Consider This from NPR - NPR Analysis Finds Growing Vaccine Divide Between Urban And Rural America

Episode Date: May 21, 2021

We know that Americans in blue states are getting vaccinated at higher rates than those in red ones. But that gap obscures another growing divide in America's vaccine campaign — the divide within states between rural and urban areas. An NPR analysis of county-level data from the Centers for Disease Control and Prevention reveals that divide exists across age groups in almost every state. NPR's Austin Fast explains why. The Biden administration says it's making progress on closing the gap. Their focus is on getting as many people vaccinated as possible. But public health officials tell NPR's Geoff Brumfiel that the U.S. may never reach 'herd immunity.' Additional reporting in this episode from Veronica Zaragovia of member station WLRN in Miami. In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

In Chicago, some people can get a COVID-19 vaccine in the comfort of their own home. Now everyone 65 and older in Chicago is eligible for in-home vaccinations. If you're interested in this, you can make an appointment. We got a phone number. In LA, if a business wants to make it easy for employees to get a shot at work, the county will dispatch a mobile vaccine unit. A vaccine van is helping get the shots to more people. In New York, vaccines are available at certain subway stations, at the American Museum of Natural History.

It sounds too good to be true. And at baseball games, where the shot comes with a free ticket. Yankees and Mets tickets if you get a shot at the ballpark. And in Miami, vaccines are available at the airport and on the beach. I had the luck to come to the beach and on the beach. Angel Sanchez, a busy single dad who works construction, hadn't had a chance to look for a vaccination site. But on a trip to Miami Beach with his sons,

the city was offering shots right on the sand, and he was happy to get one. Consider this. If you live in or around an American city, you may have an easier time getting vaccinated than almost anyone anywhere in the world. It's not the same story in more rural areas of the country. And that's just one reason for America's growing vaccine divide. From NPR, I'm Adi Cornish. It's Friday, May 21st. This message comes from WISE, the app for doing things in other currencies. Send, spend, or receive money internationally, and always get the real-time mid-market exchange rate with no hidden fees.

Download the WISE app today, or visit WISE.com. T's and C's apply. What happens after a police officer shoots someone who's unarmed? For decades in California, internal affairs investigations, how the police police themselves, were secret. Until now. Listen to On Our Watch, a podcast from NPR and KQED. It's Consider This from NPR and KQED. It's Consider This from NPR. 60 million people, one-fifth of the U.S. population, live in counties designated as rural. And earlier this month, President Biden announced a shift in the U.S. vaccine strategy to reach more of those people. Today, two months until July 4th, the president said in an effort to get one shot to 70 percent of adults by July 4th, the government would invest more in rural vaccine

clinics and community outreach. We know that vaccination rates are lower in rural areas and that's why we're going to get vaccines closer than ever to rural residents. That was May 4th. This week, the White House said it's making progress. But we know we must push further. Dr. Marcela Nunez-Smith of the White House COVID response team said the government is sending a greater share of vaccines to rural clinics and that FEMA is shifting its focus away from mass sites and stadiums to smaller community clinics.

We recognize zip code is a stronger predictor of health than genetic code in our country. So as these efforts move forward, we remain committed, putting equity at the center of everything we do. There are signs things are moving in the right direction. According to an analysis of the data by the rural news outlet The Daily Yonder, the number of new COVID-19 infections in rural America fell by 16 percent last week, reaching its lowest level since July 2020. Months ago, it would have been common to hear public health officials say the push to get more vaccines into rural areas is about getting the U.S. to herd immunity. If you get that level of herd immunity, you could essentially crush this outbreak in this country. That was Dr. Anthony Fauci in December.

But after a lot of emphasis on the concept early in the pandemic, a growing number of public health officials say it's time to stop focusing so much on herd immunity. NPR's Jeff Brumfield explains why. The appeal is clear. The herd immunity threshold represents a simple goal, more or less one number that spells the end of the pandemic. It feels really concrete, sort of something to grab onto in a time filled with so much uncertainty. Until you speak to the modelers who actually calculate herd immunity. We make a bunch of assumptions that we know aren't true. Samuel Scarpino runs the Emergent Epidemics Lab at Northeastern University.

For example, he says computer models often drastically oversimplify the way people interact with each other. So the way I decide who I'm going to have lunch with is I put everybody in Boston in a bag, and I shake the bag up, and I draw somebody out at random, and that's who I have lunch with. In the real world, people only have lunch with their social contacts, and that changes the herd immunity threshold. It's also complicated by the fact that we may not have an even distribution of immunity. Lauren Ansel Myers is at the University of Texas at Austin. She says the herd immunity threshold is usually presented as a single overall percentage of a population. But in a given city? You know, you may hear numbers like

50% of a population are immunized. But is that really 50% in every single neighborhood? Or do we have some pockets of very high levels of immunity and other pockets of low levels of immunity? If the east side of a city is immunized and the west side isn't, then the hospitals could still be overwhelmed. Finally, herd immunity is often described as a finish line to be crossed. But that is an illusion, says Mark Lipsitch at Harvard University. People talk about herd immunity as if it's a sort of endpoint. You either have it or you don't. And once you have it, you keep it. And that's not true either. Things like new variants or the time of year can cause huge

swings in how many people need to be immune to reach herd immunity. In the months since December, there have been real-world complications. Data out of Asia and Brazil suggests reinfection may be more common than thought. Vaccine hesitancy has emerged as an issue, as has the rise of more transmissible variants. All of this changes whether we can get to the herd immunity threshold. Based on the best calculations I know how to do, it will be impossible or very difficult to reach in many parts of the United States. But it could all change again in the future. And it's that squishiness that makes all of these scientists say it's time to stop talking about herd immunity.

