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On Monday, Rep. Cindy Axne (IA-03) joined Reps. Ashley Hinson (IA-01), Mariannette Miller-Meeks (IA-02), and Randy Feenstra (IA-04) to urge the U.S. Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC) to utilize the newly approved COVID-19 vaccine to ramp up vaccination efforts in Iowa’s rural areas.

The new COVID-19 vaccine from Johnson & Johnson, which only requires one dose and can be stored using regular refrigeration, was approved by the Food and Drug Administration (FDA) last Saturday.

As Members of Congress representing a state with many rural residents, we understand the specific challenges our rural communities face in looking to vaccinate residents efficiently and equitably,” the members wrote. “Prioritizing distribution of the Johnson & Johnson vaccine to rural areas would: reduce the burden on rural health care providers and county health officials; simplify the distribution and administration process; and, ensure equitable vaccine access for rural Americans.”

The members highlight that over 1.1 million Iowans live in rural areas, over a third of Iowa’s population, and that a recent study showed that one in four Americans in rural areas reported having trouble accessing health care.

“We recognize the logistical difficulties in ensuring safe vaccine distribution in rural areas – like increased transportation needs, lack of cold storage, and limited health professionals,” the members wrote. “That is why we urge you to prioritize distributing the single-shot, refrigerator-stable COVID-19 vaccine developed by Johnson & Johnson”

The members also specified that they are recommending this new vaccination option should be leveraged in addition to allocations of vaccines from Moderna and Pfizer-BioNTech.

“Critically, we urge you to ensure the Johnson & Johnson vaccine supplements distribution to states instead of supplanting doses of the Moderna and Pfizer-BioNTech vaccines currently being distributed,” the members wrote.

The full text of the letter can be found below:

Dear Acting Secretary Cochran and Director Walensky:

We write to urge you to make sure that our vaccine distribution plan reflects the needs of rural communities in Iowa and across America. Vaccinating Americans for COVID-19 is one of the largest public health initiatives this country has ever undertaken, and we cannot afford to leave our rural communities behind. 

To end the devastation caused by this pandemic, vaccines must be available to all Americans. We recognize the logistical difficulties in ensuring safe vaccine distribution in rural areas – like increased transportation needs, lack of cold storage, and limited health professionals. That is why we urge you to prioritize distributing the single-shot, refrigerator-stable COVID-19 vaccine developed by Johnson & Johnson, which received an emergency use authorization (EUA) on February 27th, 2021, to patients in rural and hard-to-reach areas.

As Members of Congress representing a state with many rural residents, we understand the specific challenges our rural communities face in looking to vaccinate residents efficiently and equitably. Over 35% of Iowans – 1.12 million people – live in rural areas, and these areas have a higher concentration of residents at risk of severe illness or death from COVID-19. The Centers for Disease Control and Prevention (CDC) has stated that older adults and those living with underlying health conditions face the highest risks from COVID-19. Nationwide, 15.9% of rural Americans live in highly vulnerable counties based on the old adult population scale, and 23.7% live in highly vulnerable counties based on underlying health concerns. These rates are 4.0% and 3.0% respectively for urban Americans.  

Gaps in health care access and availability also pose issues for rural Americans. Rural residents are more likely to lack health insurance, but even those with insurance struggle with accessibility. Approximately 25% of rural residents report a recent experience where they needed care but were unable access it; of those who had trouble accessing care, 23% reported that health care locations were too far away or too hard to get to. 69 of Iowa’s 99 counties have no intensive care unit (ICU) beds, making it more difficult to respond to cases of severe illness due to COVID-19. Furthermore, health care workforce shortages and facility closures are a persistent challenge in rural America.

Our vaccine distribution plan should reflect the realities of delivering care in rural areas – such as longer travel times, fewer health care facilities and workers, and higher vaccine hesitancy. COVID-19 vaccines developed by Pfizer-BioNTech and Moderna are highly effective at protecting against COVID-19 – with Pfizer-BioNTech’s vaccine being 95.0% effective and Moderna’s vaccine being 94.1% effective against symptomatic COVID-19. However, both vaccines present challenges for rural health systems. The Pfizer vaccine must be stored in a dry ice thermal container or ultra-low-temperature freezer to prolong shelf life and is administered in two doses separated by 21 days; the Moderna vaccine must be stored in a freezer to prolong shelf life and is administered in two doses separated by 28 days.

By contrast, the Johnson & Johnson COVID-19 vaccine can be stored for up to three months at refrigerator temperatures, is administered in a single shot, and protects against COVID-19. According to results from Johnson and & Johnson’s Phase 3 ENSEMBLE trial, their vaccine was 66% effective at preventing moderate disease and 85% effective at preventing severe disease.

Critically, despite differing efficacy rates at preventing moderate and severe illness, all three approved vaccines meet the benchmark of preventing close to 100% of hospitalizations and deaths. As Dr. Ashish Jha of the Brown University School of Public Health laid out, “What you care about is hospitalizations and deaths. And Johnson & Johnson appears to be just as good as Moderna and Pfizer at preventing those.” Americans should feel confident that the three vaccines approved for COVID-19 are effective, safe, and products of thorough review.

Prioritizing distribution of the Johnson & Johnson vaccine to rural areas would: reduce the burden on rural health care providers and county health officials; simplify the distribution and administration process; and, ensure equitable vaccine access for rural Americans. For rural residents in the most at-risk categories, simply getting to a vaccine appointment can prove difficult. A single-shot vaccine eliminates the need for multiple appointments and can ease logistical headaches for rural residents. Critically, we urge you to ensure the Johnson & Johnson vaccine supplements distribution to states instead of supplanting doses of the Moderna and Pfizer-BioNTech vaccines currently being distributed.

Iowa’s public health systems, community health centers, rural hospitals and health clinics, independent pharmacies, and health care workers are committed to advancing the well-being of rural communities in Iowa.

We stand ready to provide necessary congressional support and work collaboratively to address and solve these challenges. We thank you for your commitment to the health and safety of the American people, and we appreciate your attention to this critical matter.

Author: Press Release