Health
Low influenza vaccination rates in rural U.S. are a challenge for COVID-19 vaccines
According to experts, the poor track record of immunizing people against influenza is the future for immunizing the country against COVID-19, especially in rural areas where the virus is out of control. Causes problems in our efforts.
According to a USA TODAY analysis of influenza vaccination rates for Medicare participants, rural counties from western Texas to northern Nebraska and the Upper Peninsula of Michigan had the lowest vaccination rates in the country in 2017. This is a pattern that applies throughout the United States. The more rural the county, the lower the flu shot rate tended to be.
The data for analysis came from County health ranking With the project Relative rural indexA metric that ranks counties based on population size, density, remoteness, and urban area. The analysis identified 604 counties where less than one-third of Medicare participants were vaccinated against influenza, of which 580 were predominantly rural.
More than 13 million people lived in these places and they were spread all over the country. There was at least one low vaccination county in all but nine states.
In extreme cases, there were 215 counties where less than one in four Medicare residents was vaccinated.
“There is no convenience in jumping into Walgreens, CVS, or Wal-Mart to get a flu shot. The nearest Walgreens and Wal-Mart are 30 miles away,” said Wilson County Health Officer, family doctor in Fredonia, Kansas. Dr. Jennifer Bacani McKenney of the vaccine explained some of the rural barriers that exist in addition to the hesitation and distrust of vaccines.
Due to financial, custody, and staffing issues, she said: “There is no provider in our county and many private clinics in the state do not offer vaccinations in clinics, so patients make additional appointments and health centers.”
Of course, those who opt out of the flu vaccine may ask for it because of the coronavirus, as the pandemic killed more people than the flu each year. At the same time, those who have previously been vaccinated against the flu may not be able to get an injection of COVID-19 because the pandemic has increased skepticism about American science and drug regulators.
However, influenza vaccination rates can at least provide clues as to how the American countryside responds to the arrival of the COVID-19 vaccine. Data on influenza vaccination by Medicare registrants (primary-aged Americans) provide a detailed geographical window on how the COVID-19 vaccine is accepted by its major risk groups, he said. Dr. Randy Havac, an associate professor of rural health, said. Director of the Institute of Sexual Health at Oklahoma State University. “I think this is an exact contextual representation of what you can probably expect from a COVID vaccine.”
Potential effects on the American countryside can be seen in influenza data.Historical data from the US Centers for Disease Control and Prevention Wonder database Influenza viruses have shown a tendency to kill at a higher rate in more rural counties.
According to experts, if COVID-19 vaccination follows the same pattern as influenza, the flow of people between these communities and other areas will endanger both urban and rural populations. ..
Influenza vaccination has largely skipped much of the rural areas of the United States, as it is more difficult for people in remote areas to get to the pharmacies, clinics, or hospitals that provide the vaccine, in part. .. There has been a long-standing distrust of healthcare systems in these areas. However, vaccination of these areas with COVID vaccines is key to combating the virus that has devastated rural areas, experts said.
Dr. Thomas Tsai, a surgeon and health policy researcher at Harvard University’s TH Chan School of Public Health, said in an email, “Ensuring vaccine coverage in rural areas is to protect rural areas from COVID-19. Is an important part of our strategy. “
Herd immunity
Researchers don’t know how much of the US population needs to be protected to stop the COVID-19 epidemic.Estimate range From 50% to 90% of the population to achieve the threshold that epidemiologists describe as “herd immunity”.
If the flu vaccine is any sign, it will be difficult to reach that threshold.Only half of the countries are vaccinated against influenza on average and surveyed Performance More and more people are trying to reject the COVID-19 vaccine. Achieving a much higher vaccination rate with the COVID-19 vaccine is a nationally achieved goal for the unique and actively circulating coronavirus and smallpox, mumps, and diphtheria virus. It is different from a virus.
“The real question is how to move the needle from 50% to 75%,” said Dr. Hubach.
More:When can I get the first COVID-19 vaccine in the United States?
And the troublesome issue of vaccination is one that health authorities need to quickly understand. Two COVID vaccine candidates are expected to receive an emergency license from the U.S. Food and Drug Administration later this month, and federal and state health officials are among the components of the front-line healthcare professionals and elderly home residents. We have finalized a vaccine distribution plan to immunize. The first Americans to be vaccinated against the coronavirus, called the Phase 1a group.
The wave of vaccination is expected to occur by the end of the year. Dr. Mansef Slawi, Chief Science Advisor for Operation Warp Speed, recently said he expects the first Americans to be vaccinated within two days of FDA approval. Dr. Nancy Mesionie, director of the CDC’s National Center for Vaccination and Respiratory Medicine, said last week that everyone in Phase 1a should expect the first dose within three weeks of the vaccine being approved.
