With few pharmacies, Wisconsin’s rural counties are forced to get creative to administer COVID vaccines

Vaccine vials at UW
Madison has been selected as the hub for regional vaccine distribution. (Photo of by John Maniaci, UW Health).

Florence County is one of just 110 counties nationwide without a retail pharmacy capable of providing immunization services. Five other rural counties in Wisconsin have just one such pharmacy. 

The availability of several COVID-19 vaccine access points will be important for immunizing people in the hard-to-reach rural corners of the country, yet hundreds of counties don’t have adequate access to retail pharmacies, according to a policy brief from the RUPRI Center for Rural Health Policy Analysis at the University of Iowa.

Pharmacies are an accessible and common place to get immunized — just think of the easy access to flu shots at CVS or Walgreens — and will play an important role in the COVID-19 vaccination effort

“We have good working relationships with pharmacies and they’re a strong force in providing vaccines in any given year, particularly with flu,” said Dr. Stephanie Schauer, Wisconsin Department of Health Services Division of Public Health Immunization Program Manager. “Taking advantage of all that pharmacies offer is important,” she adds. She acknowledges that there are underserved areas of the state where pharmacies are sparse. “But for many parts of the state pharmacies are a vital part of the vaccination effort.”

While there are lots of places to get vaccinated, including “in hospitals, in local and tribal health departments, in medical clinics, in federally qualified health centers, in pharmacies, in long term care facilities, in home care agencies and more,” according to DHS Deputy Secretary Julie Willems Van Dijk, not having access to a pharmacy means local health officials need to be more creative with resources. 

That creativity will be required in counties across the state as the state health department cedes much of the actual administration of vaccine distribution to county health departments. Florence County is the only county without a single retail pharmacy capable of providing immunization, according to the brief, but Adams, Buffalo, Lafayette, Iron and Menominee counties all have just one pharmacy able to vaccinate. 

The effort is further complicated by the federal government’s Operation Warp Speed to vaccinate the entire country. The operation has partnered with common pharmacy chains, including Walgreens, CVS, Walmart and the corporations operating common Wisconsin Grocery Stores — yet 15 Wisconsin counties have a retail pharmacy that isn’t one of the federal partners, according to the University of Iowa analysis. 

“This shows the importance of the diversity of pathways for people to get the vaccine,” Van Dijk said. 

While people in Florence County won’t be able to stop into the local pharmacy once the vaccine becomes widely available, local health officials benefit from the county’s smaller population. With just more than 4,000 residents, the Florence County effort will not require the same level of resources as the state’s larger counties. 

“I think it is different in different health departments that have a large number of people to vaccinate,” says Florence County Health Director Annette Seibold. “This has been something through the public health emergency preparedness program, we’ve been planning for mass vaccinations. It is something we always knew was on the horizon. I feel good at this point in terms of starting that process. I feel locally we’ll do well.”

Seibold might not have tens of thousands of people to vaccinate, but she is operating with a smaller staff, which may require the state to develop ways to bolster county efforts. Seibold said her own staff will be vaccinated this week.

Local health departments are also planning to provide vaccination clinics outside of their current offices, according to Schauer. 

“We’ve noticed that local health departments are registering multiple sites throughout the county, so they are thinking about access points and moving throughout their communities, that is part of their thought and planning which may not be visible where one health department is located,” Schauer said.

State health officials are already thinking of ways to shore up local efforts, according to Van Dijk. The same way that the state helped counties open mass testing sites, mass vaccination clinics will be held in these rural areas, she said. 

“The philosophy is that this is local control, local responsibility,” she said. “We also recognize there are times where conditions are such that there aren’t resources. You’ve been working for the last year doing contact tracing and testing day and night, your staff has been pretty tapped. The mobile vaccination teams will be available to assist with mobile vaccination clinics in their community.”

The state can also provide more resources to the local health departments. If county departments receive more money — partially through the recently passed COVID-19 relief bill —they can maybe hire more staff to get shots into arms. 

But aside from the mobile vaccination teams and shoring up staffing, Van Dijk said it’s important to allow lots of options for accessing the vaccine. Many people are used to getting vaccinated at their doctor’s office, so the COVID-19 vaccine should be available there as well. 

“Many of those counties do have medical clinics, so accessing people’s medical home is important,” Van Dijk said. She pointed out that even if it’s in another county, clinics are a place people are used to traveling to for doctor’s appointments. “People are accustomed to receiving medical care that way.”

In addition to the local health departments and pharmacies, lots of health care centers are ready to vaccinate people. Van Dijk said the number of available providers has increased from 108 on Dec. 14 to 1,066 on Jan. 5. 

As of Jan. 7, about 110,000 doses of the COVID-19 vaccine have been administered, mostly to health care workers.