Across the Midwest, the rollout of COVID vaccines has been spotty. Lots of people are having a trouble with online signups. And vaccine demand far exceeds supply. That’s made the process challenging, especially in rural areas.

For years, the Girls State Training School in central Iowa has sat mostly empty. But on this day, the main building buzzes as a local vaccination clinic opens.

Rooms labeled for social workers, psychologists and others who once helped delinquent girls are filled with health care workers and elderly residents from the rural area. 

“It’s zooming today. We’ve noticed that despite our best efforts to say come at your scheduled time, people are coming 10-15 minutes early, ” said Shannon Zoffka, Tama County Public Health director. “They’re excited,” said a volunteer in the background. 

Zoffka said the clinic scheduled 110 people for their first doses. They were selected from a waiting list her department started last month. 

But aside from the excitement in the air, Zoffka said her small staff is stressed. They have to maintain the waiting list while making appointments to dispense a limited number of doses.

“Once it gets here, and you get rolling, and there’s just a lot of unknowns too, with how many doses are we getting? How many people can we actually vaccinate?” she said.

Zoffka isn’t the only rural health official feeling overwhelmed.

Chris Estle runs the department in Jefferson County. When word got out they were scheduling appointments, 180 slots were filled in about three hours. 

“We could hold 100 voicemails, we couldn’t even get through all the voicemails,” said Estle.

Estle said about a quarter of county residents are 65 and older. Like many rural counties, that’s higher than the statewide average. But she’s not keeping a waiting list. She said it’s too complicated with rapidly changing information coming in. 

Estle said they’re scheduling first-come, first-served appointments as doses come in. But high demand has pushed some to call or contact her through her personal Facebook account.

“Nope, not going to — not even starting that. Not, not even going to go down that road. So you have to set professional boundaries. And that’s very, very difficult in a small rural community,” Estle said.

Tinglong Dai, a professor of operations management at Johns Hopkins University, said rural areas have additional obstacles. 

For example, most just don’t have the ultra cold storage needed for the Pfizer vaccine, which accounts for just under half the doses administered in Iowa so far.

“I think we need to really think carefully about equity. So equity does not just mean the quantity of vaccines allocated to each area, it also means what kind of vaccines people are getting,” said Dai.

And Dai said to address supply problems, Iowa should follow the lead from another rural state — West Virginia. It registers qualified residents at the state level and gives them a place in line to avoid overwhelming small local departments. Gov. Kim Reynolds says Iowa is working on it.

“I don’t think people really want to get vaccines like the next day, next hour, people just want to get that kind of assurance,” said Reynolds.

That assurance is what Linda Robbins wants. She is 69 and lives in Epworth, a town of about 2,000.

READ MORE: Iowa food pantries weather COVID, face unprecedented storm coming this winter

Robbins hasn not heard anything from her county about how to get vaccinated. But several friends in Des Moines have gotten appointments at places like the Hy-Vee grocery store.

“Tell us something. You know, just let me know. I mean, I know there’s a shortage. And I know I’m probably not going to be first, but just tell us what the plan is,” said Robbins.

Back at the Girls State Training School, Debra Behounek, 67, is getting her first dose of the Moderna vaccine along with her husband and aunt.

Nurse: Do you want this in your right or your left arm?

Behounek: I think we’re gonna go left. 

Behounek said she feels incredibly fortunate to get her family vaccinated this quickly. She just happened to notice a Facebook post from the health department.

“You know, when you watch across the country, everybody, waiting and waiting. And then, it’s just this is a miracle. We got the first day,” she laughed.

Behounek said she would have been happy if her family got vaccinated by June.

This story was produced by Side Effects Public Media, a public radio collaborative covering healthcare. It is based at WFYI in Indianapolis and has partner stations in six Midwestern states, including Iowa Public Radio. Natalie Krebs works out of Iowa Public Radio.

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