Rural films Minari and Nomadland receive critical praise

As the pandemic keeps many of us at home, films and television provide an escape from the current reality. The impact of continued cultural development during the COVID-19 crisis is deftly captured by the words of Stephen King: “If you think artists are useless, try to spend your quarantine without music, books, poems, movies and paintings.”

With the release of Academy Award nominations and Golden Globe awards, such pomp may seem out of place this year. But the film awards circuit has brought to the spotlight two rural films that have achieved many firsts in the film industry and are bringing to households the rural United States as never before seen: Minari and Nomadland.

Minari is set in the Arkansas Ozarks during the 1980s and follows a Korean-American family as they pursue the American dream in a rural community. Director Lee Isaac Chung borrowed from his own childhood growing up on a farm in Lincoln, Arkansas. Filmed in Oklahoma during a hot summer, Chung directed much of the filming inside a double wide trailer, a home based on the one he dreamed of living in during his youth. Oklahoma hopes that the film’s success will bolster the state’s film industry, creating more jobs in the rural state.

Having won numerous Sundance Film Festival awards and six Oscar nominations, Minari’s receipt of the Golden Globe award for best foreign language film, rather than best drama, caused backlash. Although more than fifty-percent of the film’s dialogue is in Korean, Minari tells a quintessential American story of immigration, obstacles, and success. In creating his film, Chung expressed, “My friends back in Arkansas are the audience I wanted to connect with.”

Steven Yeun and Youn Yuh-jung, both lead actors in the film, along with producer Christina Oh made history in the awards circuits: Yeun is the first Asian-American to be nominated for best actor in a leading role, Youn is the first Korean actress to receive the Screen Actors Guild award for best female actor, and Oh is the first Asian-American to be nominated for best picture. It is troubling that such firsts are being made in 2021, and backlash over the lack of diversity in film awards ceremonies is well documented and deserved: “Since 1929, only 6.2 percent of minority actors and directors have gotten [nomination] nods.”

Nomadland, Minari’s fellow critical darling, is a film by director Chloé Zhao that follows a woman who leaves her remote, diminishing Nevada town to live out of her van as she traverses the American West. The movie highlights some stark realities of rurality in the United States, with remote towns across the country dwindling as residents leave and businesses close, discussed on Legal Ruralism here and here.

Filmed throughout South Dakota, Nomadland captures small-towns and rural expanses in the state, including Wall, where the infamous Wall Drug is located, and Scenic, whose current ownership is discussed in a blog post here. The state’s tourism sector is hopeful the success of the film will bring increased tourism to the filming locations: 

Movies have a tendency to inspire people and to really motivate them to travel to different places and… with the theme of the movie being outdoors and wide open spaces, I think it will really entice people to want to come out and to experience the Black Hills and Badlands area.

Director Zhao’s career illustrates a palpable love for the rural American West and specifically South Dakota, with all three of her feature films set in and filmed there. Her first film, Songs My Brothers Taught Me, follows a teenager and his family living in the Oglala Lakota Nation and Zhao engaged primarily local, non-actor residents for the film leads.

As a Chinese national who grew up in Beijing, Zhao found joy in the rural geography featured in Nomadland: 

As I fell in love with the American West, it was impossible not to become fascinated with the roads that lead to the many adventures beyond the horizon.

Zhao is the first woman of color to receive an Oscar nomination for best director.

These recent rural films add nuanced narratives of what it means to be rural in America. As Minari’s producer shared with the Daily Yonder, 

We wanted to make sure that everyone was, even in these rural areas, portrayed as people. Because we all are human beings after all. And we all come from different backgrounds and there’s no right way to human.

Total recall (Part III)

A volunteer for Gavin Newsom's "Stop the Republican Recall of Governor Newsom" campaign texted me yesterday. They said the recall attempt is being led by a collection of anti-maskers, anti-vaxxers and hardcore Trump supporters who want us to do less to fight COVID. Now matching the tone of those petitioning for the recall election, the California Governor has ramped up his campaign strategy since I last wrote about the issue weeks ago here. Now the recall is not only a partisan effort, but its led by radicals.

