Only half of rural voters know that Democrats voted to send them stimulus checks, new poll finds

biden stimulus hurdles
President Joe Biden.

  • A poll conducted by a rural super PAC found only half of rural voters credit Democrats with stimulus checks.
  • This is notable given that not a single Republican voted for Biden’s $1.9 trillion stimulus.
  • A persistent feature of American politics is voters’ failure to understand government’s role in their lives.
  • See more stories on Insider’s business page.

Americans have so far received three stimulus checks. The first two were distributed under President Donald Trump’s watch and not a single Republican voted for the third round, and yet, only half of rural voters are giving Democrats the credit.

A poll conducted by Rural Objective PAC – a super PAC that works to build support for Democrats in rural areas – found that 50% of voters in rural areas associate providing COVID-19 stimulus checks directly to American families with the Democratic Party, while 32% associated the payments with Republicans, 11% with neither party, and 7% weren’t sure.

“We’re not connecting with these voters, even if we have great policy,” JD Scholten, the executive director of the Rural Objective PAC, told Greg Sargent and Paul Waldman of The Washington Post, which previously reported on the poll’s findings.

The poll surveyed 2,149 voters in nine battleground states – Arizona, Georgia, Iowa, Kansas, North Carolina, Ohio, Pennsylvania, South Carolina, and Wisconsin – and while 68% of those voters support stimulus checks, it’s clear that Democrats aren’t getting credit for a cornerstone of President Joe Biden’s American Rescue Plan.

The majority of rural voters did associate Democrats with extended unemployment benefits and state aid, though, and even as Democrats are calling for recurring stimulus aid, voters are not associating the already provided aid with Democrats. Biden’s $1.9 trillion stimulus plan passed using budget reconciliation without a single Republican voting for the plan, which included $1,200 checks.

It’s true that the first two checks occurred under Trump, since he signed a $1,400 check and a $600 check into law as part of his pandemic aid efforts, although he signed both of those while Democrats controlled the House under Speaker Nancy Pelosi.

Some Democratic lawmakers are also calling to make stimulus checks permanent – something that has received broad support from both Republican and Democratic voters given that it would cut the number of Americans in poverty in 2021 from 44 million to 16 million.

Twenty-one Democratic senators urged Biden in a letter to include recurring direct payments in his $4 trillion infrastructure plan and said that “a single direct payment will not last long for most families, and we are worried about the cliff facing unemployed workers when the unemployment insurance extensions expire on September 6.”

But voters not knowing who to credit for certain policies is nothing new. When former President Barack Obama was attempting to reform the healthcare system over a decade ago, many voters don’t want the government to interfere with their Medicare when Medicare is, in fact, a government-run program.

“I got a letter the other day from a woman. She said, ‘I don’t want government-run health care. I don’t want socialized medicine. And don’t touch my Medicare,'” President Barack Obama said at an AARP-hosted town hall on healthcare in 2009. “I wanted to say, you know, that’s what Medicare is: a government-run health care plan that people are very happy with.”

The Washington Post separately reported in 2009 that a rural voter told South Carolina Rep. Robert Inglis to “keep your government hands off my Medicare,” to which Inglis had to explain to the voter that his healthcare was provided by the government.

As Scholten told the Post, if there’s one thing that Democrats could use to win support of rural America, it would be direct payments.

“This was one of the biggest investments we’ve seen in rural America since the New Deal,” Scholten told Sargent and Waldman. “It’s good policy. It should be good politics, too, but right now Democrats aren’t taking advantage of it.”

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I am a Leftist, trans woman living in the rural South and a gun owner. Biden’s proposed gun control legislation will only help the far right.

Magee Homestead, Wyoming - Gun Range
A shooting range in Wyoming.

  • After the Pulse nightclub shooting and several doxxing attempts, I decided to become a gun owner.
  • Most people who do not own guns do not understand how complicated and arbitrary gun law really is.
  • Biden’s proposed gun legislation misunderstands gun ownership and will only help far-right recruitment.
  • Margaret Killjoy is an author, musician, and podcaster living in the Appalachian mountains.
  • This is an opinion column. The thoughts expressed are those of the author.
  • See more stories on Insider’s business page.

