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Why Lagging COVID Vaccine Rate At Rural Hospitals 'Needs To Be Fixed Now'

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Originally published on May 4, 2021 8:16 am

President Biden on Tuesday is set to announce new steps to reach rural Americans in the push to get as many people as possible vaccinated for the coronavirus, a White House official tells NPR. This emphasis comes as rural hospitals are raising alarms about the pace of vaccination — even among their own employees.

The Biden administration is moving into a new phase of its vaccination campaign, one where it knows doctors and health care professionals are often more persuasive than the government.

It has prioritized a list of doctors enrolled in the vaccine system based on a "social vulnerability index" used by the Centers for Disease Control and Prevention — including doctors in many rural communities — and has been asking state government to send vaccine doses to those doctors, the official said.

The administration also plans to work with states to enroll more pediatricians and family doctors in their vaccine systems so they can begin giving people vaccines, a step that becomes "particularly critical" if the Food and Drug Administration gives emergency authorization for adolescents ages 12-15 to start getting the Pfizer vaccine, the official said.

The administration also is working with provider groups to encourage their members to sign up to give the vaccines and will be providing technical assistance to help practices get ready for vaccination, the official said.

"Tremendously problematic"

The new steps come as some rural hospitals are finding that their own staff members are reluctant to get the shot.

A new survey conducted by the National Rural Health Association and Chartis Center for Rural Health showed that 30% of the 160 rural hospital executives who responded said less than half of their employees had been vaccinated — even though health care workers have been eligible for months now. Only about a third said that 70% or more of their staff were vaccinated.

"These survey results match what we are hearing from our members and that is tremendously problematic," said Alan Morgan, chief executive of the National Rural Health Association.

"At a federal level, every effort to overcome vaccine hesitancy has health care professionals front and center," Morgan said. "So if you've got a quarter of the nation's rural hospitals having less than 50% of their staff vaccinated, you have a problem that needs to be fixed now."

This survey also lines up with a poll done earlier this year by the Kaiser Family Foundation and The Washington Post that found 29% of health care workers in rural areas didn't plan to get the COVID-19 vaccine. That's a greater well of hesitancy than the poll found among health care workers in urban and suburban areas.

Michael Topchik at Chartis said the hospitals they work with have high vaccination rates every year for the flu shot. It's required. "We were surprised at how many rural hospitals were telling us their vaccination rates for COVID-19 were significantly lower," Topchik said.

"It's too early"

In Carrollton, Mo., Jeff Tindle, the chief executive at Carroll County Memorial Hospital, is beside himself about the low rate of vaccination among his staff. Only 59% are vaccinated for COVID-19 and at this point he doesn't have much hope of that number growing dramatically.

Tindle, who describes himself as conservative, like most people in his town, said he had assumed that health care workers would understand the importance of the vaccine. "I'm disappointed that we built in so many safeguards ... first and foremost to protect our employees, and yet we had almost 40% who chose not to help themselves," he said.

The hospital had a vaccine clinic but shut it down, turning its attention to helping the public health department. Most of the people who wanted to get vaccinated in the town of 4,000 have already done so, he said. "We're worried about always wasting vaccine because we just don't have enough arms," he said.

Talking to friends, Tindle says some have told him they are afraid of being implanted with microchips, a false conspiracy theory alive and well on the internet.

"Employees that I talk to, health care employees, will be a little more rational in their irrational behavior by saying, 'Well Jeff, we don't have enough studies. It's too early,' " he said.

"I know that swayed people"

Some rural hospitals have had better luck getting employees vaccinated. Memorial Hospital in New Hampshire's Mount Washington Valley region is currently at 78%. Will Owen, who is running the hospital's community vaccination clinic, said education was key.

In December, a highly respected local physician named Victor Lazaron sent a letter to staff. "I am keen to be vaccinated as soon as possible," Lazaron said in the letter. He cited studies showing vaccines were effective and that the worst side effects were comparable to the vaccine for shingles, which is widely used.

"I hope you all will choose to be vaccinated as soon as the vaccine is available to you. In my judgment it is the best way forward. It is safe and effective. And it will help us get back to our core mission: protecting the health of our friends and neighbors in the Mount Washington Valley," Lazaron wrote.

That letter opened people's minds to the vaccine, Owen said. "I know that [letter] swayed people, because I had people tell me that," he said.

There were also Zoom sessions for staff, led by doctors, leaving plenty of time for questions. Having trusted doctors and nurses vaccinated has been reassuring to others in the broader community, said chief nursing officer Kris Dascoulias, whose roots in the community are so deep that she was born in Memorial Hospital, where she now works.

"I've gotten lots of text messages, questions. I think people relied on the hospital community that they knew and trusted to guide them a little bit in this," Dascoulias said. She said she has encouraged people, telling them, "I know it's a little scary, it's a little bit of a leap of faith, but you know it's better than the alternatives."

White House looks to local doctors

The White House knows that doctors and other trusted local leaders will be the way to break through pockets of hesitancy in rural communities, said Bechara Choucair, the White House vaccinations coordinator.

Choucair also pointed to a different Kaiser Family Foundation poll that found a majority of rural residents had been vaccinated or planned to get vaccinated, although it also shows a much smaller share of urban and suburban residents would "definitely not" get the shot than those in rural areas.

"Luckily we know that the overwhelming majority of health care providers are very supportive of [the] vaccine. Ninety percent of doctors and master's-prepared nurses have either gotten the vaccine or are in the process of getting vaccinated," Choucair told NPR, citing national data about doctors and highly trained nurses.