In my last post, I discussed a theory from an L.A. Times article that the recall campaign was rural, conservative Northern California's response to the Governor's prolonged and disproportionate lockdown of the region. Another post discussed this article and the author's firsthand experience in Colusa County. We both  noted that the article cited various sources suggesting the recall campaign was more of a mixed bag. My post ended by questioning how the Secretary of State reports the signatures and whether we could see where the petitioners are from. I wanted to know if the backlash was truly regional. 

Since my last post, the Secretary of State filed a new status report showing the most recent tally of signatures from each county (the next and final tally will be reported on April 19, 2021). As of March 11, 2021, Los Angeles County has the highest number of signatures at 181,846. That figure is not surprising purely considering LA county's massive population. Indeed, the only counties providing six-digit numbers are in Southern California: Los Angeles, Orange, Riverside, and San Diego. 

However, the picture of the recall in California looks different when you see the number of signatures per thousand residents in each county. As shown in this Redding Record Searchlight article, the map of support for the recall practically flips from Southern to Northern California. The report confirms that the highest per capita clusters of signatures came from rural communities. The Record Searchlight article notes:

At the top of the list supporting the recall are six counties accounting for at least three times the number of valid signatures expected compared to their populations. Between them, those counties — Placer, Tuolumne, Siskiyou, Sierra, Calaveras and Amador — delivered 58,329 valid signatures.

That county breakdown supports the theory that the recall campaign is coming from rural Northern and Eastern California along the Nevada border.

Just as the recall effort enters the final stretch, the state's COVID numbers are drastically improving. Today, Governor Newsom tweeted that California has administered more than twenty million vaccinations and the lowest positivity rate in the country. At this pace, the Governor announced his plan to fully reopen by June 15.

Winning on the ballot was an uphill battle for Newsom's opponents before there was a plan to reopen. If the state reopens on June 15, the arguments for recalling the Governor might fade with the memory of the pandemic. Northern California's fight not to be forgotten in this recall election will probably have to remind some of their petitioners to show up for the ballot, too.

Coronavirus in rural America (Part CXXVIII): Christians as recalcitrant on vaccines

This has been a theme in the national news the last few days.  Well, in fairness, only one of the three stories I consumed mentioned "rural," but all were focused on Christian evangelicals--mostly white--a  group often associated with rurality.  

The first story--the one that explicitly called out the rural--was from Blake Farmer, with Nashville's NPR station.  The lede for his story was:

An NPR/Marist poll found that rural, white Republicans — especially supporters of former President Trump — are among the least likely to get a vaccine. In rural Tennessee, we hear from some of them.

There are some amazing quotes in this article, but I'll focus on the ones from a few evangelical preachers who are anti-vaxxers and invoke Christianity to support their views:   

But it's rural communities where a few leaders are actively sowing doubts. They include state legislators and even a few pastors. Greg Locke is an outspoken preacher in Wilson County, Tenn., who peppers his sermons with mocking questions.

FARMER: People say, well, what are you going to do when they make the vaccine mandatory? And we'll tell them to take a hike like I've been telling them to take a hike. That's what I will do.

FARMER: Southern states where vaccination rates are lowest have seen ministers as key allies, but it's almost entirely Black churches agreeing to hold town halls or vaccine events. Pastor Omaran Lee has been working with churches and says the concerns in Black congregations aren't that different from what he hears from rural white communities.

OMARAN LEE: We don't trust the government, and we don't trust Joe Biden is what he said, right? Well, six months ago, it was, we don't trust the government, and we don't trust Donald Trump, right? Any time you have a marginalized person, you have people who are left out, they're going to be skeptical.

Two other stories, another on NPR and one in the New York Times, focused on Christian evangelicals without the rural angle specifically mentioned.  These stories suggest that national evangelical figures like Franklin Graham are supporting the vaccination campaign.  And here's a Politico story from last month on "selling" the vaccine to rural America.  Indeed, a quick search reveals lots of stories on the top of rural vaccine hesitancy, dating back to the vaccine's roll out in December.  