It was the Pulse nightclub shooting for me. I spent hours glued to the news, shaking with anger and fear. That hate crime sent plenty of people in search of more restrictive gun laws, but it sent me and an awful lot of others in the opposite direction. Over the next few years, I started going to shooting ranges more. I took a two-day concealed carry class. Now, like millions of Americans, I’m a gun owner. Importantly, I’m part of what looks like a demographic shift in gun ownership in the US.

I’m a woman in the rural South, and I’m very visibly trans. I unintentionally find myself in the center of a culture war; the way people treat me, in cities or the countryside, has changed dramatically since Trump’s election in 2016. The stares are longer, the sneers more open. Before gender identity became so politicized in the past few years, I was a curiosity. Now, I’m a walking symbol of everything the far-right hates.

Through my activism and my art, I have found myself in the crosshairs of the local far-right. A local news outlet once ran a satanic-panic style story about one of my music videos, and the more overtly fascist groups have sent me pictures of my family alongside my license plate number and home address.

I have always supposed that my safety is something I need to guarantee for myself – that no one else was going to do it for me. Since the people who hate people like me are famously well-armed, I determined I would be as well.

It wasn’t a simple decision, nor one that I would ever recommend anyone take lightly. The risk-benefit analysis of owning a tool like a firearm must always be ongoing. Yet as I’ve become increasingly comfortable with firearms, I’ve also come to realize just how misguided most efforts at gun control truly are.

Biden’s gun control legislation is misguided

Frankly, I believe that Biden’s executive orders and proposed legislation will disproportionately affect marginalized groups, both in terms of enforcement and in terms of access to the tools of self-defense. Because the legislation does not understand the gun community, I also believe the proposed laws are a gift to the far-right’s recruitment efforts.

When people talk about “common sense gun laws,” it sure feels like they mean the opposite. Gun owners are very aware of the labyrinthine laws that surround the ownership and use of guns, how they vary state by state, and what will and won’t bring the Bureau of Alcohol, Tobacco, and Firearms (ATF) down on their heads. Many attempts to make laws more “common sense” end up making them even more confusing and contradictory – and can easily criminalize people who are trying to follow the law.

Take the arm brace for example. An arm brace on a pistol allows you to shoot more accurately. In 2014, the ATF ruled that you could stabilize the brace against your shoulder, if you wanted, without the gun being considered a short-barreled rifle, which are more heavily regulated and taxed. Then in 2015, they changed their mind. The exact same legal firearm, owned by millions, would be legal if shot normally, but illegal if shot with the arm brace held against the shoulder – unless the gun owner paid a $200 tax and filed the right paperwork. In 2017, they reversed again. All this because of quibbles over the definition of a rifle, which isn’t legally concealable, whereas a pistol often is.

Now Biden wants to say people can’t have this pistol, modified with the arm brace, at all without registering it and paying potentially hundreds of dollars.

That is to say, Biden is telling millions of law-abiding Americans that they better pony up hundreds of dollars or else become criminals because of arbitrary distinctions in the length of the barrel of a gun they own. If the goal of legislation is to prevent mass shootings, calling a pistol fitted with an arm brace a rifle – and thus illegal to conceal – is the most unhelpful of legal technicalities. Shooters planning to murder a crowd of people are not concerned with the legality of how they carry their gun.

This type of legislation is a gift to far-right recruitment, which, according to leaked Telegram chats, relies on using gun rights advocacy and the fear of gun confiscation to push people further to the right. One recruitment guide listed gun control as a way to “find common ground” before introducing someone to more fringe ideas. Guns should never have become a right versus left issue.

I grew up largely outside of gun culture. My father is a Marine with a medal for marksmanship, and I shot a .22 at Boy Scout camp in middle school, but guns didn’t play any large role in my life.

When you don’t own a gun, it’s really hard to care about gun law. It doesn’t risk criminalizing you or too many people you know. We live in bubbles in the US. If you own a gun, your friends likely do too. If you don’t, your friends probably don’t.

Most advocates for gun control do not understand firearms, firearm law, or firearm culture. When people tell you what to do, while making it clear they don’t have the first idea what they’re talking about, it is always going to rub you the wrong way.

I own a gun and most of my neighbors own guns. Some of them hunt. Some of them are veterans. Some of them are concerned with self-defense. My neighbors in rural North Carolina, just like my neighbors when I’ve lived in major cities, run the full gamut of political affiliations. None of them operate under the illusion that the police would keep them safe in case of an emergency. Safety comes from knowing your neighbors. Safety comes, sometimes, from being armed.

