Coronavirus vaccine makes a long, cold journey to rural America

The Pfizer/BioNtech coronavirus vaccine completed an arduous journey through development and approval — but still is left with hundreds of miles to go to reach waiting arms once it arrives in rural America.

“Our couriers travel many, many miles. Our physicians, our staff travel miles,” said Susan Jarvis, president and CEO of Sanford Health of Northern Minnesota.

The Sanford Health system has more than 400 clinics and senior care locations, many in small towns and isolated farming communities in the upper Midwest.

In Bemidji, Minnesota, the last leg of the vaccine’s journey to a number of those communities starts when it’s unloaded from its ultra-cold storage and packed into coolers like those you might see at a cookout — except these have crucial data loggers attached.

“They’re under such scrutiny as far as their storage requirements for freezer temperature, refrigeration temperature and they’re only good for five days once we pull them out of that ultra-cold freezer,” said Matt Webb, director of pharmacy at Sanford Health.

“So that data logger is a piece of equipment that monitors the temperature during transport until they get to a refrigerator at their hospital.”

Once the doses are secured and ready to go, the next step is simply getting in a minivan — and driving. A vaccine delivery trip CNN followed started from Bemidji and ended in a 9,000-person town called Thief River Falls, a little over 90 miles to the northwest.

“I don’t think there was a worry about getting it,” said Carla Szklarski, an infection preventionist (among a number of other jobs), at Sanford Health Thief River Falls. “It was more the logistics of how was that going to happen.”

The arrival of the vaccine in rural communities — for many a light at the end of a very long pandemic tunnel — involves a major feat of logistics covering huge swaths of sparsely populated country.

President Biden has said he expects the US will be able to vaccinate 1.5 million people a day “within the next three weeks or so,” but in many parts of rural America the barrier to being a part of those vaccinations simply comes down to distance.

“It’s nice to play offense for a change,” Webb said. “Making sure that we can vaccinate people as close to home as possible is really important.”

Sanford has only five locations that are able to meet the ultra-cold storage requirements for the Pfizer/BioNtech vaccine in a coverage area of more than 200,000 square miles across North Dakota, South Dakota, and parts of Nebraska, Iowa, and Minnesota.

The state of Minnesota allotted that the vaccine be distributed only to hospitals — since they have the required storage capacity.

Sanford’s couriers pick up from those five locations and head out.

“It really was a process that was in place that we’ve been able to tap into and expand so that we can use it for the vaccination delivery and distribution,” Jarvis said.

But that doesn’t mean there aren’t roadblocks.

In Bagley, a town about 30 miles from Bemidji, some of Sanford’s lab-result runs had to be delayed because of conditions on the winter roads. “The courier routes were canceled because it was blizzard conditions,” said Stephanie McKnight, administrator of hospital and clinics in Bagley.

“I can’t think of a time where we completely didn’t have what we needed. There have been times where we’ve cut it very close.”

Nationwide, rural Americans live an average of more than 10 miles from the nearest hospital. The region that includes this part of Minnesota has a longer average travel time to a hospital than any other part of the country, according to the Pew Research Center.

“Distance obviously in northern Minnesota plays a huge role in the ability to get vaccines efficiently, it may also preclude somebody’s decision to get a vaccine if we make it difficult to receive it,” said Alyssa Carlson, pharmacy manager at the Bemidji and Bagley medical centers.

Sanford Health told CNN that as of late January in its Northern Minnesota region, it’s been able to get two doses of the vaccine to more than 1,000 staff members as part of the 1a group and at least the first dose for hundreds of 65 and older patients as part of the next phase of distribution. The system says it’s now sharing storage resources with the local county public health department in Bemidji as part of getting shots in arms as quickly as possible.

‘Everybody knows everybody’

“In a rural community, we tend to know who our patients are before they become patients,” said Dr. Colleen Swank, vice president of clinics for Sanford Health of Northern Minnesota.

“It’s not the 75-year-old man in bed with Covid, it’s Mr. Smith, my neighbor’s dad.”

Thief River Falls, about 70 miles from the Canadian border, initially thought it had avoided the pandemic — until it found it hadn’t. Health care staff told CNN that at one point, most of their in-patients were Covid-19 patients in a town where “everybody knows everybody.”

“I went home and cried that first night I had to tell somebody they couldn’t come to visit,” Szklarski said.

“We’ve always thought that, you know, nobody dies alone. The family is a huge part of their care, their emotional and physical well-being, and then not being able to have them here has been the hardest thing.”

She described these patients as being like members of her own family, which made the pain of the pandemic that much more difficult, “to go to practically a family member and tell them, I’m sorry you can’t come in and see your mother.”

Szklarski, like so many others, looks to this vaccine as a source of hope, especially on account of her dual families, the one that includes her relatives — and the one that includes her patients.

“I think it’s something in the past we’ve really taken for granted, you know? To walk into the hospital and visit our loved ones. And we can’t do that anymore,” she said.