Some NY rural counties lag behind in COVID vaccine push. What to know

David Robinson
New York State Team

Some rural communities in New York are falling behind in the race between COVID-19 vaccinations and resurgent coronavirus infections threating to extend the pandemic.

While vaccination rates climbed in many counties anchored by cities and affluent suburbs, the dire effort lagged in some rural counties amid concerns about politically motivated vaccine hesitancy and older New Yorkers struggling to access shots.

Indeed, 10 counties with among the lowest vaccination rates statewide — those with less than 30% of people receiving at least one shot — fall within more rural areas. The Bronx and Brooklyn in New York City are also in the underperforming group at about 26% and 27%, respectively.

The lagging counties included Orleans, Wyoming, Cattaraugus, Allegany, Steuben, Tioga, Fulton, Delaware, Orange and Washington, state data from Thursday show. And four other rural counties — Schoharie, Sullivan, Jefferson and Lewis — had 30% of people with at least one shot.

Moderna's COVID-19 vaccine is one of  several vaccines that is being used to combat the virus.

Statewide, about 7 million New Yorkers, or 35% of the population, have received at least one shot. The Pfizer and Moderna vaccines require two shots to be fully effective, while the Johnson & Johnson vaccine requires one shot.

The rural vaccine divide has drawn calls for more targeted vaccination sites and outreach to ensure New York has the best chance at achieving herd immunity to defeat the virus, which experts say requires vaccinating between 70% and 90% of people.

“Being rural is a disparity, and it’s very important that folks have access in their local communities,” said Paul Pettit, public health director for Orleans and Genesee counties, between the cities of Rochester and Buffalo.

“They shouldn’t have to drive over an hour and wait in line to get vaccinated,” he added.

Database: Search COVID vaccine rates by county in New York

Why COVID vaccine lags in rural counties, cities

To understand vaccine gaps, consider Monroe County, including Rochester, had about 39% of its population receiving at least one vaccine dose, far outpacing its more rural neighbor Orleans County, at 25%.

The factors driving vaccine disparity touch on personal politics and demographics, as well as vaccination site locations and heated competition for doses during supply shortages earlier this year, according to local health officials and surveys.

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Within Monroe County, for example, the vaccine appeared to be reaching white suburbanites at a far higher rate than African Americans in Rochester, with white people accounting for 87% of people getting vaccines and 79% of the population, state data show.

In contrast, African Americans accounted for about 8% of those in Monroe receiving vaccines and 15% of the population. The trend prompted local, state and federal officials to launch community pop-up vaccine clinics and a mass-vaccination site targeting communities of color in Rochester.  

In the nearby counties of Orleans and Genesee, however, mostly white rural residents went months without a state-run mass vaccination site since the rollout began in December.

A temporary mass vaccination site set up last month at Genesee Community College provided about 3,500 shots, Pettit said, but only about 20% of doses went to local residents, many of whom are older and struggle to navigate the state’s vaccine-booking website and phone hotline system that can get overwhelmed at times.

“We’re disenfranchised when it comes to actually landing these scarce appointments,” he said.  

Most of the 3,500 shots went to people from nearby Erie and Monroe counties, where vaccination sites were often booked up at the time, Pettit noted, adding the state should consider opening permanent mass-vaccination sites in more rural communities with access exclusively for local people.

“Ultimately, the vaccine allocation that’s been given to us…has been insufficient,” he said.

Vaccine doses are distributed by the federal government to states based on population, and New York then distributes doses regionally based on population.

And after New York’s allocation of vaccine ramped up in recent weeks, the state on Tuesday expanded eligibility to all adults 16 and older as part of its push to boost vaccination rates.

Currently, only mass-vaccination sites through a Federal Emergency Management Agency program have limited access to shots by Zip codes, in part, to focus on addressing vaccine hesitancy in communities of color in urban areas.

New York Gov. Andrew Cuomo speaks before getting a COVID-19 vaccine at a church in the Harlem neighborhood of New York, Wednesday, March 17, 2021. (AP Photo/Seth Wenig, Pool)

Smaller state-supported vaccination sites at churches and community centers, however, have sought to reach underserved communities across the state, spanning rural and urban communities.

Erin Silk, state Department of Health spokeswoman, defended the state’s efforts to reach all communities, noting the expansion of eligibility and vaccination sites has been driven by increases in vaccine supply.

“New York State has operationalized one of the largest vaccine distribution networks in the nation, with over 5,000 providers statewide, and more than 11 million shots administered,” she said in a statement.

“We have stood up new vaccination sites as part of our efforts to reach communities where access is low, hesitancy rates are high, or vaccination rates are below average,” she added. 

How politics, vaccine hesitancy impact rural NY

Colleen Cole fills a syringe with the Pfizer BioNTech COVID-19 vaccine at the Dome Arena in Henrietta which is one of the state COVID-19 vaccination sites with today, January 20, 2021 being their first day in operation.

Darlene Smith, Steuben County’s public health director, said vaccine struggles in her Southern Tier rural community initially stemmed from short supply.

“When the vaccine started rolling out, we were only allocated 200 doses a week, so we were certainly not going to get very far that way,” she said, referring to the local health department’s vaccine share.

But Steuben’s vaccine haul soon increased to about 600 vaccine doses before jumping to 900 doses last week, as it started to struggle to book appointments, Smith added, noting the county conducted a survey on social media that uncovered some hesitancy.

“Not surprisingly, they don’t trust it. They just think the vaccine is too new and not proven in their minds,” Smith said.

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Now, Steuben has seen just 29% of people receive at least one vaccine dose, despite the opening of a permanent state-run mass vaccination site at SUNY Corning Community College on March 19. The site has often fallen short of hitting its goal of administering 1,000 shots per day, Smith said.

In contrast, some state-run mass vaccination sites in rural communities have thrived, such as the facility at the State University of New York at Potsdam.

One potential reason for disparity is that political affiliations seemed to play a role in some rural communities across the country having below-average vaccination rates, national surveys suggest.

For example, 29% of Republicans across the country were saying “definitely not” to taking the vaccine, according to a Kaiser Family Foundation survey. In contrast, Independents and Democrats took the same stance at 9% and 5%, respectively.

Overall, 20% of people in rural communities nationally were saying “definitely not,” the survey shows, compared to 13% in suburbs and 10% in urban communities.

In November, both Orleans and Steuben counties voted by a nearly 2-to-1 margin for Republican President Donald Trump over Democratic challenger and now-President Joe Biden.

Addressing the politically motivated vaccine refusal presents a starkly different task than ongoing efforts to convince people of color to get vaccinated despite their mistrust in the effort being rooted in countless examples of racial bias in medicine and science throughout American history. 

Still, Smith is hopeful that expanded eligibility and increased vaccine supply, as well as ongoing public health campaigns promoting the vaccine as safe and effective, will soon help Steuben turn its vaccination push around.

But time is running out to avoid another coronavirus surge, she added.

“The number of positive cases is quite honestly on the rise and our average daily case count is double what it was even two weeks ago,” Smith said. “We’re on an uptick right now and just monitoring it as close as we can.”

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David Robinson is the state health care reporter for the USA TODAY Network New York. He can be reached and followed on Twitter:@DrobinsonLoHud