Rural in Biden's big infrastructure plan

 This is from NPR's report Wednesday, following the plan's announcement:  

Also, upgrading housing, schools and hospitals - a lot of focus on union jobs and helping underserved communities, both urban and rural. It specifically talks about trying to entice manufacturers to areas affected by a loss of coal jobs and helping address racial inequities by reconnecting neighborhoods that were cut off by previous highway-building.

Tamara Keith interviewed former U.S. Senator from North Dakota, Heidi Heitkamp, for the story:

HEIDI HEITKAMP: You get a bridge, and you get a bridge, and you get a bridge, and you get a road, and you get a hospital (laughter). It's the Oprah of infrastructure.

Keith also talked to Reverend William Barber of the Poor People's Campaign and asked him why Biden shouldn't do a little at a time, be piecemeal in the approach.  

WILLIAM BARBER:  Where you do the roads, but you don't prioritize rural and urban areas. Or you do the bridges, but you don't look at environmentally sustainable infrastructure jobs and the health care and the public health infrastructure and the training and the capacity. It's not or; it's and. It's and.

NPR ran another story on the plan by Kirk Siegler, who reports from out west.  That story featured the rural angle more prominently, but I have not been able to find a transcript of it online.  

Here's what the New York Times and the Washington Post had to say about the infrastructure bill.  

On rural lawyering--before and during the pandemic

Earlier this week, I was delighted to welcome 11 lawyers (10 of them UC Davis Law school alums) to my Law and Rural Livelihoods class to talk to the students about their careers and practices.   Four are in private practice, two work in county counsel offices, one is a tribal court judge, and the others do a range of public interest work.  They came to us (virtually, of course) from as far away as Del Norte County on the Oregon state line and as far south as San Luis Obispo County (SLO), specifically the communities of Atascadero and Avila.  

Here are just a few of the takeaways from the conversation. 

• Physical geography matters/can be a barrier:  The "grade" b/w "north county" and "south county" in San Luis Obispo County is significant for many who live there.  Folks in "south county," e.g., San Luis Obispo, Arroyo Grande, don't like to travel the grade, for example, to reach an attorney in "north county," and vice versa.  The attorney in Ukiah, the county seat of Mendocino County, said the same phenomenon (aversion to a "grade") applied there, as between Ukiah and Willets, where there was formerly a courthouse.  
• One attorney practicing in Avila, in SLO County, shares an office with her husband, a vineyard manager.  They have converted the office of an old plant nursery for this purpose.  
• The pandemic brought a 3- month closure to activity in the SLO County.  Then requirements to notice everything twice were imposed.  Now more people are "showing up" for hearings because they can hop on Zoom.  Previously, they would have had to take a half a day (at least) off work to come to the court house. 
• A big issue for estate planning attorneys in rural areas is how to divvy up farm and ranch land; what is a fair way to allocate that sort of wealth?
• The number of appearances by out-of-county attorneys in Lake County has risen since the beginning of the pandemic. 
• A public interest attorney working in the Sacramento Valley said she deals mostly with wage theft issues.  
• A tribal judge talked about the resources he has to allocate to support entire families, not just to "throw the book" of punitive criminal law at them. 
• There is no e-filing in Humboldt County, and it has only recently begun in Mendocino County.  
• In the "emerald triangle," nearly every matter that comes in is touched in one way or another by the marijuana trade/marijuana growing business.  
• Public interest attorneys who serve several rural and frontier counties from a relatively urban locale, e.g., Redding, Eureka, have seen some benefits from digital access to legal services for those living in more remote parts of their service area.  This is because those living hours from the legal aid office are not nudged out by those who live much closer and don't have to get up as early to get in a physical queue.  When all consultations are online, those living in remote and distant locales--assuming they have adequate internet/broadband connections--have equal opportunity for access with those living just down the street from the regional/relatively urban office.  

STEM programs for girls in rural America

Growing up in Colusa County, a USDA designated nonmetro county with a population of roughly 21,000 people, I was not able to participate in any STEM (science, technology, engineering and mathematics) programs. The first time I heard of STEM was at Boston College, where my roommate was in the school’s science program and part of Women in STEM, an organization fostering the role of women in STEM fields. As a political science major at Boston College, I was not involved in STEM programs and did not take any STEM courses beyond graduation requirements. However, I can’t help but question whether I would have chosen to pursue a career in STEM had I been exposed in middle school or high school.

