Rural Vaccine Equity in NNE

I want to share a few preliminary comments on rural vaccine equity in NH/VT based on our ongoing @dartmouth research on COVID-19 and Rural Health Equity in Northern New England.

Since March, our team has interviewed more than 60 stakeholders from health systems, social service agencies, town and city governments, and communities in NH/VT. This work is supplemented by ongoing reviews of scientific literature, journalistic accounts, and public discourse.

It’s important to situate the #covid19 vaccination effort within the larger rural #covid19 response in NH/VT. Rural health systems, public health entities, and communities have played a critical role in NH/VT’s early success in responding to #covid19.

Critical access hospitals and community health centers form the backbone of the rural health system. Rural institutions entered the pandemic with workforce, capacity, and fiscal constraints but swiftly mobilized to create capacity to care for covid-19 patients.

Early in the pandemic, rural healthcare organizations in NH/VT leveraged their role as trusted healthcare institutions to educate their communities about public health measures and worked with other partners to eliminate barriers to compliance.

Rural healthcare institutions in NH/VT worked with public health and social service entities to support vulnerable patients and populations. Many made lists of vulnerable patients and deployed community health workers to support them.

In both NH and VT, integrated networks bringing together health systems, social service providers, and communities facilitated rapid mobilization in response to #covid19 amid national and regional resource constraints. These networks remain active.

VT has more decentralized state public health infrastructure; however, NH’s regional public networks play a critical role in regional public health response and work closely with the NH state health department and local entities.

Many rural healthcare institutions, including FQHCs, were among the first established testing sites in rural regions in NH/VT. Vermont has used more targeted pop-up testing to supplement facility-based testing.

Rural institutions have played other roles in the #covid19 response. As NH state capacity become strained in the fall, rural institutions took on the role of contact tracing and played a key role in local public health responses. Schools contributed to these efforts.

Several rural communities in NH’s North Country experienced outbreaks in the fall; however, significant improvement in the region’s epidemiology amid rapidly growing cases at state level is testament to effective local responses.

Our research has highlighted many strengths in the rural NH/VT #covid19 response that will also be critical for vaccination efforts. The most important one may be trust--trust within communities as well as between institutions.

As part of the second phase of our research on #covid19 and rural health equity in NH/VT, we have asked rural stakeholders to describe #covid19 vaccination efforts and the challenges that they anticipate.

Rural stakeholders in NH/VT have described well-formulated plans for vaccination; however, many spoke to uncertainty around prioritization, distribution timelines, cold chain requirements (Pfizer), and systems that may sideline existing rural institutions.

Rural health systems anticipated playing a range of roles in vaccination efforts within their communities. Many will vaccinate their patient populations, host community vaccination clinics, and lead community education and outreach.

A common challenge confronting rural health institutions, particularly in NH, is that many are already strained by increasing cases as well as by added responsibilities related to the pandemic response, including contact tracing. Many also have growing workforce challenges.

Stakeholders in both NH/VT described supportive relationships with state public health departments; however, those in NH were more likely to describe significant strains on state public health capacity that shifted responsibility to local entities.

By early fall, many rural institutions in NH/VT were thinking about how to reach medically and socially vulnerable patients and populations within their communities using their existing structures, including community health worker programs.

Rural stakeholders in NH/VT anticipated vaccine hesitancy; however, many expressed confidence that many sources of hesitancy could be overcome with targeted messaging and reliance on trusted community messengers.

Many rural stakeholders in NH/VT spoke to the importance of engaging community leaders from town and city governments, churches, and schools in #covid19 vaccine delivery and promotion efforts.

The narrative of rural healthcare institutions and communities is often one of fragility. Rural institutions in NH/VT face resource constraints and have sustained significant impacts during the #covid19 pandemic; however, it has also highlighted their strengths.

Building on rural strengths, infrastructure, plans, and trusted relationships will be critical to achieving vaccine equity in rural NH/VT—and in other rural areas. Ensuring rural representation in planning is critical.

Rural is not a monolith, and there are significant differences across rural contexts in the NH/VT region and well as across rural America; however, our research highlights the need to build on existing strengths and support local rural leadership.

I hope that this thread provides some early insight into #covid19 vaccination efforts in rural NH/VT and that other rural health leaders and researchers from NNE and other regions will share their experiences and insights on #covid19 vaccination efforts.