Vaccine Rural Push, Attitudes Collide

Effort Underway to Expand COVID-19 Vaccinations in Rural Areas

Todd Neeley
By  Todd Neeley , DTN Staff Reporter
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Efforts are underway to expand COVID-19 vaccinations in rural areas. (Photo by Lisa Ferdinando, Department of Defense)

LINCOLN, Neb. (DTN) -- As a campaign to expand COVID-19 vaccinations across the country continues, attention has turned to rural areas, perceived by some to be the weakest link in putting the pandemic to bed.

Though rural Americans have been getting COVID-19 shots since vaccines became widely available, there is a federal push underway to reach every corner of the country -- focused on overcoming what some officials see as attitude barriers among rural communities.

Public polling on COVID-19 vaccination finds a number of conflicting results about rural America.

One poll finds the number of rural Americans who have had at least one COVID-19 shot outpaces their urban and suburban counterparts, by percentage. The polling divide comes in the number of rural Americans who indicate they'll never get vaccinated, compared to those in the cities and suburbs.

Many rural residents, including farmers and ranchers, already have stepped to the plate -- bringing into question whether rural America is a weak link.

"First, I'd like to make clear that farmers/rural Americans are not a monolithic group," Terri Moore, vice president of communications at the American Farm Bureau Federation (AFBF), told DTN.

"Their views range as broadly as the general population. Some farmers are out front blazing the trail in rural communities by hosting immunization clinics right on their farms, transporting their employees to vaccination sites and getting vaccinated alongside their workers, among other efforts."

According to Farm Market ID, a DTN company, its 2021 crop outlook survey found rural concerns about the virus have shifted.

In 2020, a Farm Market ID survey found 42.8% of farmers said they were concerned about the effect of the virus on themselves personally and 55.7% of farmers were worried about the effect on their businesses.

In 2021, the concern shifted.

A recent survey found 27.5% of farmers are extremely or very worried about the effect of the virus on themselves personally, while 33.3% were extremely or very worried about the effect on their business. The same survey found 72.9% of farmers were willing to take a vaccine once it became available.

AFBF has been helping spread the word about the benefits of vaccination among its six million members.

Moore said AFBF is a member of the COVID-19 Community Corps and is working with the Health Action Alliance, as well as the Ad Council, to increase awareness in rural America.

AFBF has shared toolkits and information about vaccine safety and the benefits of herd immunity in its e-newsletter, on its website and on social media. AFBF President Zippy Duvall wrote about the importance of getting vaccinated in his regular column and shared a vaccination photo of himself on social media.

Moore pointed to some examples of how farm communities are stepping to the plate.

In Idaho, Stephanie Mickelsen, whose family operates Mickelsen Farms, hosted an on-farm clinic where 350 people were vaccinated in a few hours.

In Maricopa County, Arizona, more than 40 farms, ag business and organizations hosted vaccine clinics, according to the Maricopa County Public Health Department.

"Regarding the reluctance among some, we've heard a variety of reasons for it," Moore said.

"Safety and side effects are a concern, particularly for those with pre-existing conditions. Among some farm workers, identification requirements are a barrier. For some, the newness of the vaccine is a source of concern.

"All of our communications center on it being a personal health choice. That said, we do note the societal benefits of achieving herd immunity, including getting the farm economy humming again as restrictions are lifted and restaurants, schools and cafeterias reopen. We have not received any negative feedback about our efforts to share information."


A Kaiser Family Foundation survey of more than 1,000 rural residents in April, found 39% of those surveyed said they had already taken at least one dose of a COVID-19 vaccine. That outpaces the 31% of urban and suburban adults who say the same.

What's more, the survey found rural residents to be more likely than urban and suburban residents to say their community has enough vaccination locations and vaccine supply.

Fewer rural residents, however, say they are planning or considering taking a vaccine compared to urban and suburban residents.

