won't get vaccinated, a number that holds true even when researchers accounted for political views or age range.
"We looked at whether they knew someone who tested positive and whether they knew someone who died," one of the Kaiser researchers, Ashley Kirzinger, said. The rate of rural residents who had that firsthand experience with the virus was similar to urban residents, "but they're less likely to be worried about that they'll get sick."
What's more, according to state data on flu vaccine uptake, rural parts of Colorado have consistently lower rates than the more densely populated parts of the state.
If limited, there has still been some of that hesitancy. Jen Fanning, the executive director of the Grand County Rural Health Network in Hot Sulphur Springs, said that over the past several years, vaccine uptake in her community has diminished. This vaccine is "even more controversial" because of the speed at which it was developed.
Still, she's not focused on addressing it right now.
"Right at the moment, the biggest concern is distributing what we have to those who want it and continuing that and pivoting as new protocols come down from the (Centers for Disease Control and Prevention) and the state," she said.
There are logistical challenges that are unique to these rural providers and clinics. Many don't have access to the ultra-cold freezers that are required to safely store the Pfizer vaccine, so they lean more heavily on the Moderna doses. Reaching the more far-flung parts of their communities requires more work; unlike in Denver, community health centers can't set up one giant drive-thru clinic and wait for most residents to flock to them.
Many of the clinics also serve migrant populations, which require more direct outreach, the providers say. Fortunately, though those migrants are by definition temporary, many are familiar to providers and thus have that established relationship that's all-important in ensuring vaccine use.
"Usually they have established relationships, or they take advantage of a van when it's on-site at the farm," said Polly Anderson, the vice president of strategy and financing for the Colorado Community Health Network. Thirty-five percent of Colorado's 200 community health sites are in rural areas and often form the backbone of care in those communities.
While using mobile clinics may not be a viable solution for every rural clinic or area, setting up clinics in rural communities when possible will be an important part, providers said. But again, unlike larger systems, many public health departments and clinics have more limited staff and resources that limit — both in quantity and in size — those opportunities. Limited vaccine availability and the need to refrigerate doses complicates that effort, as well.
"It’s hard to travel with it unless it's to Point A and Point B," said Trish McClain of the Northeast Colorado Health Department, which covers Logan, Morgan, Phillips, Sedgwick, Washington and Yuma counties. It has six nurses on staff to cover those six counties. "To take it out and give a few vaccines here and a few there — I would be really concerned about making sure we’re not wasting any. That is a challenge. I know some public health agencies that have more options as far as mobile units they can drive around. If we had something like that, I would be more inclined (to travel), but we don't have anything at our disposal of that type."
Leveraging established relationships will be key not only in working with migrant communities; it's vital for populations of all types, especially for those who may be leery of vaccines. Kirzinger, the Kaiser researcher, noted as much, as did several other providers. Because of older residents are often frequent health care consumers, that may explain why this phase has gone so smoothly, with little hesitancy.
The focus for all of the providers remains on that older population. All of them said they were caught off-guard by the state's abrupt announcement that the 70-and-older population would be moved up in the vaccination queue and needed to scramble to plan that out. But now that the processes and priorities have been set, things have settled and rolled along smoothly.
"With everything with this pandemic, it’s been hard to plan because things change so much," Fanning, the Grand County provider, said. "That’s one of the key things we’ve learned since March. We take what we know now, we do what we can in the immediate future, learn from that, build on that, along with everything we've known and done from the past. We put it together as new information and policies come down, we can implement that. If we start looking and planning for June, 100 percent, all in, it’s going to change 50 times over by then."
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January 18, 2021 at 07:30AM
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Vaccine rollout in rural Colorado going as smooth as could be expected, providers say - Colorado Springs Gazette
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