Over the past few weeks, Texas has been grappling with a major question: who gets immediate access to the first round of COVID-19 vaccines from Pfizer, set to arrive Monday?
A little over a week ago, the Texas Department of State Health Services gave the most detailed answer yet to that looming question. It published a list of hospitals in 34 Texas counties who will get shipments of the vaccine in the first week.
Big hospital systems associated with the Texas Medical Center made the list, like Texas Houston Methodist, Texas Children's and Memorial Hermann. Overall, Harris County health workers are set to receive 50,000 initial doses.
But while some mid-sized counties were represented, all rural counties were excluded.
"(There was) a lot of frustration and a lot of questions about why urban nurses are more valuable than a rural nurse," said John Henderson, the CEO of the Texas Organization of Rural & Community Hospitals, or TORCH — a group that advocates for 157 rural hospitals in Texas, including some on the outskirts of Houston.
DSHS set a limit that only hospitals with at least 975 employees can qualify for this first week's shipment.
TORCH sent the state a letter saying the requirement effectively locks out all rural communities, even though they've been dealing with COVID-19 hotspots.
"(Rural hospitals) come to me and say ‘we’re holding up, but we are exhausted,'" Henderson said. "When you have hope in a vaccine that doesn’t materialize, it's disappointing. We could have made a few 1000 doses go a long way."
Chris Van Deusen, a spokesperson with the Texas Department of State Health Services, says the agency made this decision because the Pfizer vaccine is logistically challenging to distribute. Shipments come in batches of at least 975 doses that must be kept in -100°F conditions, which bigger hospitals are more likely to have.
"I think the most important thing to remember that this is just week one," Van Deusen said. "I just want to assure people that there is more vaccine in week two, three and four and we will be able to reach much more widely across the state."
TORCH argues that rural hospitals have workarounds for these challenges, such as pooling together hospital employees in rural regions and independently distributing the batches of 975 doses. And, the group says, rural ER physicians and nurses are in shorter supply than in major metro areas, meaning losing just a few to quarantine or illness could lead to a staffing crisis.
The first doses of the COVID-19 vaccine were set to be received by hospitals across the country on Monday. In Texas, distributions will happen in phases, with frontline health care workers among the first to recieve the vaccine. Phase 2 will focus on increasing the number of doses to criticial populations. The general public is expected to get vaccinated beginning in July, according to state heath officials.
The CDC has highlighted rural communities as a critical group in discussion over vaccine prioritization. That's because they have "limited access to routine vaccination services."
Mary Beth Bess, director of the Chambers County Health Department east of Houston, said she expected obstacles with getting the vaccine to health workers and, later down the line, the general population.
"We’re going to face a lot of challenges at first," Bess said. "We don’t have a lot of local health care providers that will initially be able to give all of the vaccine, but I feel like we’ll be able to meet all the needs of our community."
One reason for the struggle to register vaccine providers is that many of them are dealing with a crush of COVID-19 patients right now, making it hard to meet all the requirements on such a short timeline. Chambers County currently has the highest numbers of coronavirus infections per capita in the region.
The county already experiences problems with access to health care and transportation. During past disasters, such as hurricanes, the county has learned to stretch the resources they have, Bess said.
"Being sandwiched in between larger jurisdictions, we do face difficulties in obtaining resources — just historically, that’s happened," she said. "But when that does happen, we pull together locally."
As a result, it's common for residents to visit neighboring Harris or Jefferson counties for their health care needs.
"We know that a lot of people will get their vaccine in another county — which is great," said Bess. "We want the people to get vaccinated wherever they can get vaccinated."
Sara Willa Ernst is a corps member with Report For America, a national service program that places journalists into local newsrooms. Sara’s work at Houston Public Media is made possible with support from KERA.