"Three in ten rural residents say they will either 'definitely not' get vaccinated or will only do so if required, and few unvaccinated rural residents (11%) say they have tried to get an appointment," the Kaiser survey found. "These results suggest that vaccination uptake in rural America may start lagging behind urban and suburban areas."

The survey found diverging rural attitudes about vaccines.

"About six in 10 rural residents (compared to less than half of urban and suburban residents) say getting vaccinated against COVID-19 is a personal choice," Kaiser said. "Rural residents are also less likely to say they are worried about themselves or their family members getting sick from coronavirus or that they wear a mask most of the time when they leave their house."

In addition, Kaiser said rural residents are less likely to view the pandemic as a serious threat either to the country or their families. The survey found the most likely reason why some rural residents won't get vaccinated is because the vaccines are new, and there is a lack of information about long-term effects.

It's interesting to note rural residents are less likely to view COVID-19 as a threat, according to the USDA, although the rural population is older than urban and suburban areas. In addition, the Centers for Disease Control said eight in 10 COVID-19 deaths were among people age 65 and older.

According to the Centers for Disease Control, more than 245 million doses of COVID-19 vaccines were administered in the United States from Dec. 14, 2020, through May 3, 2021.

During that time, there were 4,178 reported deaths -- far less than 1% -- among people who received a COVID-19 vaccine.

"CDC and FDA (Food and Drug Administration) physicians review each case report of death as soon as notified and CDC requests medical records to further assess reports," CDC says on its website.

"A review of available clinical information, including death certificates, autopsy, and medical records has not established a causal link to COVID-19 vaccines."


As part of the Biden administration's push to have 70% of adults COVID-19 vaccinated, the federal government launched a widespread effort to expand the number of vaccinations in rural areas in the next two months.

The White House's plans include delivering vaccines directly to rural health clinics, especially in more underserved communities.

More than $100 million in American Rescue Plan funding is expected to be announced for about 4,600 rural health clinics to support vaccine outreach.

In addition, the Health Resources and Services Administration (HRSA) is providing about $860 million to help rural health clinics and rural hospitals broaden their COVID-19 testing and mitigation. HRSA is expected to provide up to $100,000 per clinic to each of the 4,600 federally designated rural health clinics and up to $230,000 per hospital to 1,730 small rural hospitals to increase COVID-19 testing.


Speaking to a group of agriculture journalists last week during the North American Agricultural Journalists conference, American Medical Association President Susan R. Bailey said much of the trepidation in taking vaccines may center on misinformation or political attitudes.

Bailey said the AMA estimates if about 80% of the American population is vaccinated the "pandemic will largely be over."

A recent survey by Pew Research showed 60% of Americans say they would definitely or would likely get a COVID-19 vaccine -- meaning 40% would not.

"Given this political divide around vaccines and the unfortunate politics of this pandemic from the beginning, it's not surprising which states are leading the way in terms of vaccine adoption, and which states have some room for improvement," she said.

"In particular public health officials face considerable challenges reaching communities in America's rural south and west."

Although the time generally needed to move vaccines to market was cut dramatically on COVID-19 vaccines, Bailey said the vaccines are safe.

"We are very confident that the FDA and the CDC have followed a vigorous, fully transparent and evidence-based process to deliver safe and effective vaccines against this virus, confident that we can and are recommending these vaccines to our patients," she said.

Once a new drug application has been approved by the FDA, the vaccine undergoes three phases of testing.

"So once the vaccine has cleared this testing phase and receives FDA authorization," Bailey said, "it's subject to additional monitoring requirements to determine its safety and its effectiveness, to make sure that it's delivering on its claims."

Bailey said some people have had "minor, temporary" side effects. "We know that this just means that you're gaining immunity," she said.

"About 90% of physicians and 80% of all nurses have been fully vaccinated, healthcare professionals know that these vaccines are the best way to gain immunity to prevent the spread of COVID-19."

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