Gun ownership as a symbol

What I didn’t realize, until I was in the environment I’m in now, is the importance of the gun as a symbol for many communities. A rifle in a safe, or a handgun on a bed stand, says, “I’ll never go hungry, because I can hunt.” It also says, “I will not be a passive victim of a violent attack.” It says: “Me and the people I love are the ones who keep ourselves fed and safe.”

Taking that away from someone, or just making it even more legally complex to own a gun, will never go over well. No amount of statistics will ever outweigh the emotional and symbolic importance of that ability for self-determination. The far-right heavily leverages that symbolic weight for recruitment – perhaps more than anything else.

I’m not advocating for universal gun ownership. I don’t believe an armed society is a polite society. I also recognize that for a lot of people – maybe even most people – gun ownership makes them less safe instead of more safe

But it’s poverty, patriarchy, and racist policing that drives most gun violence, and those underlying issues are where change ought to be focused.

There’s a slogan, albeit a cynical one, that people involved in mutual aid organizing use that resonates a lot with me: “We keep us safe.”

There are people who want to hurt me for who I am, and I don’t want to let them. My safety is my responsibility. Maybe it shouldn’t be, in some perfect society, but we don’t live in a perfect society. We live in the USA.

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To reconnect with rural voters, Democrats must invest in local renewable energy projects

solar panels water treatment rural colorado
Mark Russell, public works superintendent, pulls on an anchor of a floating solar array that feeds into the power supply of a water treatment plant in rural Colorado on Thursday, August 22, 2019.

  • Democrats did poorly among rural voters in the 2020 election. 
  • To reconnect with rural America, lawmakers can spur economic growth with local renewable energy projects. 
  • Communities are already on board, and the investment would create millions of jobs and slow the effects of climate change. 
  • Brandon Presley is Public Service Commissioner for the Northern District of Mississippi.
  • Jeff Cramer is executive director for the Coalition for Community Solar Access, a national trade association representing innovative businesses and nonprofits working to expand customer choice and access to solar for all American households and businesses through community solar.
  • Jigar Shah is president and co-founder of Generate Capital. 
  • This is an opinion column. The thoughts expressed are those of the authors. 
  • Visit the Business section of Insider for more stories.

President Joe Biden may have won the 2020 election by the largest margin against an incumbent since 1932, but more than 74 million Americans – close to half of all the people who cast a ballot – voted for the incumbent.  

Nowhere is this disconnect between the Democratic Party and voters more stark than among rural Americans. As Biden won in cities and towns, former President Donald Trump dominated in the rural regions. 

There are many reasons Biden did poorly in rural areas, but chief among them is that rural communities have seen little appreciable economic development since the rise of candidate Bill Clinton in 1992. Across the country, so-called “non-metro” regions have remained bound by sluggish economic growth, higher poverty rates, stagnant job creation, and little room for upward mobility

Even as COVID raged – and rages – with the death toll soaring past 280,000 in 2020, rural voters’ chief concern, as the election neared, shifted from the coronavirus to the economy. And the Republican Party has effectively and steadfastly homed in on these fiscal concerns.

To borrow from Clinton’s chief ’92 strategist, it’s the (rural) economy, stupid. 

Local renewable energy projects can strengthen rural communities

Democrats now have a singular opportunity to offer a clear economic vision for rural America. With the start of a new administration and an urgent need for broad economic stimulus, lawmakers – and the nation as a whole –  not only have the opportunity to rebuild the nation, from its bridges to its transmission grids, they also have the chance to reconnect with rural voters by reinvigorating local economies and putting America’s rural counties first. 

Lawmakers can achieve this with a clean energy “Marshall Plan” that will empower rural communities with local renewable power, millions of new jobs, billions of dollars in economic activity, slashed health costs, and, yes, help slow climate change. 

Take the Samson Solar Center in Texas as an example: This $1.6 billion project in Lamar, Red River, and Franklin counties, announced in November, will support up to 600 jobs through its three-year construction period. What’s more, the project promises more than $250 million in payments to local landowners, and another $200 million in property-tax payments to local communities over the lifetime of the project. 

