America’s Next COVID Obstacle: Vaccine Deserts

A health-care worker registers people for the Moderna COVID-19 vaccine at a mass vaccination site inside the Darlington Raceway in South Carolina. Photo: Micah Green/Bloomberg via Getty Images

When the coronavirus arrived last March, Joe Pepper hunkered down in his home in Orangeburg, South Carolina. A retired military veteran in his 70s, in constant pain due to arthritis, he lives alone and he doesn’t have a car, relying on his twin sister to get around. “I don’t hardly go anywhere because I’m scared of the virus,” he said.

So when Pepper heard that vaccines were starting to become available in December, like many others, he was excited to get the shot and soon became eligible because of his age. His sister is steadfastly helping him to find appointments, but they’re few and far between in the state’s rural, impoverished communities. And even if he finds one, there’s the matter of getting there. Pepper says he knows of a nearby pharmacy that is administering the shots. “It’s not really walking distance, but it’s reasonable. I know it’d take me a long time now because my back bothers me a lot,” he said. “By the time I’ve walked about a mile, I have to sit down.”

There’s a state-run service that could provide him with transportation, but it would require him to notify them three days in advance. “It’s very frustrating,” he said. “I don’t like to beg and I’ve got too much pride. With the help of the Lord I’m going to make it, really. I’m struggling now, but I’m a fighter.”

About an hour northwest of Charleston, Orangeburg County, where Pepper lives, is one of the poorest in the state and has limited health resources, with one hospital serving people in four surrounding counties. More than half of its population of 86,000 is Black and has suffered over 200 deaths from the coronavirus. In this small, rural part of South Carolina, the COVID-19 shot has been hard to come by. According to state data, just over 12,000 of the county’s residents have been fully vaccinated.

As the nation’s vaccine supply grows, the next challenge will be getting shots to these harder-to-reach communities, which is necessary to reach herd immunity and bring the virus under control. Public-health experts call these areas “vaccine deserts,” where eligible people — often poor people and people of color, such as Pepper, who is Black — do not have easy access to vaccinations. A recent analysis found that 111 rural counties have no pharmacy that can give the vaccines. Vaccine deserts aren’t unique to rural areas. Urban areas, like some New York City neighborhoods, often lack a single vaccination hub. In Missouri, a consulting firm hired by the state earlier this year found vaccine deserts were expanding across a swath of St. Louis and Kansas City — in some areas, people were seven miles from the nearest provider.

One reason for the deserts is a wave of rural hospital closures since the early 2000s, according to Janice C. Probst, director emerita of the University of South Carolina’s Rural and Minority Health Research Center. “Health care facilities make money based on the patients they serve,” Probst told Intelligencer. “Where you don’t have the requisite number of patients who can pay, you lack services. Rural manages to ring both of those bells: too few people, and not all of them can pay.” Hospitals were especially important during the initial stage of vaccination, with the first approved shot from Pfizer requiring their ultracold freezers.

In a 2007 report, Probst found that half of the trips made by Black Americans for medical care nationally took more than a half-hour, compared with 25 percent of trips white people made.

“It’s almost like a double jeopardy of racial and ethnic issue disparities, as well as disparities related to living in rural areas,” said Dr. Saundra Glover, an Orangeburg resident who has spent more than three decades at the University of South Carolina, helping address the health-care needs of vulnerable populations.

That’s part of why the vaccine rollout has already been uneven. Only ten states have vaccinated at least 10 percent of their Black population, while 40 states have already achieved that protection threshold for their white residents, according to Bloomberg News, despite the disease ravaging minority populations at a disproportionate rate. Five states have already vaccinated 20 percent or more of their white population. Despite headlines about vaccine hesitancy, an earned mistrust in the U.S. health-care system among communities of color, they’ve rapidly joined the ranks of people who want a shot, according to the Kaiser Family Foundation. Its survey found that 41 percent of Black adults say they want a vaccine or have already received their first dose, up from 20 percent in December. For Hispanic adults, 52 percent were eager to get the vaccine, compared to December’s 26 percent.

When doses do find their way into rural counties, spotty broadband service — about 650,000 South Carolinians do not have high-speed internet access, for instance — and a lack of reliable transportation can make it cumbersome to schedule and keep an appointment.

One potential solution is using churches as pop-up vaccination sites. Since early January, Glover has been working with community-based organization Hold Out the Lifeline to get information out about the virus. Now, these efforts are focusing on actually getting shots in arms. “In most rural counties in South Carolina, you will find an AME church, a Methodist church, or a Baptist church,” Glover said. Beginning March 11, for example, Brookland Baptist Church in South Carolina’s West Columbia County, will host a clinic for those who are eligible to receive the vaccine.

Other states are working on similar efforts to get vaccines to underserved populations. “We’re having to find creative ways to utilize other infrastructure and communities that don’t have hospitals or pharmacies or clinics that can manage,” says Thomas LaVeist, dean of Tulane University’s School of Public Health and co-chair of Louisiana’’s COVID-19 Health Equity Task Force. “We’re looking at things like schools, community centers, churches, community-based organizations, and other nontraditional infrastructure.” He said that since last week thousands of Louisianans have lined up at a pop-up clinic run by the East Baton Rouge Council on Aging at Living Faith Christian Center in North Baton Rouge to get vaccinated — an effort LaVeist hopes the state can use as a model to get more vaccines into Black communities.

Distribution of the vaccine is also getting easier. New data from Pfizer suggests their vaccine can be stored at normal refrigerator temperatures, rather than deep-freeze conditions, for up to two weeks. Moderna’s vaccine only needs to be frozen at regular freezer temperatures, and Johnson & Johnson’s recently approved single shot can be stored in a regular refrigerator, making it easier to transport to hard-to-reach areas.

As efforts to vaccinate South Carolinians ramp up, Pepper is prepared to do whatever it takes to get the shot. “[If] I’ve got to stay all day in a long line, I’m going to do it,” he said. After the shot, he expects he’ll be doing the same thing he’s been doing for the past year — “I’ll just wear my mask, stay safe, and stay where I am,” he said, though after being vaccinated, he’s looking forward to being able to help his neighbor, who is diabetic.

And with three authorized vaccines currently available, he is not exactly picky. “I’ll just take the first one that I can get.”

America’s Next COVID Obstacle: Vaccine Deserts