Tania Thies was working 20-day stretches when she was first offered the COVID-19 vaccine at Palouse Country Assisted Living, where she works as the kitchen supervisor.

She knew she didn’t want to call in sick should she need a day or two to recuperate after getting the vaccine, so she waited.

She also wanted her husband, Don, to get vaccinated with her . He works shifts at the center as well as farms in Fairfield, about 25 miles south of Spokane.

Last week, the couple was able to get vaccinated at the first clinic offered in Fairfield on May 14.

Thies said they would have eventually gone to Spokane to get the vaccine, but having the shot so close to home and available right before her day off last week was a relief.

The Thieses, like many other community members, saw a Facebook post for the vaccine clinic and signed up right away.

Last Friday afternoon as kids got out of school and people left work, there was an obvious addition to downtown Fairfield: a giant RV parked along Main Street, which is home to the Range Community Clinic, a WSU-affiliated primary care clinic on wheels.

Lately, the small but mighty clinic team of four to seven staff has been busy offering the COVID-19 vaccine in communities all over Eastern Washington. The Range mobile clinic is hosting nearly a dozen clinics in the next week alone, predominantly in rural parts of Eastern Washington.

Range came to Fairfield due to Cheryl Loeffler’s persistence, or as she calls it, being a “squeaky wheel.”

If you use the state’s vaccine locator tool with a Fairfield zip code, the closest vaccine appointments are in Spokane.

Loeffler, who is Fairfield’s clerk and treasurer, knew this. She had tried to get a vaccine months earlier when wait lists and lines formed and even people who were eligible were forced to wait due to limited supplies. She eventually got her first dose in Spokane, but she knew that many people in her community might not make the trip to Spokane to get their shots. If the vaccine was brought closer to home, however, they might.

She called the health district and other health care providers in Spokane for weeks about bringing doses to Fairfield. Eventually, the health district directed her to Range, which answered the call. She initially told Range they could get about 20 people to get vaccines.

Last Friday, turnout was nearly double that, however, with nearly 40 people getting their first dose of the Pfizer vaccine. Entire families came to get their shots together at the Fairfield Community Center; younger couples, and even some older residents who had missed getting the vaccine earlier this year were wheeled in to get immunized.

The success of the Fairfield clinic indicates there are still many more people in rural Washington towns who might be willing to get vaccinated, if it is made more convenient.

“One of the first people who called me was a gal who called for her mother who was 98, and she said ‘I can’t get her to go to Spokane for anything, but I want her to get it,’ ” Loeffler said. “I said, ‘You are exactly the reason I did this.’ ”

Rules relax to get more people vaccinated

As vaccine demand has waned, the real work has begun in many rural counties, where access to health care before the pandemic was already a challenge. Rural health systems have always done more than their surface-level job descriptions, and the pandemic simply added to that.

Some local health departments don’t have the capacity to do mobile vaccine clinics or administer vaccines on their own, which forces them to rely on providers in their counties. This is the case in Adams County, where two hospitals serve opposite ends of the county.

Vaccination is an extremely time intensive effort, Karen Potts, community health director at Adams County Health Department, said.

With disease-control protocols and contact tracing to do with already small staffs, it’s difficult for smaller counties to actually vaccinate people, she added.

Local clinics and hospitals in rural counties are also responsible for testing and treating COVID-19 patients as well as taking care of health care needs for everyone else in the community. Not all health care providers can offer vaccines while getting back to business as usual.

Demand for vaccines was so low in Pend Oreille County that Newport Hospital decided to not offer them for now after the incident management team that had taken over vaccine efforts in the northeastern region disbanded. Safeway is just a few blocks away from the hospital and has vaccines available.

“Initially that’s not how we wanted to do it, but the amount of resources it takes for us to put together a vaccine clinic for just a few people is huge,” Jenny Smith, public information officer at Newport Hospital, said earlier in May.

The Northeast Tri County Health District is planning to continue vaccine efforts through mobile teams, especially after the state loosened vaccine restrictions.

Earlier in May, the Department of Health removed the 95% rule, which forced providers to use almost all of their doses within two weeks of receiving them. This freed up health districts and departments in rural regions to store vaccine for longer periods of time in the event that they get a walk-in request or need to set up an impromptu clinic.