I think we're focusing too much of our time, our effort, on quibbling over a number. Instead, Lauren Anselmeyer says all the computer models show a very clear way forward. Every vaccination gets us a step closer. Every vaccination makes our community, our society, a safer, healthier place. There's no magic finish line, but as long as vaccinations continue, things can and will get a lot better than they are now. NPR's Jeff Brumfield. So yeah, herd immunity, no longer the government's main focus. Now it's simply about vaccinating as many people as possible. And that brings us back to where people

are being vaccinated and where they're not. You've probably heard that, by and large, Americans in blue states are getting vaccinated at higher rates than those in red ones. That divide is real. But it obscures another growing divide in America's vaccine campaign, one that exists within states of all kinds. According to a new NPR analysis of CDC data, people who live in rural counties are increasingly being vaccinated at lower rates than people in and around cities. There's actually just two states where rural counties grew ever so slightly faster than urban ones over the past month, and that's in Alaska and New Hampshire. Everywhere else, rural counties fell more behind over the past month. Austin Fast with NPR's investigations team has been looking at the CDC data on a granular county by county level for months. We spoke about the rural urban vaccine

divide and why it's about more than just political ideology. This is something we observed about a month ago in early data from people over the age of 65. And now as more and more younger people have been able to get vaccinated as states have opened up to anyone 16 plus and now 12 plus, we've seen this rural urban divide show up across age groups in almost every state. Earlier, we talked about the idea of rural urban divide and red and blue states. But how much does political ideology actually mean in all this when you get down to all the issues around vaccination? Right. I mean, there's a lot of factors going into it. So political ideology is part of it. And that's what I heard from a researcher who studies rural health at Texas A&M University, Timothy Callahan. There's more conservative individuals in rural areas,

and those conservative individuals are less likely to vaccinate. So his research shows that rural residents are also less likely to take other preventative measures against COVID-19. And that includes things like just wearing a simple face mask or avoiding indoor dining. That potentially leads to the need for more health messaging so you can avoid negative outcomes in rural areas. What about the issue of access, though? Because there are still a lot of people who want to get vaccinated and they haven't been able to do that. Absolutely. Yeah. As Callahan told me, he gave an example as if, you know, say you live on work on a farm that's 30 miles away from the nearest vaccine site. That's a pretty big commitment to leave your job to go do that, especially if you have

issues with child care or, you know, trying to get the time off of work, for example. And not to mention, there's a large number of migrant workers in some rural areas. You can run into language barriers, transportation challenges. It could be difficult to locate a vaccine site, too, if you only have a smartphone and, you know, nothing else to access the internet. Another thing, in the last decade, there's been over 130 hospitals in rural areas of the United States that have closed down. So that matters a lot in rural places because research shows people are more likely to have underlying chronic conditions and more likely to delay medical care when they need it in rural areas than urban areas. So there's a lot of reasons for this divide. If there are places that have overcome this divide, where are

they? What can you tell us about them? Sure. Yeah, I was really excited to find a notable success in Santa Rosa, New Mexico, which is a small town two hours east of Albuquerque. And so Santa Rosa has just one 10-bed hospital and a single pharmacy that serve the 4,300 people that live in Guadalupe County, New Mexico. And by the time I found them in February, they'd already vaccinated 40% of residents when most other counties nationwide still had vaccination rates that were barely out of the single digits. Christina Campos is the administrator at that single county hospital. You know, when our numbers got publicized statewide and raised a lot of eyebrows, we were kind of informed, OK, hold off. You're way ahead of everybody else. We're going to hold you back for a while. Now, what do you think explains that? Well, Compass told me that part of it goes back to the fact that this is a really small county, and they had nine COVID deaths, including some

young people, you know, as young as their 30s, pretty early on in the pandemic. And so in a town where everyone, or in a county where everyone knows everyone else, that really drives home the seriousness of the virus when you see someone who unfortunately has passed away. And so when vaccines became available, they held a big vaccination drive in the high school gym, and the hospital's pharmacist drew up about 900 shots personally in one day. The hospital staff, local volunteers kept lines moving, local businesses donated meals. So the key thing here was that this was a small town, but the vaccine effort was a community effort where everyone got involved.

And that seems to be in line with what we've heard from other public health officials, the idea that getting vaccinated is, for lack of a better term, contagious, right? Like, if you see more people, if you see someone doing it, someone that you trust, then you might want to do it as well. Absolutely. And I heard a great story about that exact idea from Christina Campos, the hospital official in Santa Rosa. She told me at one point in the pandemic, there was a man in town who got incredibly sick with COVID. And he was the patriarch of a big family. And most of them got positive too. His wife was really sick, and he wound up in the hospital, but he got better. And when he was discharged, he went back to his favorite hangout spot at the local feed store to talk to his buddies about getting vaccinated.

And his friends, like at the feed store and all that, that had absolutely said, no, no, not going to get it. COVID's not real. It's not that bad. I think he educated them and told them how real it was and how bad it is. And so we had like the head of the feed store who had said, it has 57 percent of its adult population fully vaccinated now. 57 percent. That's still top 10 in the state. And that number is well ahead of the national county average of 36%. Austin Fast with NPR's investigations team. It's Consider This from NPR. I'm Adi Cornish.