SURRY, Va. -- When Charlome Pierce searched where her 96-year-old father could get a covid-19 vaccine in January, she found zero options anywhere near their home in Virginia. The lone medical clinic in Surry County had none, and the last pharmacy in an area with roughly 6,500 residents and more landmass than Chicago closed years ago.
To get their shots, some residents took a ferry across the sprawling James River to cities such as Williamsburg. Others drove more than an hour past farms and woodlands -- the county got its first stoplight in 2007 -- to reach a medical facility offering the vaccine.
At one point, Pierce heard about a state-run vaccination event 45 minutes away. No more appointments were available, which perhaps was for the best, as the wait there reportedly could last up to seven hours.
"That would have been a daunting task," she said, citing her father's health conditions and frequent need to use the bathroom. "I could not have had him sit in a car and wait for something that might happen. We're not in a Third World country."
As the nation's campaign against the coronavirus moves from mass inoculation sites to drugstores and doctors offices, getting vaccinated remains a challenge for residents of "pharmacy deserts," communities without pharmacies or well-equipped health clinics. To improve access," the federal government has partnered with 21 companies that run free-standing pharmacies or pharmacy services in grocery stores and other places.
More than 40,000 stores are expected to take part, and the Biden administration has said that nearly 90% of Americans live within 5 miles of one, from Hy-Vee and Walmart to Costco and Rite-Aid.
But there are gaps in the map: More than 400 rural counties with a combined population of nearly 2.5 million people lack a retail pharmacy that's included in the partnership. More than 100 of those counties either have no pharmacy or have a pharmacy that historically did not offer services such as flu shots, and possibly lacks the equipment or certified staff to vaccinate customers.
Independent pharmacies that have traditionally served rural areas have been disappearing, casualties of mail-order prescriptions and more competition from chains like Walgreen's and CVS with greater power to negotiate with insurance companies, said Keith Mueller, director of the University of Iowa's RUPRI Center for Rural Health Policy Analysis.
"There are a lot of counties that would be left out" of the Federal Retail Pharmacy Program, said Mueller, whose research center compiled the pharmacy data on the 400 counties. "In the Western states in particular, you have a vast geography and very few people."
Challenges to obtaining a vaccine shot near home aren't limited to rural areas. There is a relative dearth of medical facilities in some urban areas, particularly for Black Americans, according to a study published in February by the University of Pittsburgh's School of Pharmacy and the West Health Policy Center.
The study listed 69 counties where Black residents were much more likely to have to travel more than a mile to get to a potential vaccination site, including a pharmacy, a hospital or a federally qualified health center. One-third of those counties were urban, including the home counties of cities such as Atlanta, Houston, Dallas, Detroit and New Orleans.
Additionally, the study identified 94 counties where Black residents were significantly more likely than white residents to have to go more than 10 miles to reach a vaccination site. The counties were mostly heavily concentrated in the southeastern U.S. -- Virginia had the most of any state with 16 -- and in Texas.
The shortage of pharmacies and other medical infrastructure in some of the nation's rural areas highlights the health care disparities that have become more stark during the pandemic, which has disproportionately affected members of racial minority and lower-income groups.
The former drugstore in Surry County, where about 40% of the residents are Black, is now a cafe. No one seems to remember exactly when Surry Drug. Co. closed, but cafe co-owner Sarah Mayo remembers going there as a child. Now, she drives 45 minutes to a Walmart or CVS.
"I don't know if more people would take the vaccine" if the pharmacy still existed, said Mayo, 62. "But at least you would have a local person that you trust who would explain the pros and cons."
Surry County residents also used to pick up prescriptions at Wakefield Pharmacy in neighboring Sussex County until it, too, closed in November. The owner, Russell Alan Garner, wanted to retire and couldn't find a buyer.
"We've become dinosaurs," Garner said.
LEFTOVER SHOTS
In Missouri, on the other hand, more than 7,700 doses of vaccine were left over after mass vaccination events across the state last week, fueling frustrations that rural counties haven't been able to find enough people to use them while urban residents are desperate for a dose.
Records from the Missouri Department of Public Safety show that the remaining doses were usually transferred to another local provider or held by the health department for later use, the St. Louis Post-Dispatch reported.
