A Learjet 31 took off before dawn from Helena Regional Airport in Montana, carrying six Veterans Affairs medical providers and 250 doses of historic cargo cradled in a plug-in cooler designed to minimize breakage.
Even in a condition where speed limits of 80 mph are normal, long-distance ground transportation is risky for Moderna mRNA-1273 vaccine, which must be used within 12 hours of thawing.
The group’s destination was Havre, Montana, 30 miles from the Canadian border. About 500 military veterans live in and around this small town of about 9,800 people, and millions more reside in rural and hard-to-reach areas in the United States.
About 2.7 million veterans who use the VA health system are classified as “rural” or “very rural” patients, residing in communities or on land with fewer services and less access to health care. than those in densely populated cities. According to the department, an additional 2 million veterans live in remote areas and are not receiving their VA health care. To ensure these rural vets have access to covid vaccines, the VA relies on a mix of tools, such as charter and commercial planes and partnerships with civilian health organizations.
The challenges of immunizing ex-combatants in rural areas – which the VA considers to be anything outside an urban population center – and “very rural” areas – defined as having less than 10% of the population. workforce moving to an urban center and with a population of no more than 2,500 – expand beyond geography, as more than 55% of them are 65 years or older and are at risk of severe cases of covid and only 65% can be reached via the Internet.
For the Le Havre event, VA clinic workers called every patient served by the Merril Lundman VA outpatient clinic in a large area made up of small farming and ranching communities and two Native American reservations. And for those who were hesitant to get vaccinated, a nurse called them back to answer questions.
“At least 10 more veterans chose to be vaccinated after we answered their questions,” said Judy Hayman, executive director of the Montana VA Health Care System, serving the state’s 147,000 square miles.
The Le Havre mission was a test flight for similar efforts in other rural areas. Thirteen days later, another plane took off for Kalispell, MT, carrying vaccines for 400 veterans.
In Alaska, another rural state, administrators at the Anchorage Veterans’ Medical Center on Thursday finalized plans for suppliers to take an Alaska Airlines commercial flight to Kodiak Island. There, VA workers were to administer 100 to 150 doses at an immunization clinic run in partnership with the Kodiak Area Native Association.
“Our goal is to vaccinate all veterans who have not been vaccinated in and around the Kodiak community,” said Tom Steinbrunner, acting director of the Alaska VA Health System.
VA began educating rural veterans for the immunization program late last year, as the Food and Drug Administration approached emergency use authorization issuance dates for Pfizer-BioNTech and Moderna vaccines. , according to Dr. Richard Stone, the acting officer of the Veterans Health Administration. assistant secretary. It made sense to turn to planes to deliver the vaccines. “It seemed logical to us to reach rural areas which, [like] in Montana, we had a contract with a company that had small propeller planes and short runway capability, ”said Stone, a retired Army Reserve Major General.
Veterans responded, Stone added, with more than 50% of rural veterans making appointments.
As of Wednesday, the VA had counted 220,992 confirmed cases of covid among veterans and VA employees and 10,065 known deaths, including 128 employees. As of Wednesday, VA had administered 1,344,210 doses of the Pfizer or Moderna vaccine, including 329,685 second vaccines, to veterans. According to the VA, about 25% of these ex-combatants live in rural areas, 2.81% live in very rural areas and 1.13% live on remote islands.
For rural areas, the VA has relied primarily on the Moderna vaccine, which requires cold storage between minus 25 degrees centigrade (minus 13 degrees Fahrenheit) and minus 15 degrees C (5 degrees F), but not the necessary freezer. to store the Pfizer vaccine (minus 70 degrees C or minus 94 degrees F). This, according to the VA, makes it more “transportable to rural areas”.
The VA predicts that the Johnson & Johnson single-dose vaccine, if it receives emergency use clearance from the FDA, will make it even easier to reach distant veterans. Moderna’s and Pfizer-BioNTech’s vaccines both require two injections, spaced a few weeks apart. “One dose will allow veterans in rural areas, who often have to travel long distances, to achieve their full immunization coverage,” VA spokeswoman Gina Jackson said. The FDA’s vaccine advisory committee is set to meet on February 26 to review J & J’s clearance request.
Meanwhile, in places like Alaska, where hundreds of veterans live outside the network, VA officials have had to get creative. Flying to serve individual veterans would be too expensive, which is why Anchorage VA Medical Center has partnered with tribal healthcare organizations to ensure veterans have access to a vaccine. Under these agreements, all veterans, including non-native veterans, can be seen in tribal facilities.
“This is our main outreach in much of Alaska because the tribal health system is the only health system in these communities,” said Steinbrunner.
In some rural areas, however, the process has proved frustrating. Army veteran John Hoefen, 73, served in Vietnam and has a 100% AV disability rating for Parkinson’s disease linked to exposure to Agent Orange. He is receiving his medical care from a VA site in Canandaigua, New York, 20 miles from his home, but the facility has not specified what phase of the vaccine rollout he is in, Hoefen said.
The hospital’s website simply says that a staff member will contact veterans when they become eligible – a “don’t call us, we’ll call you,” he said. “I know a lot of veterans like me who are 100% disabled and speechless,” Hoefen said. “I went there for audiology a few weeks ago and my technician had not even received his vaccine yet.”
VA Canandaigua referred questions about the current phase of the establishment to its website: “If you are eligible for a vaccine, your VA health care team will contact you by phone, SMS, or secure message (via MyHealtheVet) to take appointment, “it says. A call to the special covid-19 phone number set up for the Canandaigua VA, which falls under the department’s Finger Lakes Health System, places the caller on the main hospital services menu, without any specific information on vaccine distribution.
For the most part, the VA uses guidelines from the Centers for Disease Control and Prevention to determine priority groups for vaccines. After immunizing most of its health workers and first responders, as well as residents of VA nursing homes, it vaccinated those 75 and older, as well as those with chronic illnesses that put them at risk for severe cases of covid. In some places, like Anchorage and throughout Montana, clinics vaccinate people 65 and over and go walk-in when extra doses are available.
According to Lori FitzGerald, chief of pharmacy at VA Hospital in Fort Harrison, MT, providers ended up with extra doses that went to inpatients or veterans seen at the facility. Only one dose was wasted in Montana, she said.
To determine vaccine eligibility, facilities use databases and algorithms from the Veterans Health Administration Support Service Center to aid in the decision-making process. The facilities then notify veterans by mail, email, or phone or through VA portals of their eligibility and when they can expect to be vaccinated, depending on the department.
Air Force veteran Theresa Petersen, 83, was delighted that she and her husband, an 89-year-old U.S. Navy veteran, were able to get their shots at the Kalispell event. She said they had been informed by their primary care provider of the opportunity and jumped at the opportunity.
“I would do anything to give the Veterans Affairs medical system as much credit as possible,” said Petersen. “I’m so in love with the concept, ‘Yes there are people who live in rural America and they have health issues too. “”
The VA is authorized to provide vaccines only to veterans currently enrolled in VA health care. About 9 million US veterans are not registered with the VA, including 2 million rural veterans.
After veterans were turned away from a VA clinic in West Palm Beach, Florida in January, Rep. Debbie Wasserman Schultz (D-Fla.) Wrote to acting VA secretary Dat Tran urging her to include these veterans in their covid vaccination program.
Stone said the agency was not licensed to provide services to these veterans. “We have had discussions with Capitol Hill on how to reconcile this,” he said. “Some of them are very old veterans and we don’t want to turn anyone away. “
This story was originally published by Kaiser Health News.