This utility-scale project – once built, the biggest in the US – is just one type of rural clean-energy investment. Thousands of smaller ones can be built across rural America – not top-down from big corporations or the federal government, but built locally from the ground-up by the nation’s rural electric co-ops. 

Rural co-ops once revolutionized American energy, bringing electricity to the communities too small or isolated for the big utilities to bother with. Decades since that effort, they’ve become saddled with the most expensive coal-fired power plants in the country, costing families an extra billion dollars a year while imposing enormous health costs from the pollution.

But due to innovative local leadership, rural electric co-ops have, with little fanfare, become hotbeds of innovation in America’s energy economy – creating millions of local jobs in the process. In Mississippi, for example, the Public Service Commission has steadily expanded solar generation – not only with large, utility-scale projects like the one in Texas, but with smaller, locally managed solar farms. 

This locally-managed effort has catapulted the Magnolia State, with its deep-red bona fides, into the top ranks of green energy generation. In fact, more than 500 rural co-ops in 43 states have started implementing solar power. With access to cheap land, plummeting costs for solar, and subsidized loans from the federal government to convert all of their electricity generation to renewable energy, this transition is accelerating.

Many communities are already on board

This shouldn’t be surprising. We’ve long known that conservative and liberal voters alike broadly support clean energy investment – Democrats largely for the environmental reasons, Republicans for the cost savings and energy independence that solar delivers. 

Community and rooftop solar or “local solar” projects, like the kind implemented in Mississippi, enhance these benefits – especially when paired with batteries to provide around-the-clock power. Local solar systems, for example, can save consumers a half a trillion dollars over the next three decades. And that’s before even including so-called “indirect” benefits like job growth, economic investment, and the health, social, and environmental benefits of less pollution.

State lawmakers, of both parties, are finally starting to catch on. In Pennsylvania, for example, Republican lawmakers, with support from the state farm bureau, backed a bill for community solar. The legislation didn’t quite make it to the governor’s office, but momentum is growing. 

Rural co-ops have far less red tape than traditional utilities and grid operators, allowing them to move more quickly and at lower cost. It’s of course far easier to build infrastructure in less densely populated areas. The electricity these resources generate is cheaper than coal, gas, or oil, saving money for local landowners. And the projects are locally sited, empowering communities to make the pragmatic choices that are best for them. That’s a win-win-win-win.

The Biden administration entered office pledging to Build Back Better, at the plan’s centerpiece a $2 trillion clean energy roadmap. But energy, like politics, is local. To best succeed, and reestablish a long lost connection with rural voters, lawmakers must harness the work and innovation in America’s rural communities, and empower them to lead the way.

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5 ways the Biden administration can bridge the divide between rural and urban America

A worker at a hog processing plant eats behind plexiglass screens installed in the facility's cafeteria to try to contain the spread of the coronavirus disease (COVID-19) within the plant, in Guymon, Oklahoma, U.S., May 13, 2020. Picture taken May 13, 2020. Seaboard Foods Inc./Handout via REUTERS
A worker eats behind plexiglass screens at a cafeteria in Guymon, Oklahoma in May 2020.

  • Rural and urban America are experiencing a cultural, economic, and ideological divide that has only grown wider in recent years.
  • Law professors Ann Eisenberg, Jessica A. Shoemaker, and Lisa R. Pruitt say the Biden administration can help bridge this divide by allocating government resources to the programs that distressed rural communities need.
  • Improving K-12 schools, providing internet access to isolated areas, and addressing hunger and childcare needs can make a world of difference to low-income and marginalized communities around the US. 
  • Visit Business Insider’s homepage for more stories.

It’s no secret that rural and urban people have grown apart culturally and economically in recent years. A quick glance at the media – especially social media – confirms an ideological gap has also widened.

City folks have long been detached from rural conditions. Even in the 1700s, urbanites labeled rural people as backward or different. And lately, urban views of rural people have deteriorated.

All three of us are law professors who study and advocate intervention to assist distressed rural communities. The response we often hear is, “You expect me to care about those far-off places, especially given the way the people there vote?”

Our answer is “yes.”

