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Rural Health Departments in Missouri Struggle to Meet Overwhelming Vaccine Demand

Paltry Supplies of Vaccine, Staff and Patience

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Above image credit: A hand wrapped in rubber gloves holds a disposable syringe of COVID-19 vaccine for injection in a needle. (Frank Hoemann | AP Photo)

KINGSTON, Mo. — Elizabeth Little and her husband just moved to Caldwell County from California in 2020. Back in the Golden State, some of her friends are receiving their doses of the COVID-19 vaccine.

Here in Kingston, about an hour northeast of Kansas City, Little and her husband are on a waitlist to get their shot, and they aren’t sure exactly how long that will be.

Little is hoping to get the vaccine quickly, so she can substitute teach in the county. Her husband is 78-years-old with underlying health issues. She can’t start work if it will put him in harm’s way.

“I feel like we’re on borrowed time, like we’re trying to hold out and beat the COVID with the vaccine,” Little said. “But also, I need to work, you know? I’m in debt. And so I’m not sure what to do.”

Just 359 of the 9,020 residents of Caldwell County — about 4% —  have received their first dose of the vaccine. There is just one vaccine distribution center in Caldwell County, the county’s health department. The health department has just three people on staff to administer shots, and has routinely received less vaccines from the state than requested.

Missouri currently is 49th among U.S. states in the percentage of population vaccinated, at 5.6%. Rural counties in particular are lagging even that figure.

“It’s pretty overwhelming,” Caldwell County Health Department Administrator Tracy Carman said. 



Meeting Demand

In Mercer County, health department administrator Gina Finney has been trying to get an order of vaccines since December. She has had no luck.

“I haven’t even gotten all of my 1A people a shot because I have not gotten my hands on vaccines,” Finney said. “I’ve tried to call hospitals just to get vaccines for my 1A people.”

Even the people in her department and volunteers who will actually be giving the shot out haven’t been vaccinated.

Mercer County, east of Interstate 35 next to the border with Iowa, has vaccinated just 2.6% of the population, with just 94 people getting their first dose. Finney says most of these shots were given to people in nursing homes and residential care facilities who received the shot directly from their pharmacy.

In Caldwell County, Carman has routinely gotten fewer doses than she ordered from the state. She says she ordered 500 shots, and only received 100. Her strategy now is to order more vaccines, in the hopes that even if it doesn’t meet her order, it still is more than what she would get if she requested less.

“My plan is to order 1,000 and hope I get 250,” Carman said. “And realistically, we only have three people to vaccinate, that would be all (the shots) we could get in a week anyway, is about 250.”

The demand in her county is high. There are currently 1,000 people signed up and in line to receive the vaccine. The county has 100 doses to administer.

Annette Ashbach is one of those people waiting for the vaccine in Caldwell County, and she is not enjoying the waiting game.

“It’s very frustrating,” Ashbach said. “It’s just a waiting game I guess. Just waiting, trying to be patient.”

Ashbach is in a rush to get the vaccine, because she is over the age of 65, and works in a place where not all of her co-workers are wearing their masks. She has been on the waitlist for more than a week.



The Tri-County Health Department covers DeKalb, Worth and Gentry counties in northwest Missouri. It has a wait list of 1,500 people, and has had to add another phone line for the department to handle incoming calls. In addition, department administrator Teresa McDonald has four cell phones in order to take all of the calls trying to schedule vaccination appointments, and the lines have still been backed up.

DeKalb County has vaccinated 3% of its population. Gentry has given shots to 9.6% of its population. And 8.1% of the population in Worth has received a dose.

Worth doesn’t even have a vaccine distribution center. People who live independently have to travel out of the county to Albany or Stanberry to receive their shots. McDonald said they will go to Worth if people in nursing homes need a dose.

“If they live in a facility, then we will go to them,” McDonald said. “We don’t want 30 90-year-olds on a bus trying to get to us.”

Tri-County’s most recent shipment was 90 vaccines, but it is planning on having another 640 doses by the end of this week.

The state has faced a lot of scrutiny in the last week from media and state representatives for not getting enough shots administered to the people.

State Sen. Tony Luetkemeyer, whose district includes Buchanan and Platte counties, wrote in a letter last week to Randall Williams, director of Missouri’s Department of Health and Senior Services:

“I am aware of the challenges before us, but those challenges underscore the need for the Department to proactively ensure the allocation of resources and implementation of an effective vaccine administration plan. The only metric that matters right now is getting vaccines into the arms of those who need it.”

Gov. Mike Parson has tweeted out higher amounts of doses administered than the Centers for Disease Control and Prevention’s COVID data tracker. Missouri’s COVID vaccine dashboard, launched last week, shows the state has administered 530,485 total doses as of Feb. 2, compared to the CDC’s data showing 462,202 doses administered. The CDC’s data page does say numbers may differ from data reported by the state.

Patience for Patients

Rural health departments such as in Mercer County are limited in the number of doses they can give out in a day. Finney said she can only distribute 50 shots in a day. This has made the process slow, and has made citizens impatient.

“On top of everything else, people are upset about contact tracing and quarantine,” Finney said. “So we’ve not been in a great situation in the public’s eye there, or appreciated… and then you throw this on top.”

Ashbach and Little both expressed frustration with their health department. But Carman has urged people to be patient, as they wait for more shots to come in.

“It’s just so slow, because (we have to) be able to get the vaccine in, and we have so much demand, we can only get a delivery once a week.”

Jacob Douglas covers rural affairs for Kansas City PBS in cooperation with Report for America.

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