Subsequent deployments should proceed quickly. In a call to Operation Warp Speed on December 2 with reporters, Dr. Slawi awaited FDA approval, with 20 million people vaccinated against Pfizer or Moderna in December, 30 million in January and February. He said he expected 50 million people to be vaccinated. .. By early 2021, vaccination will go beyond front-line health care workers and nursing home residents to essential workers, followed by adults with high-risk medical conditions and people over the age of 65.
However, vaccination of essential workers and the elderly, especially in rural areas, continues, given the historically low immunization rates that researchers sometimes refer to as “ingestion” in rural counties. Will be a challenge. Why is the vaccine intake so low? Dr. Havac said a number of factors, including years of general health and social inequality, and distrust of healthcare providers.
Dr. McKennie of Kansas sees increasing distrust of the vaccine both in private clinic visits and in public city hall discussions on the coronavirus.
“I hear people hesitate to get this vaccine,” McKennie said. “They are nervous. They don’t want to be the first. It’s in line with the country’s idea of doubting government and science.”
More:Kentucky State Parliamentarians pre-submit a bill banning universities from mandating vaccines
McKennie is worried as the entire Kansas and plain community has been hit by COVID-19 in recent months.
“The numbers we’re seeing in our community now make me a little scared of what happens before we start vaccination,” she said. “What will happen next month or two months?”
But despite the damage, people have not changed their behavior. “Despite these numerous cases and deaths, it has not yet returned home for people,” McKennie said. “They are saying,” only 1 percent die. It’s not a big deal. ‘”
More than 300 deaths per 100,000 people and COVID surges in rural counties in Dakota, Kansas, Montana, and Mississippi. Influenza and other respiratory illnesses have also hit many in the same county in the past, but at much lower levels, averaging about 25 deaths per 100,000, according to 2018 CDC data. doing.
Endemic
Rural residents who opt out of vaccination are far from monolithic for that reason.
Lynn Ogren said he regularly inherits influenza vaccinations and all other vaccines in Jerauld County, South Dakota, and that one in five residents was vaccinated in 2017. I try to have a strict diet to stay healthy. She said she would not be vaccinated against COVID-19.
“I don’t put anything I don’t need in my body,” Ogren said. “I have never been vaccinated against the flu and have not been vaccinated at all.”
Residents of Jerauld County die from COVID-19 at a rate of more than 640 per 100,000 inhabitants, which is one of the highest rates in the country.
Health experts warn that if the population does not acquire herd immunity, cases and deaths from the virus known by the scientific name SARS-CoV-2 will continue to surge in unvaccinated areas. However, in countries like the United States, where vaccine hesitation is widespread, achieving herd immunity can be a serious challenge. The result is a seasonal coronavirus that guarantees continued distress.
“What if the country does not reach high vaccination rate levels? First, SARS-CoV-2 becomes endemic, but the levels are low … in the Northern Hemisphere there are mountains in winter and valleys in summer. There is, “the author of the letter writes. Release Last month’s Lancet Journal pointed out the challenge of herd immunity.
In an interview, Dr. Roy Andersson, one of the authors and a professor of public health at Imperial College London, said the virus would continue to circulate if herd immunity was not reached. Rural areas are inevitable.
“The virus remains endemic, but the city will be the main reservoir for sowing rural areas,” said Dr. Anderson, who was determined that the virus would never go away. “It will be endemic and seasonal.”
Dr. Krutika Kuppalli, an assistant professor of infectious diseases at the Medical University of South Carolina, is also concerned.
“Do you think it will be endemic?” Kuppari said. “Yes, that’s right. With millions of cases, it’s likely to be endemic. My hope is that there are enough people to get the vaccine.”
Promotion of vaccination
Despite historically low vaccine intake in rural counties, Hubach believes there is an opportunity to better communicate with their communities about the COVID-19 vaccine. It is very important to utilize religious leaders and community outreach workers who understand the local situation and climate. How do you get them to say, “Vaccination is one of the things we can do for the public good”? “He said.
More:The side effects of the COVID-19 vaccine mean that “your body responded as expected,” experts say.
Relying on patient-physician ties, in addition to tailoring public health messages to specific communities in local counties, is important for building confidence in the COVID-19 vaccine and increasing vaccination coverage. That’s the way, says Dr. Brian Chow, Physician and Principal Investigator, about the AstraZeneca COVID vaccine trial at the Tufts Medical Center in Boston. Chow explained that many rural communities have historically been marginalized and denied health care, or worse. Promoting COVID vaccination needs to overcome distrust in health care.
“Most people will be vaccinated through their clinic,” Chow said. “It’s important to take advantage of these relationships. Strong recommendations from primary care providers really affect people’s acceptance of the vaccine.”
Aleszu Bajak can be posted on Twitter @aleszubajak or emailed to abadak @ usatoday.com.
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