The Way We Work Now

What I’ve Learned Giving Vaccines in Rural America

We don’t have many doses yet. Giving them out fairly is a challenge.

The Way We Work Now is a series chronicling how people’s lives and careers have fundamentally changed because of the pandemic.

Leia, a thirtysomething pharmacy student in Texas, volunteers in administering the Covid-19 vaccine. She spoke with Mai Tran about the uneven distribution of vaccines across various regions.

I’m a doctoral student doing rural pharmacy rotations, and unfortunately, the majority of vaccines are going to large cities. Sometimes it’s hard to get our community to drive two or three hours to the nearest city that has vaccines. Regulations vary state by state so some places are better about distribution than others.

I was on a six-week rotation with Indian Health Service at Choctaw Nation in Oklahoma when we received a shipment of the Pfizer ultracold vaccine. It came to a hospital that had the storage capacity for it in a deep freezer. I watched a video on how to administer and store it, and started the campaign with hospital staff. I was furnished with surgical and N95 masks, face shields, and gloves. The vaccine was hard to transport storage-wise, so we had people come to us. Everything was completed within two weeks of us getting the doses for the health care workers.

I came back to my school in Texas just before Christmas, and the university sent out an email saying they had gotten the Moderna vaccine and were looking for volunteers to vaccinate health care workers. I volunteered and got my vaccine at the same time. My team had an OB-GYN doctor and several nurse practitioners. We did health care workers first — I actually vaccinated several nurses who were interested in volunteering, but we didn’t necessarily need them for that period. On our last day we had 1,000 doses left. Not all the students were in town because it was winter break, so we opened it up to people aged 65 and over. They didn’t have to register ahead of time and just came. We administered about 3,000 doses in total.

The health workers and students I’ve vaccinated were fine, but the general public, which is mostly the 65-pluses, was very excited. They couldn’t understand people not wanting to get it. They talked about a generational gap, saying, “When we were kids we had to get the polio vaccine… I’m going to have to talk to my kids and grandkids and say, ‘If your 90-year-old grandfather can get a vaccine, you can get a vaccine.’” They felt like we were finally turning the corner with public health measures.

Hopefully it doesn’t turn into an annual vaccine like with the flu.

We decided it would be too prohibitive to bill insurance, so the actual vaccine is free. What you can bill to insurance is a dispensing or administration fee, and on average, that’s anywhere from $12 to $15 to offset the costs of things like gloves, alcohol swabs, and syringes. If you bring your insurance card with you, we take a copy of it, but for mass vaccine campaigns it’s a bit too much administrative burden to do that.

Now, I’m in a community pharmacy that received a small shipment of vaccines. The pharmacist and I are the only two immunizers, but we have 10 stations so we’re pretty brisk and the line is less than an hour. At the same time, our county health department is doing mass vaccinations at a large community center. They had about 5,000 doses but I heard their lines could be six hours, especially in the first days they were administering. Because some 65-plus people might have heart failure or be on oxygen tanks, it was really difficult for them to stand in line so they came to us. We schedule appointments in 10-minute increments because we don’t have the facility to host a large line of people.

The more people that get vaccinated, the more information we receive in regards to reaction time, unusual reaction, and efficacy, which we can report to the CDC, the FDA, and the manufacturer. I’m hoping the vaccine covers us for various mutations that will occur with the coronavirus, and that it will be something we only need to get vaccinated one time, or something like a tetanus shot where we might need boosters every 10 years. Hopefully it doesn’t turn into an annual vaccine like with the flu.

writer based in new york

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