Rural Alaska is getting Covid-19 vaccinations right. Here's what the rest of the US can... - 0 views
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The immovable challenges of living in Alaska would, in theory, make it a nightmare to vaccinate all of its 731,000-plus residents: It's the largest state in the US in terms of land size, has some of the most extreme weather of any state and many resident Alaska Natives, who are disproportionately dying from Covid-19, live in the remote throes of the state.
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And yet, at 40 doses administered per 100 people, Alaska is one of the leading states in the US when it comes to Covid-19 vaccinations.
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What works in Alaska won't work everywhere -- it's over 660,000 square miles, after all, and not every state requires health care workers to travel by dog sled to administer vaccines. But the rest of the US can take cues from the state's unique approach to its unique problems.
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Alaska's public health structure was built for complications -- its size and tendency for inclement weather require it. So when it came time to start vaccinating residents, the state didn't have to build a robust public health system from scratch like some others, said Dr. Anne Zink, Alaska's chief medical officer.
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A localized approach to vaccination hasn't worked everywhere, but it's worked in Alaska, Zink said. The state distributes vaccines to different regions but doesn't give directives, she said -- it's up to the communities to decide how to administer vaccines based on their needs.
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Because so much power has been turned over to different regions of Alaska and the health care providers trusted in those areas, health care workers have been able to "meet people where they're at," Zink said: That means they'll deliver vaccines by boat, dog sled, helicopters and small planes, or go door-to-door in small communities to vaccinate as many community members as possible.
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Vaccine eligibility in Alaska is more expansive than it currently is in most other states: Vaccines are available to anyone 55 years or older, people with certain underlying conditions, essential workers, residents of a multigenerational household, anyone who assists a senior in getting vaccinated and anyone who lives in a community where 45% of houses don't have pipes or septic tanks.
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In areas where the population is mostly Alaska natives, there's a greater amount of people living in multigenerational housing. That qualifies young people who may live with an at-risk elderly person to get vaccinated, too, said Dr. Bob Onders, administrator of the Alaska Native Medical Center in Anchorage. And since 25% of rural Alaska doesn't have running water or sewage, which can heighten residents' risk for respiratory illness, it didn't make sense to exclude rural residents from the first round of vaccinations, Onders said.
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Another way to alleviate that burden is to prioritize zip codes in addition to age and health status, Karmarck said. Vaccinating residents of low-income neighborhoods or areas where the majority of residents are Black, indigenous or people of color could reduce Covid-19's disproportionate impact, though backlash is likely: In Dallas, county officials axed their plan to prioritize residents in "vulnerable zip codes" after the state threatened to reduce its vaccine allocation, the Texas Tribune reported in January.
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"Rather than a top-down mechanism, where someone from outside of Alaska or rural Alaska is dictating how things are going, it's much more about giving them supplies," Onders said.
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Alaska asked the federal government to be treated "like a territory instead of state," so it would receive a monthly allocation of vaccines versus a weekly or biweekly lot. That made it easier to plan ahead and deliver vaccines "creatively," Zink said.
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It can be costly to transport vaccines to some remote reaches of Alaska -- over $15,000 for one trip, in some cases, Zink said. To make vaccinations more cost-efficient, some areas that are less densely populated receive their entire vaccine allotment, which makes it possible to vaccinate entire communities in one go.
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"We've been doing redistribution of vaccines for years," said Dr. Anne Zink, Alaska's chief medical officer. "It was pretty easy for us to stand up our existing [public health] structure."
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Invest in protecting minority communities. Alaska expanded its eligibility for the first round of vaccines to include Alaska Natives and low-income residents of the state that are more vulnerable to Covid-19. While there's still work to do to alleviate that disproportionate risk, Onders said so far, it's working.
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Alaska Natives have borne the brunt of Covid-19 in the state -- the Kaiser Family Foundation's Covid-19 data tracker shows that Alaska Natives make up more than a quarter of Covid-19 cases but 15% of the population, compared to White residents, who made up 38% of cases but 68% of the population.
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Enlist trusted members of communities to educate. In communities where residents are hesitant to get the vaccine, particularly among Black and Latino Americans, sharing information about vaccine access is crucial to address Covid-19 racial disparities, Karmarck said.
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Customize the approach. States that were lagging in vaccinations are catching up, Karmarck said, as they formalize an approach to vaccination that best fits their state. In Massachusetts, for example, large vaccination sites have opened up at Fenway Park and Gillette Stadium to accommodate more people and storage the vaccines require. It's improved the state's vaccination rates, she said.