This week, I read a few news articles on STEM camps and programs for girls in rural American counties. The first was about a free summer camp for middle school girls in rural East Tennessee. Roane State Community College holds the STEM program at two different campuses in Scott and Cumberland Counties. Scott County has roughly 22,000 residents, while Cumberland County has just over 60,000. The camp lasts three weeks and teaches girls activities like coding, virtual reality, and robotics. Girls who previously attended the camp loved it. One camper said that since attending, she now hopes to become a Vet and learned how to make prosthetics for animals with 3D printing.

The second article, in The Bakersfield Californian, highlights the Women’s and Girls Fund grantees in Kern County. The Women’s and Girls’ Fund is part of the Kern Community Foundation, a community nonprofit that awards charitable funds to local organizations to help improve Kern County. The Women’s and Girls’ Fund operates to empower women and girls in the county.

The Women’s and Girls’ Fund awarded $25,000 to two STEM groups. Mighty in STEM Sisters was one of the recipients; the group will focus on communities in Eastern Kern County with “limited enhanced educational opportunities for girls” and expose them to STEM fields like physics, aerospace, and robotics.

The second recipient was the Kern County Superintendent of Schools Educational Services Foundation for its Girls Excelling in Math and Science program (Gems). Gems is a year-long program for fourth and fifth grade Hispanic students and is led by California State University, Bakersfield female STEM majors.

I think these programs are perfect for rural communities and can give girls important opportunities that could change the trajectory of their future. These programs can also help fill the STEM gap for girls and young women. The STEM Gap, according to Forbes, represents the fact that “girls and young women remain less likely to pursue education and careers in” STEM. The Forbes article discusses an interesting Microsoft study, which found that “over 75% of girls who participate in hands-on STEM activities outside the classroom feel a sense of empowerment.” There is no question that this gap is larger in rural parts of the country, where similar hands-on STEM programs are less prevalent than in urban settings. Accordingly, programs like those in rural Eastern Tennessee and Kern County can help young girls feel empowered and encouraged to take part in STEM.

Looking back, I wish that there were STEM programs for young girls in my rural county. I would have certainly taken part and know many of my friends and classmates would have as well. And who knows, maybe I would have pursued an entirely different career path had I been exposed to STEM before attending university. I hope similar programs continue to gain popularity in rural America.

The gun divide

Two recent mass shootings in America have propelled the issue of gun control back to the forefront of the zeitgeist. President Biden has called on Congress to implement a universal background-check requirement and an assault-rifle ban. 

Where do rural Americans stand on these gun control proposals? What motivates their views on gun-related issues?

It is no secret that rural Americans have differing views on guns than their urban or suburban counterparts. A Pew research poll from 2017, found that only 59% of urban gun-owners see the right to own guns as an "essential freedom," whereas 82% of rural gun-owners see this right as "essential." So even amongst rural and urban gun-owners there are differing cultural values.

The greater reverence that rural Americans have for the right to own guns has led to a rural-urban divide on views towards gun-control legislation. Only 46% of rural Americans believe we need stricter gun control laws, whereas 65% of urban Americans do. 

What causes this difference in opinion? I think some of this cultural divide can be explained by the difference in gun-ownership rates. Fifty-eight percent of rural Americans live in a household containing a gun, while only 29% of urban Americans live with a gun in their home. Thus an American born into a rural family is more likely to have grown with a gun-owning parent. This could have a cultural impact on rural Americans, who may see firearms as less terrifying than their urban counterparts due to that increased exposure to them.

Another reason rural Americans may not see stricter gun control measures as necessary, is due to the fact that gun violence affects urban Americans more. Urban counties produce five times the level of gun violence that rural counties experience. In addition, a recent study found that universal background checks produced a 13% decrease in firearm homicides in big cities, but had no discernible effect on firearm homicide rates in smaller localities.

Perhaps rural Americans don't see a need for stricter gun control laws because the effects of our current laws are felt most distinctly in the major cities. It's also unclear how much these gun control laws would reduce gun violence in rural communities, which could also lead to rural indifference towards them.