In the ongoing efforts to vaccinate 12- to 17-year-olds, this rule will come in handy. The Pfizer-BioNtech vaccine comes in pallets of more than 1,000 doses, way more than one rural county can distribute.

The Department of Health relaxing the 95% rule enables health districts and providers to share amongst other providers without fear of those doses needing to be used quickly.

On Wednesday, the Department of Health announced the creation of an online marketplace function for vaccine providers to post about their extra doses, enabling them to share doses across counties easier.

The Department of Health also changed its no-waste rule earlier this month.

“Previously we’ve been functioning under the idea that we’d experience no loss of doses for vaccine which meant if somebody came in and we had a vial of Pfizer with six doses in it, unless we knew we had six people lined up we wouldn’t puncture that vial,” Matt Schanz, administrator at Northeast Tri County Health District, said.

Now vaccine distributors are being instructed to “not turn anyone away if you are worried about waste,” new guidance from the state  says. The department says a provider can puncture a new vial, even if it’s the end of the day for a patient to get a vaccine. In essence, vaccines in arms is now taking precedence over waste.

Combating low rates

Vaccine rates remain low in many Eastern Washington and rural counties.

According to an NPR analysis a month ago, in many states, older residents in urban counties are getting vaccinated at higher rates than those in rural counties. This was true in their analysis of Washington as well, with elderly residents in urban counties being 3.7 times more likely to get vaccinated than those who live in rural settings.

County-level vaccine data from the Department of Health through the end of April bear this out to be true to some extent, although in Washington there is not only a divide between urban and rural counties but also a stark contrast between counties, rural or not, east of the Cascades and those west of the mountains.

Of the 13 counties with the lowest percentage of their total population vaccinated, 11 of them are located east of the Cascades. Counties in the northeastern and southeastern corners of the state are sparsely populated and also have some of the lowest vaccination rates.

Even rural health districts that can vaccinate community members and host community clinics are struggling.

In Lincoln County where 41% of the population older than 16 is vaccinated, Ed Dzedzy, the county health administrator, said their community clinics are now offering vaccines through appointments and walk-ups.

“For us in Lincoln County, our biggest risk and threat is the lack of demand,” he said. “We have the capacity and vaccine to vaccinate more people; we’re just having a hard time getting those people to be vaccinated.”

Vaccine hesitancy in rural communities sometimes stems from experience. If COVID-19 has not affected the community, there might be less urgency to get a vaccine. This was the case in Ferry County, that is, until a super-spreader event in Republic led to more than 100 cases, multiple hospitalizations and two deaths. A few weeks after the outbreak, providers saw demand for the vaccine.

“We are vaccinating COVID patients after they’ve finished their quarantine for 10 to 14 days,” Cindy Chase, chief nursing officer at Ferry County Memorial Hospital, told reporters earlier this month. “Our vaccine program is very alive and well.”

Demand was so high in Republic that leaders there called the Range clinic to help administer vaccines and support the rural hospital there, which was slammed with treating patients and offering testing for community members.

Meet people where they’re at

For the Range team, offering the COVID-19 vaccine in towns with no health care settings is in line with the clinic’s mission.

Fairfield, like many rural towns throughout Eastern Washington, used to have a clinic downtown, but when Kaiser Permanente took over the clinic, they moved its operations and doctor to Spokane, leaving the small town and assisted living facility without immediate, nearby health care.

Range is working to close those gaps in care, but the immediate need in the region is vaccination.

Dr. Luis Manriquez, who was administering the vaccines in Fairfield on Friday, said that at clinics so far, people are receptive and grateful and might just have a few questions they want answered.

“It’s really about meeting people where they are and engaging with a trusted partner,” he said. “Now, it’s about people who aren’t opposed to it but want it close at hand.”

Traci Larrison works across the street from the community center, and when she got off work, she came by to get her shot. She, too, had seen Loeffler’s Facebook post and noted how convenient it was.

“It’s hard not to come when it’s right downtown,” she said.

Don Thies thinks clinics like the one in Fairfield will lead to more people getting vaccinated than if the effort wasn’t made at all. Other Fairfield residents echoed this same sentiment.

“This is fantastic,” he said after receiving his first dose last Friday. “I think they’re getting people who wouldn’t get it otherwise – people on the fence.”

Editor’s note: This story has been updated to reflect that the WSU-affiliated clinic is called Range Community Clinic, not Range Health.