How one healthcare group is addressing vaccine access in rural Alabama

Most of Dr. Thomas Broughton’s days are spent fielding questions from patients about the COVID-19 vaccine.

When will it be available? Is it safe?

Many of his patients are older and have chronic medical conditions that should technically make them a high priority to receive the vaccine.

But supply in the state is still limited. As of Feb. 23, about 12% of the population had received the first dose of the vaccine, according to data from the University of Alabama-Birmingham. There are 288,486 available vaccine doses in Alabama and close to 4.5 million people in the state have not been vaccinated.

The problem is compounded in rural areas where healthcare resources are strained making it more difficult to store, distribute and track vaccinations. Broughton, who divides his time working at the Monroe County Hospital and as the Rural Health Medical Program’s chief medical officer, functions at the center of this challenge. The organization operates a mobile health unit and eight rural health centers across western Alabama, including the Monroeville Health Center, where Broughton is based. In total, RHMP serves nearly 8,000 patients.

While he is currently unable to administer the vaccine at the center, Broughton hopes this will change in a matter of weeks.

RHMP is finalizing the approval process to receive and start offering the Moderna COVID-19 vaccine. This means, pending approval, vaccines would be available by appointment starting in mid to late March. Currently, vaccines are available to people over 65 and certain frontline essential workers in Alabama.

The approval process is extensive and RHMP has spent months preparing to become a vaccination site.

It’s required sourcing the proper refrigeration to store the vaccine and identifying clinics that can handle potential surges in patients who want to be vaccinated. The Moderna vaccine can be stored in a conventional freezer or refrigerator for up to 30 days after it’s thawed.

To make better use of limited resources, sites have had to establish clear communication strategies to circumvent misinformation about the vaccine and identify partners to find, track and refer patients as they start receiving vaccines. As community health workers, they’re also addressing other needs, including food access and rental assistance among their patients.

“We are considering so many factors all at once to make sure this is done right,” said RHMP CEO Keshee Dozier-Smith, who leads outreach for the agency. 

“My vision is to have real-time data to plan, design, and roll out a plan to show communities in rural west Alabama our abilities as public health leaders,” she said. “That we are working on the communities' behalf to maintain healthy communities and more positive health outcomes.”

Site leaders are unclear on the number of doses they will receive, though doses are typically allocated in proportion to the number of patients served. 

“At first, we were worried about the costs for our uninsured patients, would we be able to afford the required equipment to store the vaccine, how do we get funding to educate team members to conduct vaccine clinics, how do we get that information out to our patients?” Smith said.

She added that they also must consider who is interested in getting vaccinated, who qualifies, and who is most at risk for serious complications from COVID-19.

Lakimbrell Marshall, the director of nursing and a nurse practitioner at the RHMP’s Marion County Health Center, estimates that about 80% of her patients have an underlying medical condition, such as obesity, diabetes, or heart disease. Patients diagnosed with underlying conditions are at greater risk for severe illness from the virus that causes COVID-19.

“It’s something a lot of clinics are dealing with, who gets it first?" she said." We work in rural areas where a lot of patients are at risk for complications, and we know we are not going to have enough vaccines at first to get them all vaccinated." 

Concerns about the limited supply of vaccines have been reported across the state.

Certain hospitals had waiting lists between 5,0000 to 10,000 people for COVID-19 vaccines in early February, according to a press release from the Alabama Department of Health. The health department launched eight mass vaccine clinics statewide starting Feb. 8 to ramp up vaccinations. More than 76,000 Alabamians have been vaccinated at the mass clinics so far, according to state data.

However, these one-time events are not enough to close the gap in demand for the vaccine, particularly in rural and underserved parts of the state, explained Dr. William Curry, the associate dean for Primary Care and Rural Health at the University of Alabama-Birmingham.

“There’s a real risk that people in those communities are facing a serious lack of access to vaccines,” he said. “You have a disproportionate number of people with underlying (medical) conditions that put them at bad outcomes and it’s worse for people in rural communities and among minority populations. I worry about a problem of equal access in those communities.”

The first round of vaccine distribution targeted healthcare workers at hospitals in city centers. But as vaccines become more available in rural communities, clinics are grappling with challenges that pre-date the pandemic.

Staffing shortages and vaccine hesitancy are ongoing concerns. Primary care physicians in rural communities often work long hours, dividing time between hospital care and clinic hours.

“Between taking care of acute infections, injuries, underlying conditions and then tracking who has gotten the COVID vaccine, it’s an incredibly demanding day,” Curry said. 

Dr. Meneka Johnson, the chief operating officer at Rural Health Medical Program, said that as vaccinations begin, they’ll rely on established partnerships with UAB and other community organizations to help with any staffing issues.

The organization coordinated several large-scale COVID-19 testing events with a team of three to four people, she recalled.

“We are in very rural communities, there was a provider shortage pre-COVID, so we are used to making things work with less,” she said. “The doctors who choose to work in these communities are part of these communities.”

Broughton grew up in Monroeville, where he now works. For the last 15 years, he's also served as a minister at the Greater Mount Calvary Baptist Church in nearby Brewton, Alabama. 

While Broughton and other providers at Rural Health have observed less hesitancy about the vaccines among their patients, it remains a concern. The history of the Tuskegee Syphilis experiment, where African American men were unknowingly deprived penicillin so doctors could study the long-term impact of the disease still looms. The politicization of COVID-19 and the vaccine has also made it more difficult to build trust around vaccinations.

Broughton said as a Black doctor and pastor he knows he plays a vital role in minimizing those fears.

Broughton and his family have been vaccinated. And while he tries to steer clear from politics at the pulpit he continues to share this detail with parishioners and patients.  

COVID-19 cases have started to decline after a spike in cases through mid-December that overwhelmed Monroe County hospital’s ICU. Broughton has since seen growing interest in the vaccine.

At times he finds it hard to believe a little over a year ago life was normal in his beloved town.

Now he can’t remember the last time he stepped out of his car without wearing a mask.

“We have seen hard times, and I’m very tired. But I just keep thinking about the people who will soon have easier access to the vaccine,” he said.

Maria Clark is a general assignment reporter with The American South. Story ideas, tips, questions? Email her at mclark@gannett.com or follow her on Twitter @MariaPClark1. Sign up for The American South newsletter. Follow us on Instagram, Facebook, and Twitter.