Rural communities provide much of the food and energy that fuel our lives. They are made up of people who, after decades of exploitative resource extraction and neglect, need strong connective infrastructure and opportunities to pursue regional prosperity. A lack of investment in broadband, schools, jobs, sustainable farms, hospitals, roads, and even the US Postal Service has increasingly driven rural voters to seek change from national politics. And this sharp hunger for change gave Trump’s promises to disrupt the status quo particular appeal in rural areas.

Metropolitan stakeholders often complain that the Electoral College and US Senate give less populous states disproportionate power nationally. Yet that power has not steered enough resources, infrastructure investment, and jobs to rural America for communities to survive and thrive.

So, how can the federal government help?

Based on our years of research into rural issues, here are five federal initiatives that would go a long way toward empowering distressed rural communities to improve their destinies, while also helping bridge the urban/rural divide.

1. Get high-speed internet to the rest of rural America

The COVID-19 era has made more acute something rural communities were already familiar with: High-speed internet is the gateway to everything. Education, work, health care, information access, and even a social life depend directly on broadband.

Yet 22.3% of rural residents and 27.7% of tribal lands residents lacked access to high-speed internet as of 2018, compared with 1.5% of urban residents.

The Trump administration undermined progress on the digital divide in 2018 by reversing an Obama-era rule that categorized broadband as a public utility, like electricity. When broadband was regulated as a utility, the government could ensure fairer access even in regions that were less profitable for service providers. The reversal left rural communities more vulnerable to the whims of competitive markets.

Although President Joe Biden has signaled support for rural broadband expansion, it’s not yet clear what the Federal Communications Commission might do under his leadership. Recategorizing broadband as a public utility could help close the digital divide.

Read more: Here’s what the Biden administration must do to quickly – and easily – win over the crypto community and take advantage of big economic potential

2. Help local governments avoid going broke

It’s easy to take for granted the everyday things local governments do, like trash pickup, building code enforcement, and overseeing public health. So, what happens when a local government goes broke?

A lot of rural local governments are dealing with an invisible crisis of fiscal collapse. Regions that have lost traditional livelihoods in manufacturing, mining, timber, and agriculture are stuck in a downward cycle: Jobs loss and population decline mean less tax revenue to keep local government running.

Federal institutions could help by expanding capacity-building programs, like Community Development Block Grants and Rural Economic Development Loans and Grants that let communities invest in long-term assets like main street improvements and housing.

Rural activists are also calling for a federal office of rural prosperity or economic transitions that could provide leadership on the widespread need to reverse declining rural communities’ fates.

3. Rein in big agriculture

Only 6% of rural people still live in counties with economies that are farming dependent.

Decades of policies favoring consolidation of agriculture have emptied out large swaths of rural landscapes. The top 8% of farms in America now own more than 70% of American farmland and the rural people who remain increasingly bear the brunt of decisions made in urban agribusiness boardrooms.

Rural communities get less and less of the wealth. Those in counties with industrialized agriculture are more likely to have unsafe drinking water, lower incomes, and greater economic inequality.

What many rural people want from agricultural policy is increased antitrust enforcement to break up agricultural monopolies, improved conditions for agricultural workers, conservation policies that actually protect rural health, and a food policy that addresses rural hunger, which outpaces food insecurity in urban areas.

Access to affordable land is another huge issue. Beginning farmers cite that as their biggest obstacle. Federal support for these new farmers, like that imagined in the proposed Justice for Black Farmers Act or in other property-law reforms, could help rebuild an agriculture system that is diversified, sustainable, and rooted in close connections to rural communities.

Biden’s plan to bring former Secretary of Agriculture Tom Vilsack back in the same role he held in the Obama administration has cast doubt on whether Biden is really committed to change. Vilsack built a suspect record on racial equity and has spent the past four years as a marketing executive for big dairy, leading many to worry his leadership will result in “agribusiness as usual.”

Read more: Here’s what the Biden administration must do to quickly – and easily – win over the crypto community and take advantage of big economic potential

4. Pursue broad racial justice in rural America

One in five rural residents are people of color, and they are two to three times more likely to be poor than rural whites. Diverse rural residents are also significantly more likely to live in impoverished areas that have been described as “rural ghettos.”

More than 98% of US agricultural land is owned by white people, while over 83% of farmworkers are Hispanic.

Criminal justice and law enforcement reforms occurring in cities are less likely to reach small or remote communities, leaving rural minorities vulnerable to discrimination and vigilantism, with limited avenues for redress.

