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Why vaccine-hesitant rural family caregivers pose a threat to millions of seniors

Tom Sullivan | March 17, 2021

Among the U.S.’s estimated 53 million family caregivers that so many people are dependent on to access medical care, nearly 36 percent in rural communities will refuse the vaccine themselves and 31 percent indicated they will not take older adults they care for to receive the COVID-19 vaccine — more than double the 16 percent of respondents who indicated similar sentiments in suburban and urban settings.  

That’s according to new data from SCAN Health Plan and conducted by Wakefield Research, which surveyed 1,000 U.S. family caregivers with oversamples for 400 Hispanic and 400 Black respondents.

The researchers also found that 81 percent of family caregivers in rural areas doubt the vaccine is safe, with 28 percent answering that they are “not at all confident” in the vaccines safety. That contrasts sharply with the 9 percent of urban and suburban peers lacking confidence.  

Health Evolution Editor-in-Chief Tom Sullivan interviewed Romilla Batra, MD, Chief Medical Officer at SCAN Health Plan about what the results suggest, the impact on herd immunity, and when it will be safe to reopen the economy.  

Health Evolution: What impact do you envision the findings about rural family caregivers being so hesitant will have as the nation strives to vaccinate as many people as possible and achieve herd immunity?  

Batra: We worry about the trends because many people in our patient population are dependent on their caregivers and those people will have a barrier in terms of getting the vaccine. These are people with higher risk of morbidity and mortality, so that is very worrisome for us. Not only do we have to think about vaccine hesitancy, we also have to look through the lens of caregivers to convince them to get it themselves because they are in a position to infect the people they care for.  

For SCAN, herd immunity is important because the folks we are worried about are older adults more susceptible to COVID-19 infections. If I get infected, I might have 6 or 7 bad days, but I wouldn’t likely be hospitalized or die. Caregivers might also have less severe consequences, but if you look at the population we serve it’s critical those people and the people who care for them get vaccinated.  

Our own population is somewhere in the 14 percent range of people with a first vaccine. We won’t feel comfortable until we achieve 70 percent at SCAN. At that point, the new normal may be something like a backyard barbecue in July.

Romilla Batra, MD, Chief Medical Officer, SCAN Health Plan

Health Evolution: The research found a stark difference between those in urban and suburban areas. Is there also a marked difference in the likelihood of being exposed to COVID-19 in the first place among the different geographical regions?  

Batra: Rural versus urban – it all depends on who you are and where. Urban, exposure is greater but just because you’re in a rural setting doesn’t mean you won’t be exposed. In rural areas they might not be taking public transportation, but they can still be exposed to caregivers, and they’re still at a risk of infection. We did see significant infections, hospitalizations and deaths in rural areas and now in California we’re seeing a variant of up to 25 percent that can cause more disease and have more burden.  

Health Evolution: It’s tempting to look at the increased vaccine production, the new J&J dose, declining infections, hospitalizations and deaths and be optimistic for the first time in a year that we might be coming out of this pandemic. What do you see as a reasonable timeframe for the economy opening up again?  

Batra: That’s a good question. If you go to the CDC or ask Anthony Fauci, MD, there are good signs that we are headed in the right direction. In California, we had a worrisome trend in the red tier so reopening is dependent on how soon we can get vaccines in arms and how many caregivers and patients are vaccinated. Our own population is somewhere in the 14 percent range of people with a first vaccine. We won’t feel comfortable until we achieve 70 percent at SCAN.

At that point, the new normal may be something like a backyard barbecue in July. July is the timeframe everyone is going toward but there are a lot of caveats, none of the new variants can have an impact, we need herd immunity. As more people get the vaccine I am hoping it will become more available in pharmacies and in primary care practices — because we need to ensure people have equitable access so vaccine distribution happens in an equitable manner especially in the rural areas we serve.


Dive deeper: With a new working guide for CEOs, Health Evolution Forum shares 10 emerging best practices for developing an action plan to increase vaccine confidence and accessibility. 

About the Author

Tom Sullivan, EVP & Editor-in-Chief of Digital Content

Tom Sullivan brings more than two decades in editing and journalism experience to Health Evolution. Sullivan most recently served as Editor-in-Chief at HIMSS, leading Healthcare IT News, Health Finance, MobiHealthNews. Prior to HIMSS Media, Sullivan was News Editor of IDG’s InfoWorld, directing a dozen reporters’ coverage for the weekly print publication and daily website.