Vaccine hesitancy among rural elders, caregivers nearly double of more urban counterparts

Older man with a band-aid on his upper arm

Photo: SELF Magazine via Flickr

A recent survey of family caregivers revealed some troubling information about the divide between rural and urban communities regarding COVID-19 vaccines.

According to the poll, nearly one in three (31%) family caregivers who live in rural communities say they won’t take the older adult under their care to get the COVID-19 vaccine—nearly double the refusal rate of urban and suburban caregivers (16%). About the same number (36%) of rural caregivers say they won’t get vaccinated themselves.

Safety concerns primarily drive caregivers’ unwillingness to get the vaccine for their loved ones and themselves, according to survey respondents. Among the rural family caregivers surveyed, an overwhelming 81% have doubts that the COVID-19 vaccine is safe and more than a quarter (28%) are “not at all confident” in the vaccine’s safety. In comparison, 9% of their urban and suburban peers are not at all confident. Taken together, experts say the findings show how difficult it will be to save lives in communities where access to healthcare is already limited.

“The biggest thing that comes up from our members is ‘how do I know it’s safe. It came so fast. In the past, these things would take years’,” Romilla Batra, M.D., a practicing internist and SCAN’s chief medical officer, said in a Zoom interview. “The mistrust, doubt and uncertainty among rural family caregivers could upend efforts to get vulnerable seniors in these communities vaccinated.”

Additionally, this population often lives in areas with a high social vulnerability index — ranging from language barriers to Wi-Fi access and around food and transportation, Batra said. “Those folks are at a higher risk of being hesitant and not getting the vaccine, above and beyond whatever their beliefs are.”

Wakefield Research conducted the survey on behalf of SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage plans. It polled 1,000 U.S. family caregivers who provide care for a family member older than 65 years, and oversampled for 400 Hispanic and 400 Black respondents.

Nationally, 53 million family caregivers in the United States provide care to adults and children with an array of needs. People rely on family caregivers for transportation, nutritional needs and assistance accessing medical care.

According to AARP and the National Alliance for Caregiving, “The typical caregiver of someone who lives in a rural area is a non-Hispanic white 48.8-year-old woman. They have lower education and household income than caregivers of those living in a suburban or urban area,” Additionally, these caregivers typically don’t live in a rural area themselves, but often care for a parent, or parent-in-law, whose average age is about 67, and more likely to be male. The rural care recipient typically has long or short-term physical conditions or memory problems.

The survey was commissioned to better understand the attitudes of SCAN members toward COVID-19 vaccines, so the health plan can find innovative ways to build trust. Some 20% of family caregivers polled said their insurance provider is one of their most trusted resources for COVID-19 vaccine information.

Respondents across the board said they have high levels of trust in their physicians and public health officials. So one way to build more trust among those who are hesitant would be to ensure that trusted health providers — local pharmacists, nurse practitioners, and doctors — are the ones administering the vaccines, according to Batra. She said many of the plan’s members have expressed wariness of the “mega-sites” offered by states and counties because they don’t know or trust the person giving the shot.

“It’s new, it’s unknown and it doesn’t provide the same level of trust as their nurse or doctor, where they have an existing relationship,” she said. Batra stressed the importance of providing fact-based information to the family caregivers. “They are the ones who are going to be taking their loved one for the vaccine, so we need to reassure them it’s safe, especially with a lens towards health equity.”

Here are some questions to answer in your reporting on this issue:

  • What is your county/state doing to address the hesitancy concerns of rural elders?
  • How are they (or are they) reaching out to family caregivers to provide factual, evidence-based information to encourage them to get their loved one vaccinated?
  • Are barriers like transportation also being addressed?
  • Are respected members of the target communities stepping up to help allay vaccine fears?

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