How North Carolina is bridging the urban-rural divide during the vaccine rollout

North Carolina

RALEIGH, N.C. (WNCN) — The gap between rural and urban counties during the COVID-19 vaccine rollout appears to be much smaller in North Carolina than it is in other states, a data analysis found.

Countering a trend observed in other parts of the country, the proportion of doses of vaccine in the state going to rural, urban and suburban counties is remarkably similar to their share of its population.

“Not all states look quite as good as we do on that front,” said Dr. Lesley Curtis, who chairs the Duke School of Medicine’s department of population health sciences.

In fact, rural counties are leading the way in North Carolina’s robust vaccination effort: Of the 21 counties that meet or exceed the statewide average of 28 percent of all people at least partially vaccinated, 20 are rural counties — with urban Durham County the exception.

Part of that is sheer volume: 82 of the state’s 100 counties are classified as rural by the North Carolina Rural Center.

But eight of the state’s 12 suburban counties — along with urban Mecklenburg County rank — among the bottom 19 counties on that list, with a partial vaccination rate below 20 percent.

Those rural counties combine to have 4.6 million people living there, accounting for 43 percent of the state’s total population. Those people have received 44 percent of all doses of vaccine given in the state.

The proportions are also in line with the other two classifications: Suburban counties, which have 22 percent of the state’s people, have received about 20 percent of doses. The six urban counties have 35 percent of the population and have received 34 percent of doses.

That breakdown wasn’t as equitable early in the rollout, Curtis said.

“Early on, the logistical challenges with distribution, I think that really, we saw real differences in terms of who was actually getting access to it,” she said. “Now, the good news … is that as the logistical issues have been addressed, and more vaccine distribution sites have been set up, we’re seeing that distribution looks to be much more equitable across these different kinds of areas, which is really important.”

Other states are dealing with discrepancies between their densely packed urban centers and more remote rural places, potentially leading people in those lesser populated spots lagging behind or having their vaccine hesitancy unchallenged.

A survey by the Kaiser Family Foundation found a smaller share of rural residents say they’ll definitely get the shot compared to urban people. 

More than a third say they’ll probably or definitely not get vaccinated, compared to a quarter of suburban and urban people.

Curtis says one of the keys to North Carolina’s success has been the ambitious data dashboard that allows health leaders to see potential trouble spots in real-time and adjust resources to keep things balanced.

“It gives our leaders and our community leaders and public health leaders our real line of sight into like, ‘Well, what do we need to do today? Or what do we need to do tomorrow?’” she said. “To make it better than it was yesterday, it’s impossible to do that if you’re looking at data from four weeks ago, given how quickly everything is changing.”

How can the state keep those numbers from getting out of whack in the future?

Curtis says one solution is to keep an eye on certain subgroups in those counties that continue to show discrepancies even as the overall numbers look relatively comparable. For example, the vaccination rates for people 65 and older are as low as about 30 percent in some counties to 75 percent in others.

“So that’s a pretty big difference right?” she said. “Now, we’ll want to keep an eye on that over time, because what we want to see is that that gets higher and higher, and that those differences get smaller and smaller, those differences are much smaller among are larger in our larger counties.”

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