I discovered an interesting proposal to help solve this dilemma: let cities and rural areas pass different gun laws. There are obvious flaws with such an idea. The first being that urban Americans could just drive to the nearest "rural area" to circumvent their stricter urban gun laws. It's important to note that this flaw is present in our current system as well; since Americans can drive to neighboring states to circumvent gun laws.

Another concern is whether it'd be legal for a state to apply its laws differently to its own citizens depending on where they live. Arizona once attempted to pass a gun law that only applied to counties with populations greater than 500,000.  This law was then struck down by the Arizona Supreme Court, who ruled that the population requirement violated a provision in Arizona's state constitution that prohibits the  enactment of local laws concerning crimes or misdemeanors.

A statutory scheme that treats Americans differently based upon the population totals of their county of residence seems ripe for an equal protection claim under the Fourteenth Amendment. Thus this proposal may be unconstitutional, and its merits needn't even be discussed.

Rural Americans often have a different set of experiences regarding firearms than urban Americans do, and these experiences may bleed into their opinions on gun control. This may necessitate gun laws that vary upon locality, or perhaps a federal approach that's more moderate to appease rural Americans. Or perhaps rural America's love for firearms is irrelevant when compared to the public health crisis that guns have created. Regardless, rural Americans have a reverence for firearms that needs to be addressed if you wish to change their mind on gun control.

The potential impact of the House's newly passed immigration bills in California

The House recently passed two immigration bills. The first, H.R. 6, The American Dream and Promise Act of 2021 is aimed at Dreamers, undocumented immigrants who were brought to the U.S. as children. The recently passed bill would, among other things, create a pathway to citizenship for Dreamers.

The House also passed H.R. 1603, the Farmworkers Modernization Act, which would allow farmworkers and their immediate family members to obtain permanent resident status if they remain working in the agriculture industry.

Although the bills are set to face an uphill battle in the Senate, it is important to note that if passed, these immigration bills could have a significant impact on California.

California is home to more than two million undocumented immigrants. This is “nearly a quarter of the nation’s undocumented immigrants.” More than half reside in counties like Orange, Los Angeles and Santa Clara. However, a sizable share of those undocumented immigrants lives in the Central Valley. It’s estimated that close to 70,000 live in Fresno county, another 37,000 live in Tulare county, 50,000 in San Joaquin county and the list continues. More on immigration in rural areas can be found here. 

Many of these undocumented immigrants have significant ties to the state. Not only are they working and studying in California (California has more than 200,000 DACA recipients), but they’re also getting married and having children. It is estimated that more than five million U.S. children have an undocumented parent.

So, what impact would these immigration bills have on California?

The first bill, the American Dream and Promise Act would benefit the younger generation(s) of undocumented immigrants. It is estimated that there are more than 200,000 DACA recipients living in California so, assuming they meet the requirements, about a quarter million immigrants in California could earn legal status through this bill.

Moving on to the second bill, The Farmworkers Modernization Act has the potential to reach many more undocumented immigrants than the American Dream and Promise Act. For starters, it is important to note that in 2016, undocumented immigrants made up nine percent of California’s workforce. Although undocumented immigrants work in a variety of industries, there is a concentration of undocumented workers in crop-related jobs. Immigrants make up 90% of California’s crop-workers and half of those crop-workers are undocumented. Crop-related jobs encompass those that are performed on “farms, orchards, groves, greenhouses, and nurseries [and] that are primarily engaged in growing crops, plants, vines, or trees and their seeds.”

Thus, under The Farmworkers Modernization Act, California’s agricultural industry would see the most benefit, as many of its undocumented workers could earn permanent legal status under this bill. According to some, allowing undocumented workers to obtain legal status could serve as “an economic stimulus.” Legalization of undocumented immigrants has the potential to expand the economy given that “the legalized will pay more taxes, and immigrants will add tax revenue and economic activity.”

The Central Valley in particular would stand to gain from The Farmworkers Modernization Act given its considerable number of undocumented immigrants, most of which work in the agriculture industry. This likely explains why one of the few Republicans who supported the bill was David Valadao, representative of the 21st congressional district which covers a large chunk of the Central Valley including all of Kings county and parts of of Tulare, Kern, and Fresno counties.

