'Pharmacy deserts' create barriers to COVID-19 vaccine for vulnerable North Carolinians

Pharmacists across North Carolina are standing by to assist in the state's COVID-19 vaccination efforts, but when the doses get into their hands, access won't be equal for everyone.

The ABC11 I-Team in partnership with the ABC Owned Television Stations uncovered 45% of zip codes across the state do not have a pharmacy, creating multiple 'pharmacy deserts.'

North Carolina has an average of three pharmacies every 10 square miles. However, more than 90 percent of counties across the state report even fewer.

Wake County is home to four times the number of pharmacies in Granville County where Gary Bowman has run Professional Pharmacy for nearly 30 years.

"We pride ourselves in knowing who our customers are, calling them by name, we're the same people that go out to eat with them, that go to church with them, that go to little league ball games with them," Bowman explained.

As an established and trusted health professional, Bowman said now people are turning to him for advice and news about the COVID-19 vaccine.

"Oh, lot of calls. 'Do you have the vaccine? Are you going to have the vaccine? When can I get it? Can I get on a list?'" he said.

He's one of nine pharmacies in the county with more than 60,000 residents.

Bowman said over the years, two other independent pharmacies have closed.

Stephanie Kiser, a pharmacist and director of Rural Health at UNC, said there is a fear of more closures.

"When we see pharmacies close and we see people having to travel further distances to access a pharmacy that feels unfamiliar and that often does not encourage the trust of that provider-patient relationship that they would like to have," she explained.

Closures in rural areas also lead to larger gaps in access between urban and rural communities.

With 46 pharmacies every 10 square miles, Mecklenburg County has the most pharmacies in the state. While Mecklenburg County is also one of the most populated areas, it has 2,300 times more pharmacies in the same space compared to Northampton County where there is only two pharmacies every 1,000 square miles.

While these disparities have existed for decades, today they are taking on more dire consequences.

"We're really recognizing the value of these pharmacies in these small communities that may be the closest place to get a vaccine," Kiser said.

Transportation and distance to a vaccine can be one more barrier for people who aren't 100% onboard with the COVID-19 vaccine.

"To drive across the county for some older adults that's a really far trip, they don't want to make the trip," Kiser explained. "The thought of getting in the car and having to drive 20 miles may be a major deterrent."

Unfortunately, these pharmacy deserts tend to exist in rural communities home to an older population.

The ABC11 I-Team also uncovered many of the zip codes without a pharmacy tend to be in communities with higher levels of poverty and home to Black and Latino residents. A finding that means the COVID-19 vaccine will be harder to get for poorer, Black and Latino residents; the same communities already disproportionately impacted by the virus.
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Though Black and Latino North Carolinians were disproportionately affected by COVID-19 in the spring and summer, those disparities have begun to shrink.

Russell's Pharmacy and Shoppe opened in East Durham two years ago to fill this exact need.

"You're looking at a historically marginalized area, there are a lot of people who don't have as much transportation, they don't have as many ways to get access, to just drive down to the CVS or Walgreens or the Walmart, so they need something in the community that is very close to them that they have access to," said Dr. Darius Russell, the pharmacy manager and owner.

The nearest pharmacies to his business are both chains and are a 30-minute walk away.

Russell said being in the community also offers him a chance to form relationships and trust with his patients; a relationship that can help in the COVID-19 vaccination effort.

"Having a pharmacy in the area really helps to build that trust so people don't feel like I'm just going to some big conglomerate. I'm actually going to a place where I know they are going to tell me the truth, they're going to tell me really what I need to hear," Russell said.

While pharmacists like Russell might be in a good position to give the COVID-19 vaccine, they are not part of the vaccination process in North Carolina yet.

"They are a bit frustrated because they feel like they could be making a difference in their community if they had access to the vaccine," explained Dr. Penny Shelton, the executive director of the North Carolina Association of Pharmacists.

Just like there are tiers to get vaccinated, the state has tiers on who can provide the vaccine and when. Pharmacists currently rank 4th, a position that has many waiting until February or March to administer doses.

"The greatest challenge right now is the supply. It's having local pharmacies whether you are rural, suburban or urban assisting with vaccinating patients having the supply and having that supply allocated is right now is insufficient to support broader distribution by our state and not just North Carolina and other states as well," Shelton said.

Kiser has been working with other health experts across the state and points to West Virginia as a model for North Carolina.

With more than 80% of its doses administered, West Virginia is ranked top in the U.S. for vaccine distribution, according to the latest vaccine data from the CDC. More than 11% of the state's residents above 16 years old have received the vaccine; a percent beat only by Alaska.

Kiser and others say a large part of the state's success is because they gave pharmacists, particularly rural pharmacists, vaccines to distribute.

"When you are going to focus on older adults and you really want to improve access, depending on pharmacies should have been sort of a topline thing in my mind because there are already people in every community of our state who often have a relationship with their pharmacist and their community pharmacist," said Gina Upchurch, the executive director of Senior PharmAssist.

Her nonprofit helps Durham seniors pay, access and manage medications. Now, like many others, the group has become a resource for vaccinating residents.

Upchurch said while it's a waiting game everywhere it's even harder to get answers in rural areas.

"I wish my parents live in Durham County right now. My parents live in Rockingham," she said. "I'm depending on their community pharmacist to get the vaccine...They are comfortable with him, he will come out to the parking lot and give it to them and that works well for my parents but it's just a waiting game."

Russell and Bowman also playing the waiting game; undergoing intensive training, learning the state's processes all while hoping to get allocated doses soon.

Both pharmacists said they had to invest time and money into becoming a future vaccine site. Many rural independent pharmacies ABC11 called said they were not going to offer the vaccine.

"It wasn't just, 'Ok, I want the vaccine, so send it to me,'" Bowman explained. "We had to go through a lot of training and a lot of processes to make sure we were set up to go through that adequately and that was important. I wanted to be a site where people could come and get vaccinated."

Shelton said as North Carolina waiting for more supplies multiple groups across communities are brainstorming creative partnerships to help expand access to the vaccine.

Earlier this month, the state health department announcing the allocation of $2.5 million to offer free transportation to vaccination sites.
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