"We need to do that across the board for health care professionals and non-health care professionals and will continue to do that," he said.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

RACHEL MARTIN, HOST:

President Biden is going to announce plans today for the next stage in the push to vaccinate as many Americans as possible against COVID-19. An administration official tells NPR the FDA is likely to authorize the use of Pfizer for 12- to 15-year-olds in the next week as well. One area of concern is rural America, though, where demand for vaccines may be hitting a wall. About 32% of the U.S. population is fully vaccinated at this point, but it's been going more slowly recently. NPR has learned exclusively that Biden will announce targeted steps today to get rural doctors delivering shots, and that's important because rural health care leaders are raising alarms. We're joined now by NPR White House correspondent Tamara Keith. Good morning, Tam.

TAMARA KEITH, BYLINE: Good morning.

MARTIN: These new steps are coming in as you have gotten your hands on another data point that underscores the challenges of reaching people in rural America, right? Tell us what you found.

KEITH: Yeah, I got early access to a survey conducted by the National Rural Health Association and a group called Chartis. They reached out to rural hospital executives to get an idea of what share of their employees are getting vaccinated, and the results have them worried. Thirty percent of these executives said that less than half of their staff have taken a COVID vaccine. And keep in mind that health care workers have been eligible for vaccination for months now, since late last year.

MARTIN: Wow. So health care workers themselves not getting the vaccine. What are hospital leaders saying about why?

KEITH: I spoke with Jeff Tindle. He's the CEO at Carroll County Memorial Hospital in Missouri. His hospital serves a town of about 4,000 people. And he's beside himself about the low rate of vaccination among his staff. Only 59% are vaccinated for COVID at this point, and he doesn't have much hope of that number growing.

JEFF TINDLE: I made every single decision, with the start and the end of those decisions - how can I protect my employees the most? Every decision. And yet, you know, I want them to kind of help meet me halfway, and let's protect you and your families - and 59%.

KEITH: Much like in the hospital, Tindle says most of those in the community who wanted to get vaccinated have.

TINDLE: We don't have enough arms to put, you know, the - we're worried about, you know, always wasting vaccine because we just don't have enough arms.

KEITH: The nursing homes were hit hard, but the rest of his community didn't experience COVID in the same way as more urban areas. The hospital wasn't overwhelmed. Talking to friends, Tindle says some share vaccine fears driven by false conspiracy theories about microchips.

TINDLE: Employees that I talked to, health care employees, will be a little more rational in their irrational behavior by saying, well, Jeff, you know, we don't have enough studies; it's too early.

KEITH: One hundred and sixty hospital executives responded to the survey. And Alan Morgan, who is CEO of the National Rural Health Association, is really concerned about the results.

ALAN MORGAN: These survey results match what we're hearing from our members, and that is tremendously problematic.

KEITH: This survey also lines up with a poll done earlier this year by the Kaiser Family Foundation and The Washington Post that found 29% of health care workers in rural areas didn't plan to get the COVID vaccine. That's a greater well of hesitancy than the poll found in urban and suburban areas. Why does this matter? Morgan says these are people who have influence in their communities.

MORGAN: At a federal level, every effort to overcome vaccine hesitancy has health care professionals front and center. So if you've got a quarter of the nation's rural hospitals having less than 50% of their staff vaccinated, you have a problem that needs to be fixed now.

KEITH: Michael Topchik at Chartis says the hospitals they work with have really high vaccination rates every year for the flu shot. It's required. So these numbers stand out.

MICHAEL TOPCHIK: And we were surprised at just how many rural hospitals were telling us that their vaccination rates for COVID-19 were significantly lower.

KEITH: Some rural hospitals have had better luck getting their employees vaccinated. In New Hampshire, at Memorial Hospital in the Mount Washington Valley, they're currently at 78%. Will Owen, who is running the hospital's community vaccination clinic, says education has been key. Early on, a highly respected physician sent a letter to staff.

WILL OWEN: When he came out with his strong opinion for it, I think that opened people's eyes - like, Dr. Lazaron just wrote this amazingly supportive letter. And I know people - that swayed people because I had people tell me that.

KEITH: There were also Zoom sessions for staff led by doctors, leaving plenty of time for questions. Having trusted doctors and nurses vaccinated has been reassuring to others in the broader community, says chief nursing officer Kris Dascoulias. Her roots run so deep, she was born in Memorial Hospital, where she now works.

KRIS DASCOULIAS: And to be able to say, no, we're going to do this, and I know it's a little scary; it's a little bit of a leap of faith, but, you know, it's better than the alternatives, and we're going to do this, and it's going to be OK.

MARTIN: So, Tam, I mean, obviously, this is a big concern if you can't even get health care workers to get the vaccine. What's the White House saying about it?

KEITH: Yeah, they know that doctors and trusted local leaders are going to be the way they break through in rural communities. I talked to Bechara Choucair, the White House vaccinations coordinator, about this.

BECHARA CHOUCAIR: Obviously, there's still some pockets and issues around vaccine confidence, and we have to continue to work on that, whether in the health care space or in the general communities overall.

KEITH: But he is accentuating the positive and said that a majority of rural adults are vaccinated or planned to do so, even if the rates are a bit lower than in other areas.

MARTIN: So the Biden administration sees local health care officers as the key to vaccinations. What's the president going to say about it today?

KEITH: Well, we have learned exclusively that he will talk about additional steps to get more local doctors delivering shots. The administration is asking states to give more vaccines to doctors' offices, especially in vulnerable areas with limited access to health care, like rural communities. And they're working to sign up family doctors and pediatricians, something that an official told me will be particularly critical if the FDA gives the OK for adolescents to start getting vaccinated soon.

MARTIN: All right. NPR White House correspondent Tamara Keith. Thank you.

KEITH: You're welcome. Transcript provided by NPR, Copyright NPR.