Thirty percent of rural Americans have received at least one booster against Covid-19, compared to 39% of their urban counterparts, according to a Daily Yonder analysis.
Booster rates are lower in rural counties than metro counties
Due in part to low vaccination and booster rates, cumulative rural death rates were 36% higher than urban rates last week. Carrie Henning-Smith, deputy director of the Rural Health Research Center at the University of Minnesota, says death rates are exacerbated by pre-existing health challenges in rural America.
“There were already existing disparities between rural and urban health before [the pandemic],” said Henning-Smith in a phone interview with the Daily Yonder. “Those include an older age structure, reduced access to health care, and more underlying health conditions among the population.”
The lag in vaccination and booster rates in rural counties just exacerbates existing health problems.
Great Variation from Region to Region
But rural America is not all the same. Half of the adult residents of rural Maine and 43% of rural Minnesotans have received at least one booster, according to our analysis of data provided by the Centers for Disease Control and Prevention. Garfield County, Nebraska, is the leader in rural booster rates, where 84% of the adult population has received a booster dose. That’s 36 points higher than the rural average.
(We should note that when there are data anomalies, they can have a big impact on reported vaccination rates in rural counties. See, for example, Brett Kelman’s reporting on how Tennessee’s vaccination tracking system creates erroneously inflated figures for some counties.)
Henning-Smith said demographic factors could explain the diversity in vaccination rates among rural areas. Things like education levels and the age of residents can affect booster rates.
“[Booster rates] might also reflect different approaches that states have taken in promoting and rolling out the vaccine. Some state governors and departments of health were very proactive in finding ways to get the vaccine to hard-to-reach communities.”
Minnesota made use of mobile vaccine units that met people where they were, making sure that anyone who wanted one could easily get one.
Poverty and Vaccinations
Poverty can affect one’s ability to have the time or transportation to get a vaccine. But internet access may also affect one’s ability to receive vaccines.
“The extent that vaccine rollout happened online, that would disenfranchise people who … might not have access to reliable broadband internet,” said Henning-Smith. “There was a lot of promotion and education about the vaccine that happened on online platforms.”
Being poor in a rural area has unique challenges when it comes to health than being poor in an urban area, particularly when it comes to transportation. If you live in poverty in an urban area, you might be close to public transportation that could get you closer to a health clinic. But this is not always true for rural places.
Rural areas with high poverty rates might also be facing hospital closures or a shortage of medical professionals, according to Henning-Smith. From 2010 to 2021, there were 136 hospital closures, 103 of which occurred in rural counties.
Out of the 103 rural hospital closures between 2010 and 2021, 40% were in counties with high poverty, defined as having 20% or more of the population living below the federal poverty line. About half of the rural closures occurred in counties with poverty rates between 10% and 20%, while the remaining six closures occurred in counties with low poverty rates.
Many of the counties with high poverty rates have not had a hospital present in the last decade, regardless of closures. Hidalgo County, New Mexico, is a rural, high-poverty county with no hospital. Out of the 15 counties in high poverty in New Mexico, three of them have no hospital.
Social Cohesion Is the Key to Change in Rural Areas
A strong sense of community and trust in local professionals can also help vaccination rates.
“After the vaccine was available here in Minnesota, Cook County led the state [in vaccination rates] … Cook County is a very rural county in a fairly remote northeast corner of Minnesota,” said Henning-Smith. “And I think what worked really well was a sense of community and a social cohesion that was already built into the fabric of the community. People trusted one another.”
Henning-Smith said she noticed that a strong sense of community is a common denominator among the rural counties that lead the way in vaccination rates. And while national health and political leaders do have some influence, they are not as important in rural places as local leaders.
“I think what moves people to action is really those personal connections with people they already know and trust.”
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