There has been a mixed response to these bills. While some Republicans are working on immigration legislation of their own, others have said the immigration bills will be set aside until the issues at the U.S.-Mexico border, namely the surge of unaccompanied minors, are under control. Finally, some politicians have opposed the bills on the basis that they are too broad in scope. Senate Minority Leader Mitch McConnell argues that the bills are “a massive proposal for blanket amnesty.”

Again, the bills are predicted to stall in the Senate so there are no guarantees that these bills will become law. However, if they did, it’s possible that California, being the state with the most undocumented immigrants, could see the most benefits. Thus, it is worthwhile to track the progress of these bills as they move through the legislative process.

Siskiyou County’s mental health court

The California Report Magazine recently reported on how one woman’s cycle of incarceration and mental illness encouraged a rural county to change it’s system. A resident of Siskiyou County, Marlene Baker’s untreated mental illness led her to have frequent contact with law enforcement for minor offenses associated with homelessness, and be repeatedly booked into and released from their overcrowded jail.

Siskiyou County is in far Northern California and spans 6,000 square miles, but is home to just 44,000 people. Many common rural disadvantages intersect for the residents there, such as a lack of public transportation or community healthcare resources.

According to the California Report,

Mental illness plays a role in a high number of criminal cases here. What to do once those people enter the system, said Siskiyou County District Attorney Kirk Andrus, is a vexing question.

“You've got a community that wants to be protected,” he said. “But you also have a person who needs intervention and not necessarily the kind of intervention that we have to offer. It's a massive problem.”

In Baker’s case, though, despite those rural challenges — in some ways because of them — a number of key people took some risks and bent some rules to help her heal in the community, with her freedom intact. And her success is helping to bring about some bold changes in the way Siskiyou County confronts its mental health crisis.

When Baker was charged with a felony, she became a test case for a new way of addressing the intersection of crime and mental illness in the county. The judge, the public defender, county mental health officials, and prosecutor, came to an agreement that instead of returning her to jail or sending her to a state hospital, they would try to help her on the outside. Her case worker found her housing, which she credits as the key to her success. She was able to continue showing up to her court dates, a challenge without public transportation, and ultimately had her record cleared and legal competence restored.

Siskiyou County now has what they call a behavioral health court. It wipes the criminal charges off the records of participants who complete mental health treatment, and keeps them in the community while they do it.

Siskiyou County’s approach to a mental health court can potentially be a model for other counties in California, rural or urban. Studies have proven that mental health courts are effective. Specifically, “participants are significantly more likely to utilize treatment services, less likely to be rearrested, and spent fewer days in jail as opposed to nonparticipants.”

People with mental health disabilities are overrepresented in jail and prison. In a moment where much of our national conversation is centering on how to move away from our carceral system and integrate a nuanced understanding of mental health, it seems appropriate to include in our community court systems. Perhaps Siskiyou County can be one model for keeping people in their rural communities while also finding a way to get them the mental health supports they need.

On small town bank closures

Here's a story from NPR's Scott Horsley headlined "'What Are We Going To Do?': Towns Reel As Banks Close Branches At Record Pace."  An excerpt follows: 

George Holland, the mayor of Moorhead, Miss., remembers the feeling when he heard that Regions Bank was closing its branch in his small, rural town a few years ago.

"That was actually the only bank in our community and the next-closest bank was probably 8, 9 miles to Indianola," Holland said. "I was thinking, 'What are we going to do?' "

Banks have been permanently shuttering branches for years, but the number of closures hit a record in 2020 as the pandemic accelerated the move by many customers to online banking.

Banks closed 3,324 branches last year, according to a tally by S&P Global Market Intelligence.

It makes financial sense for banks given the cost of operating branches.

"The reality is, the vast majority of the activity that happens in a branch is not revenue generating," said Steven Reider, who as president of the consulting firm Bancography advises banks on branch locations. "In fact, it's cost-carrying activity."