At a minimum, the federal government can enhance workplace protections for farm laborers, strengthen protections of ancestral lands and tribal sovereignty and provide leadership for improving rural access to justice.

5. Focus on the basics

People who live in distressed rural communities have important place-based connections. In many cases, the idea of “just move someplace elseis a myth.

The greatest historic progress on rural poverty followed large-scale federal intervention via Franklin Roosevelt’s New Deal and Lyndon Johnson’s War on Poverty. Although these reforms were implemented in ways that were racially unjust, they offer models for ameliorating rural poverty.

They created public jobs programs that addressed important social needs like conservation and school building repair; established relationships between universities and communities for agricultural and economic progress; provided federal funding for K-12 schools and made higher education more affordable; and expanded the social safety net to address hunger and other health needs.

A new federal antipoverty program – which urban communities also need – could go a long way to improving rural quality of life. The 2009 American Recovery and Reinvestment Act targeted many of these issues. But urban communities’ quicker and stronger recovery from the Great Recession than rural ones shows that this program neglected key rural challenges.

Some of these steps will also require Congress’s involvement. So the question is, will federal leadership take the bold steps necessary to address rural marginalization and start mending these divisions? Or will it pay lip service to those steps while continuing the patterns of neglect and exploitation that have gotten the US to where it is today: facing an untenable stalemate shaped by inequality and mutual distrust.

The Conversation

The Conversation


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Why getting COVID-19 vaccines to rural Americans is harder than it looks

Pfizer Vaccine Transport
The Pfizer vaccine is shipped in 975 doses and requires cold storage transportation.

  • With fewer health care providers, smaller hospitals, and limited access to information, many rural residents will have difficulty getting the COVID-19 vaccine once it rolls out to the general public. 
  • Pfizer and BioNTech and Moderna — the two authorized mRNA vaccines — are only delivered in large batches, and must be shipped and handled in cold temperatures, which puts a strain on rural hospitals. 
  • Misinformation can also affect rural residents, who rely heavily on media, word of mouth, politics, and religion to determine whether or not they should receive the vaccine. 
  • Getting vaccines to rural areas will potentially require new shipping and storage processes, doses with less stringent storage requirements, and community pharmacies to deliver the vaccine to patients. 
  • Visit Business Insider’s homepage for more stories.

The enormous job of vaccinating the nation is underway, but for rural Americans, getting a COVID-19 vaccine becomes harder the farther they are from urban centers.

The current vaccines’ cold storage requirements and shipping rules mean many rural hospitals can’t serve as vaccination distribution hubs. That can leave rural residents – about 20% of the US population – traveling long distances, if they’re able to travel at all.

Getting the word to rural residents about when they can be vaccinated isn’t easy either, and the extraordinary amount of misinformation downplaying the risk of the coronavirus this past year has had an impact on rural residents’ willingness to get the vaccine.

We work in rural health care settings and have been examining the barriers to health care for these patients to find ways to ensure health and safety.

Read more: Biotech execs hunting for COVID-19 vaccines and treatments have raked in more than $1 billion by selling company stock this year. Here are the 27 leaders who’ve cashed in the most.

The problem with big batches and cold storage

The first two authorized vaccines – one made by Pfizer and BioNTech and the other by Moderna – are mRNA vaccines. It’s a new type of vaccine that uses the molecular instructions for building virus proteins rather than injecting parts of the weakened virus itself. Both must be kept in very cold temperatures.

To ensure stability, the vaccine doses are shipped in special containers with dry ice, and for now, vaccines are being delivered only in large batches.

The Pfizer vaccine is shipped in increments of 975 doses, which creates a challenge for small hospitals. Urban areas will be able to quickly distribute those doses, but finding enough patients to vaccinate quickly in rural areas may prove more difficult.

Moderna’s vaccine is somewhat more manageable, with a minimum order of 100 doses.

Both vaccines also require two doses per person, with the second dose of Pfizer’s vaccine given 21 days later and Moderna’s 28 days later.

As a result, the vaccine distribution efforts will favor hubs that cater to more populated areas to avoid wasting any vaccine or leaving patients unable to get their second dose.

