NRHA's Grassroots Initiative To Target Rural Vaccine Hesitancy

CEO Alan Morgan, MPA, shares how COVID is continuing to affect rural communities and how rural health stakeholders can successfully target vaccine hesitancy in their communities.

Rural America has faced continued disparity in infection and death rates during the coronavirus pandemic.

According to a recent study by the Rural Policy Research Institute, the COVID-19 death rate in rural communities is double the level of urban communities. In mid-October, rural counties, which make up 14% of the U.S. population, accounted for 25% of COVID-19 related deaths in the country.

A new initiative from the National Rural Health Association (NRHA) is looking to change that through vaccination efforts in rural communities.

The Rural Vaccine Confidence Initiative, which launched in September in conjunction with the Rural Health Clinic Conference, is a grassroots effort to increase vaccination rates across rural communities. Its focus is spreading awareness and education on a local level and utilizing community leaders to help spread the messaging.

Alan Morgan, MPA, who serves as CEO of the NRHA, spoke with HealthLeaders about the initiative, how COVID is continuing to affect rural communities, and how rural health stakeholders can successfully target vaccine hesitancy in their communities.

This transcript has been lightly edited for clarity and brevity.

HealthLeaders: What is the ultimate goal of the initiative?

Alan Morgan: To save rural Americans.

COVID Is killing rural Americans at twice the rate of people in urban America. We're entering a new phase of the pandemic where we're seeing nationally the numbers decrease, but it's just not decreasing among rural populations.

As of Oct. 25, there was an 80% higher infection rate among rural Americans than urban. It's not surprising because while you've got 57% of the general population vaccinated, only 43% of rural America is vaccinated. You're seeing a situation where the rural populations, which are most at risk for COVID, have the lowest vaccination rates, and you're seeing the subsequent increase in both infections and mortality as a result.

Lower vaccination rates in rural communities are caused by many factors including cultural barriers among rural African American, Hispanic, and Latino communities; misinformation; lack of health access; and political messaging. These barriers are occurring among populations that are often times older with existing multiple chronic health conditions.

You'll continue to see that, and the danger is most people when they turn on national news and they see cases decreasing. They think, 'Oh, we're through with this.' People are going to be even more challenged trying to keep rural communities safe.

HL: How did the idea of this initiative come about?

Morgan: It was clear at the beginning of the year that from a communication standpoint, we were doing this wrong when it came to rural Americans. Sometimes, people view rural America as a small version of urban and it's not. It's a unique environment, and you need to approach it differently.

Early on, the messaging was that federal officials and health officials said you need to get vaccinated, and that is just a bad strategy. What we want to do is talk about this in a context that resonates with rural communities. Instead of the federal government saying you need to get vaccinated, let's talk about how to keep our community safe, how to keep our schools open, how to protect our small businesses, and changing that strategy to one of civic pride.

Part of that is recognizing the heightened risks that rural communities face. Rural communities have a greater percentage of their population older, sicker, and poorer, with fewer healthcare access points, and chronic health workforce shortages.

A lot of times, you hear communications talking about urban areas, and how do we keep those populations safe. There wasn't a discussion of why this is important, why it's relevant, and how do we talk about it from a rural perspective.

HL: A big part of this initiative is that it's a grassroots effort, where community leaders help play a role in the communication. How can rural hospital leaders support this initiative in their communities?

Morgan: In small towns across the U.S., rural hospitals are the largest employer, and in fact, healthcare is the largest employer in almost every rural county. When you talk about rural hospitals, you talk about their boards, and on their boards are business leaders, agriculture leaders, and members of the faith community, and those are the three key influencers that that need to be spreading the message.

We have found that the most successful strategy to date has been a local small-town clinician talking with their patients, saying, 'I know you. I know your family history. Here's why I think you need to get vaccinated.'

A large focal point in this is understanding that we're not going to make headway on relying on people from Washington, DC, we're going to need local leadership.

We've seen cases where that does work. Part of our effort is an ongoing basis. NRHA is currently recruiting "Pioneer Rural Hospital Messengers" who have agreed to track community vaccination rates while implementing our developed strategies and communication tools. We have identified rural hospitals that are implementing these new strategies, so we're real-time checking to see what works, what doesn't, and what initiatives work.

HL: How can rural hospital marketing teams utilize the communication toolkit to further drive the grassroots initiative?

Morgan: Small hospital marketing teams don't have the budgets that the large health systems do. So, we developed customizable tools, documents, and strategies, free of cost, that hospital marketing teams and communication teams can simply download, insert their own local information, and even bring in local leaders in the community, and plug them into these templates. It's just designed to make it so easy for them to have something that works in their community and is reflective of their own command.