This reminds me of the upsides to postal banking, which is common in Europe, and which Prof. Mehrsa Baradaran has championed, though not with a focus on rural communities.  

Coronavirus in rural America (Part CXXVII): Rural areas feeling left behind in White House vaccine distribution push

President Joe Biden has emphasized getting the Covid-19 vaccine to those most affected by the pandemic, with a focus on racial and ethnic minority groups, such as Blacks and Latinos, who have been dying at higher rates than whites and have thus far been less likely to receive the vaccination. However, in that push, it has become evident that many of the steps the White House has taken so far disproportionally benefit urban areas and do not take into consideration the unique challenges rural areas have been struggling with.

On a related note, NPR has a great 3-minute listen on how more Black And Latinx Americans are embracing the COVID-19 vaccination. 

Rural communities have been some of the hardest-hit by the pandemic. The death rate for rural areas was 48 percent higher in December than that of urban areas. In North Dakota, about 1 in 500 residents has died from the virus. Rural areas have borne a greater brunt from the virus in part because they tend to have older populations and a high prevalence of underlying medical conditions. People in rural areas may also be more vulnerable because of a lack of nearby medical care or health insurance.

The struggle to secure adequate vaccines is evidenced at the Heart of Texas Healthcare System, located in the rural town of Brady, Texas. Each Friday afternoon, the staff at the Healthcare System have rehearsed what they will do when their shipment of Covid-19 vaccines arrive: they have a plan in place for how they will let the public know when they can sign up for an appointment, they have the space at the town civic center to administer the vaccines, and they have staff trained to dole out the shots. However, each week that they put in their request for the Covid-19 vaccine from the state, the doses never arrive.

Tim Jones, CEO of Heart of Texas Healthcare System — the only hospital serving a four-county region two hours west of Austin — said last week:

We have been ready for two months. The only missing piece in the equation is the vaccine. This story is ubiquitous with every little town of 2,500 to 5,000 people. From Amarillo to Brownsville, it is a carbon copy.

Bill Finerfrock, the executive director of the National Association of Rural Health Clinics also noted:

There needs to be some initiative to get vaccines out to those communities and an acknowledgement that we need to not forget about those rural underserved areas. Our concern is that it doesn’t seem to be part of the conversation.

To make the determination about where to set up mass vaccination centers and which retail pharmacies should get the vaccine, the White House has been using the Centers for Disease Control and Prevention’s social vulnerability index, which measures how susceptible a community is by looking at metrics like poverty, lack of vehicle access and crowded housing. However, those metrics often overlook the unique needs of rural areas.

Moreover, the Biden administration has, in addition to emphasizing the use of mass vaccination centers and retail pharmacies to administer the vaccine, been shipping doses directly to federally funded community clinics, which serve 1 in 5 rural residents. However, the focus of the community clinics has primarily been to serve the homeless population, public housing residents, migrant agricultural workers, and people with limited English language skills. About a third of vaccine doses that have been sent through that federal program have gone to rural clinics.

While the Biden administration has talked about deploying mobile vaccination units to rural areas, the effort hasn’t been fully rolled out so far. Rural providers said they were hoping they would get a large share of the single-dose Johnson & Johnson vaccine, which doesn’t require the special refrigeration capacity many rural clinics lack. But White House officials said last week it will be distributing that vaccine evenly across the country and not targeting it at any specific areas.

Alan Morgan, CEO for the National Rural Health Association said:

This vaccine distribution isn’t equitable when it comes to urban and rural, that is the perception. These communities are also most at risk. There are hundreds of these small towns with a greater percentage of elderly, people with multiple chronic health issues and chronic workforce shortages. Some of these communities aren’t adhering to public health measures like wearing masks, and now you have an unequal distribution of vaccines. What more could possibly go wrong here? It is the worst possible public health setup.

In the coming months, it is very likely that the federal government will need to take action to increase the number of doses sent to rural areas, as well as address both the shortage of health care workers to administer the vaccination and the needs of older populations who lack the ability to travel far distances and have limited access to the internet.

NPR has a wonderful 3-minute listen on the vaccine rollout in rural areas.

More posts of the COVID-19 vaccine in rural America can be found here, here, and here.