NC’s urban areas aren’t getting enough vaccines. Is that going to change?

After a balky start, North Carolina has gained speed on COVID-19 vaccinations and is now running ahead of schedule in some counties. As of Tuesday, roughly one in five adults in the state – 1.48 million people – has been fully vaccinated.

But the progress has been uneven and unfair for many in urban areas. At least five rural counties have seen vaccine demand drop to the point where they have opened eligibility to all adults, but many in urban areas are hard pressed to get an appointment.

The vaccine allocation shouldn’t be so skewed depending on where one lives. While the state has stressed equity in distribution by income and race, it has not allowed for equity by geography. Some urban residents have mastered shopping online for vaccine appointments and others have the flexibility to travel to rural sites where the vaccine is more available. But many people in urban counties don’t have the ability to work the internet or take half a day to go where they can get a shot.

Action is needed now to fix this imbalance. The supply of vaccine provided to the state and to pharmacies is growing and the added supplies should go to where the demand is greatest.

Kody H. Kinsley, a deputy secretary at the state Department of Health and Human Services, said urban access to the vaccine is expanding as more pharmacies, including Walgreens and CVS, are getting vaccine doses directly from the federal government. The state received 260,000 vaccine single doses last week and participating North Carolina pharmacies received 144,000 doses, and those numbers are expected to increase.

“We’re rapidly getting to a place where if one county has this much and the other county has that much, it’s not going to matter because every county will have enough for the people who want them at those moments,” Kinsley said.

At the same time, the state is adjusting distribution to get vaccines to frontline workers who can’t get to a vaccine site. He said vaccine distribution sites will be set up outside food processing plants and other work sites, including in urban areas.

“We just have to continue to increase the access points to make this as reachable for folks who are from a lot of different backgrounds and a lot of different walks of life,” Kinsley said.

That’s a worthy effort by DHHS, but it should expand access beyond frontline workers to all who are eligible but live in areas where the vaccine is hard to get.

Building more equity into the distribution process was hindered by complications with packaging and storage of the vaccines, Kinsey said. The Pfizer vaccine, for instance, comes in packages of 1,170 doses and requires extremely cold storage. That limited distribution sites to those big enough to move all those doses in a timely manner. The state is seeking to have those packages broken down so more sites with less traffic can distribute vaccines.

“Smaller amounts and more providers would have made this smoother,” Kinsley said.

The state expects all adults to be eligible for a vaccine by May 1 and possibly sooner.

In some rural areas, distribution sites have seen requests for appointments slow, moving local health officials to open eligibility and step up efforts to tell more people about the availability of vaccines and the value of getting vaccinated.

What rural counties may be showing is that even when vaccine availability becomes widespread, hesitancy about its safety and outright opposition to getting vaccinated could hinder the state’s ability to reach levels of so-called herd immunity.

“We found our older adults were very interested” in getting vaccinated, said Melissa McKnight, the deputy health director in rural Jackson County. “Some additional groups did have some vaccine hesitancy.”

Liz Hamel, director of public opinion and survey research at the Henry J. Kaiser Family Foundation, said her group’s polling shows roughly one in four rural residents do not want to get vaccinated compared with 15 percent of the population nationally.

North Carolina health officials will need to adjust vaccine allocations to better meet the urban demand.

This story was originally published March 25, 2021 at 12:00 AM.