When we think of the painful toll of Covid-19, we often picture urban scenes: lines for tests, overflowing hospitals, refrigerated trucks serving as makeshift morgues. Yet, staggering new data shows that the death rate from Covid in rural areas is now double what it is in urban ones. You would think that fact, coupled with medical professionals pleading with people in rural America to get vaccinated, would lead more to get their shots. Yet, people in rural states lead the list of those who remain unvaccinated, putting themselves and others at risk.
Instead of blaming them for their vaccine hesitancy, we need to acknowledge that we all share responsibility for the crisis.
It’s enough to make increasingly angry vaccinated people shout: “Why won’t you listen to your doctor?”
To which, I respond: “What if they don’t have one?”
Many in rural America aren’t vaccinated because two pernicious forces — the implosion of the rural health care system and the decay of local news — have left them with limited sources of information. That has allowed them to become prey to misinformation and overconfident quacks.
Instead of blaming them for their vaccine hesitancy, we need to acknowledge that we all share responsibility for the crisis. We all failed to invest in the doctors and nurses who could be trusted sources of accurate information for rural patients. We all failed to provide adequate funding for rural hospitals and local clinics. We all failed to help a rural health system adapt, instead of decay.
If we want people in rural America to get vaccinated, we’re going to have to rebuild the rural health care system. It will take time. It will be expensive. Yet, it will save lives. And it will replace the callousness of letting the underserved die with both empathy and access to care.
The Covid pandemic intensified the rapid decline of rural health care that was already underway for decades. Hospitals in these areas are both hemorrhaging money and are stretched past their capacity. Covid created a surge of patients on whom hospitals lose money. Medicare and Medicaid, which cover a disproportionate number of Covid patients, do not compensate for the full cost of the coronavirus treatment, while crowding out many of the elective procedures from which hospitals derive the most revenue.
This crisis comes on top of the 108 rural hospitals that closed in the decade preceding the pandemic, which left more than 400,000 people without a hospital within 30 minutes of them. And the failure to expand Medicaid has left a glut of uninsured patients for whom hospitals must eat the cost of lifesaving emergency treatment.
The upshot is clear: Rural America lacks access to doctors. There are only 39.8 doctors per 100,000 people (well below the urban rate), and 26 percent of those in rural America say they have not received needed health care at least once in the past few years because they didn’t have access to it. The acute national nursing shortage does not help.
In other words, people in rural America aren’t getting information about the Covid vaccine from their doctors, because they often don’t have one easily available to them.
Fifteen years ago, local news would have filled the gap in providing vaccine information from a regional, known entity. But that’s no longer the case, either. In a span of a decade and a half, 1 in 5 newspapers across the country closed and the number of journalists working for newspapers has been cut in half. The result is nearly 1,600 counties have just one small weekly paper, and over 200 have no newspapers at all.
Rural America is now filled with news deserts. “As local news outlets shutter, rural America suffers most,” a 2019 Pew Charitable Trust report explained. “The people with the least access to local news are rural residents, who are typically poorer and less educated than the average American. As rural counties lose population, they often become unable to support a newspaper worthy of the name.”
So what’s left? Facebook, where the most popular post of the first quarter of this year was misinformation about the vaccine. Scammers looking to sell untested “alternatives.” Media-savvy doctors who have abandoned their duty to public health.
Yes, individuals are ultimately responsible for their own health decisions, and yes, employers may provide incentives for workers to get vaccinated. But it’s absurd to expect people to make good decisions when their sources of information are a rogues’ gallery with limited knowledge or malicious intent.
That’s not to say all is lost. By harnessing data and technology, we can improve health care in small towns. For instance, community health improvement plans can address the needs of individual rural communities by better allocating limited resources to increase access to care and preventive services.
We can also provide opportunities for telehealth, which offers flexible, affordable health care appointments and reduces transportation barriers. We can forge connections between public health experts at public universities and the professionals who run rural clinics, so people in the trenches can more immediately access information and resources.
Rebuilding rural health care will take longer than arguing with strangers on social media or letting the virus run rampant among the unvaccinated. It’s harder than judging people for making a poor decision. But it will work. It will save lives. It will limit opportunities for Covid mutations. It will get us back to a semblance of normalcy.
The frustration vaccinated people feel with the rural unvaccinated is understandable. But it is not helpful. We as Americans must not lose patience. It is our duty to help.