Cold storage is another challenge, since small hospitals are less likely to have expensive freezers. The Pfizer vaccine must be stored at minus 94 degrees Fahrenheit (minus 70 Celsius) and Moderna’s at minus 4 Fahrenheit. There are limits on how many times the vaccine shipping containers can be opened and how quickly the vaccines must be distributed. Once thawed and prepared, the Pfizer vaccine must be used within five days and Moderna’s within 30 days.

Each patient must receive both doses of the vaccine from the same manufacturer to ensure safety and effectiveness, adding to the challenge. Manufacturers have included personal dosing cards for patients to carry with them to help.

Read more: Here’s how 9 leading drugmakers are racing to develop a new kind of coronavirus treatment despite an early setback

Rural America’s take on COVID-19 and vaccines

Rural America already has difficult barriers to health care access.

It has fewer health care providers serving a more geographically diverse population than in metropolitan communities. And in many of these areas, rural hospitals have been closing at an alarming rate, leaving people to travel farther for care. The population is also older. Public transportation that could help poor or elderly residents reach hospitals is rare, and distance and geography, such as mountain roads, can mean driving to those sites takes time.

Getting accurate information about the vaccine and how to receive it into rural areas has also proved difficult. Many rural counties still have limited access to broadband internet connections, smartphone service, and other technologies. That often means residents rely on television, newspapers, and radio for news, which can limit the depth and scope of information.

While some rural counties have started getting the word out, many don’t not seem to have specific plans on how to inform their residents about how and when each person can get the vaccine, let alone specific plans for actually giving it. They often rely just on local press releases that many residents never see.

Rural nonprofit health care organizations have tried to bridge that gap and improve rural communications about vaccines and the pandemic. Care Compass Network, which coordinates organizations across southern New York, has offered educational webinars with the latest information about the virus and the vaccines, for example. But there is still much work to do.

Rural Americans’ views on vaccines are influenced by media and word of mouth, politics, and religion, as well as previous experience with vaccinations and, perhaps most importantly, the difficulty of accessing health care.

In a survey conducted by the Kaiser Family Foundation in December, about 35% of rural Americans said they probably or definitely would not get the vaccine, higher than the 27% nationwide.

Read more: We just got our first promising data on a new kind of drug to treat COVID-19. Here’s how Lilly and 13 other top drugmakers are sprinting to develop vaccines or treatments that can halt this pandemic.

Small batches, new vaccines, and pharmacies

Getting enough of the US vaccinated to eventually end the pandemic will require more work in all of these areas. That includes improving shipping and storage processes so orders can be broken up and distributed to smaller hospitals, distributing more vaccine doses, and improving communication.

With Moderna’s vaccine arriving in smaller batches and not requiring such low temperatures for stability, it may prove to be more accessible for rural areas. Utah has already taken advantage of those characteristics to get initial doses to smaller hospitals and has started vaccinating health care providers. Pfizer has said it may be able to offer smaller batches by April.

Other vaccines on the horizon are also expected to have less stringent storage requirements and may potentially be delivered in one shot. The British government on December 30 authorized one of them, a two-dose vaccine made by AstraZeneca that can be stored in a normal refrigerator for six months. US officials are awaiting more testing on it, however, and don’t expect authorization for US use until April.

The falling number of rural hospitals also remains a challenge for getting vaccines to patients. Allowing community pharmacies to offer the vaccine – particularly if independent pharmacies are included – could eventually help expand the distribution network in rural areas.

This article was updated December 30 with the UK’s AstraZeneca vaccine authorization.

Bennett Doughty, clinical assistant professor, pharmacy practice, Binghamton University, State University of New York and Pamela Stewart Fahs, professor of rural nursing, Binghamton University, State University of New York

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Conversation
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Biden is expected to nominate Tom Vilsack as Secretary of Agriculture

Tom Vilsack
Former Secretary of Agriculture Tom Vilsack.

President-elect Joe Biden is expected to tap former Secretary of Agriculture Tom Vilsack to reprise his old job leading the department, according to a Wall Street Journal report.

Vilsack, a former two-term governor of Iowa who has deep roots in rural America, where Democrats have struggled mightily over the past two presidential cycles, led the Agriculture department from 2009 to 2017 during nearly the entire tenure of former President Barack Obama.

The former secretary has long supported Biden, backing the president-elect in November 2019 before the Iowa caucuses.

This story is developing. Check back for more updates.

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