Over the course of those clinics, 152 doses were thrown away, including in Putnam County, where 143 doses spoiled. In some cases, the spoilage resulted from dislodged needles or duplicate appointments and others when residents didn't show up for their slots.
In Putnam County, 1,488 doses remained after a vaccination event last weekend. In Bollinger County, only about half of the available doses were used at an event Feb. 24, and the leftovers were sent elsewhere.
In Lewis County, a vaccination event concluded with hundreds of extra doses. That left enough vaccine for a follow-up day that catered largely to people from far outside the area.
State agencies say they are adjusting. The state will transition vaccination teams to hold more large-scale events in the Kansas City and St. Louis areas.
EASING RESTRICTIONS
Meanwhile, states have continued steadily lifting restrictions, despite warnings from top federal health officials like Dr. Anthony Fauci that new coronavirus cases in the United States have plateaued at a very high level after their drastic drop has stalled, and that the country urgently needed to contain the spread of more transmissible variants.
Arizona, California and South Carolina joined a growing list Friday by loosening restrictions, to varying degrees. Arizona's governor ended capacity limits on businesses but said they must still require masks. South Carolina's Republican governor lifted the state's mask mandate in government buildings, while recommending restaurants continue requiring masking.
California will allow amusement parks and outdoor sports and live events at stadiums to restart April 1, with reduced capacity and mandatory masks.
"We've just now recently experienced the worst surge," Fauci said Friday during a White House coronavirus briefing, adding that the country had plateaued at between 60,000 and 70,000 new cases per day. "When you have that much of viral activity in a plateau, it almost invariably means that you are at risk for another spike."
The seven-day average of new cases was about 61,000 as of Friday, the lowest average since October, according to a New York Times database. But that number was still close to last summer's peak.
Fatalities are falling, too, in part because of vaccinations at nursing homes. Yet the nation is still routinely reporting 2,000 deaths per day.
Fauci warned the United States could be following the same treacherous path that Europe has recently been on.
"They plateaued," he said. "And now, over the past week, they saw an increase in cases by 9% -- something we desperately want to avoid."
He warned that the virus mutates as it replicates, a process that can be extended when immunocompromised people are infected. He said maintaining masking, hand-washing and social-distancing was urgent.
The B.1.1.7 variant, first identified in Britain, is spreading so rapidly in the United States that data analysis suggest that, as of last week, it has most likely grown to account for 20% of new U.S. cases. And scientists in Oregon have identified a single case of a homegrown variant with the same spine as B.1.1.7 that carries a mutation that could blunt the effectiveness of vaccines.
Last week, Texas and Mississippi, both Republican-led states, lifted mask mandates. President Joe Biden denounced those moves as "a big mistake" that reflected "Neanderthal thinking," saying it was critical for public officials to follow the guidance of doctors and public-health leaders as the coronavirus vaccination campaign gains momentum.
Other Republicans have been more cautious. Gov. Mike DeWine of Ohio said he would lift all public-health measures aimed at curbing the virus crisis, but only once new cases there drop under a certain threshold. In Alabama, Gov. Kay Ivey said she would extend the state's mask mandate through April 9.
In Arizona, Gov. Doug Ducey has taken what he calls a "measured approach," barring local leaders from enacting measures that shut down businesses and allowing major league sports to restart if they receive approval from the state's Department of Health Services.
Among Democrats, Gov. Gretchen Whitmer of Michigan said Tuesday that she was easing restrictions on businesses and would allow family members who had tested negative for the coronavirus to visit nursing homes. In California, the state's public health department also loosened some restrictions Friday, saying amusement parks could reopen on a limited basis as soon as April 1.
In New York City, limited indoor dining has returned. And on Thursday, Connecticut's governor said the state would end capacity limits later this month on restaurants, gyms and offices. Masks remain required in those places.
Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, has implored states not to relax their restrictions yet.
A new report from the CDC found that counties that allowed restaurants to open for in-person dining in the United States had a rise in daily infections weeks after. The study also said that counties that issued mask mandates reported a decrease in virus cases and deaths within weeks.
Information for this article was contributed by Ben Finley, Adam Beam, Kathleen Ronayne, Janie Har and staff members of The Associated Press; and by Ron DePasquale and Isabella Grullon Paz of The New York Times.
