VACHERIE — Ralph and Rose Kliebert slowly walked from the St. James Parish Reception Hall on River Road to the waiting car being driven by their son.

The Klieberts, both in their early 80s and married for 63 years, had just gotten their first doses of the Pfizer coronavirus vaccine after Ralph had pushed a hesitant Rose days earlier to do so.

"He said he wanted it, 'so if I'm taking it, you're taking it too,'" Rose said, as their son helped Ralph her into the car Friday morning.

"After 60 some-odd years," she added, "hey, go ahead."  

The Klieberts are part of the elderly demographic that officials in parish government and St. James Parish Hospital say they are trying to put on waiting lists for the vaccine. But, because St. James is such a rural parish, they have had to take increasingly proactive efforts to reach those residents.

The difficulties in St. James are shared to one degree or another by other rural parishes in Louisiana, where resources can be limited, local officials said. Those parishes are having to take a different approach than more densely-populated ones.

Assumption Parish, for example, doesn't have a local, stand-alone pharmacy to offer vaccines. Poor, elderly populations can have limited familiarity with or access to the internet to sign up. And some people have limited transportation to receive the vaccine, local government and medical officials said.

Facing those hurdles, some parishes, are hustling to find places to distribute doses. In spread-out and isolated St. Helena, for example, parish officials are looking at the parish's fire stations as potential sites.

Other parishes and medical providers have already created their own workarounds. But the pace of delivery of the vaccine is still slow, raising questions about how larger numbers of vaccinations will be achieved in the most rural areas once eligibility opens up and more doses are available.

"This has been a gigantic undertaking for our small hospital, who, by the way, is still caring for our largest wave of COVID patients. So, we don't just magically have the staff to handle all this," said Kassie Roussel, director of marketing for the 25-bed St. James Parish Hospital. 

Gov. John Bel Edwards and state health officials say they have focused first on a "low and wide" strategy toward distributing the vaccine by building capacities within local clinics, pharmacies and other locations enrolled in the vaccination distribution program. More than 1,900 have joined so far statewide.

"Building a vast network of diverse providers is time and labor-intensive work, but we view it as fundamental to achieving equitable coverage, a top priority in Louisiana’s planning and rollout from the very beginning," said Aly Neel, spokeswoman for the state Department of Health.

State health officials recognize there are still gaps, but say those are being narrowed with weekly feedback. 

Health officials are readying plans for mass vaccinations once sufficient supply is available. But Edwards has flatly said if the state tried large-scale vaccination at this point, it would quickly run out.

Still, some local officials in rural parishes say they want to move more quickly toward some version of those events. John Boudreaux, Assumption Parish homeland security director, said one primary care office and a rural health clinic associated with the 15-bed Assumption Community Hospital are the only places offering vaccines in the parish of nearly 21,900 people.

Last week, the physician's office, Reddy Family Medical of Napoleonville, needed help from a National Guard team to help administer 200 doses in two days, Boudreaux said.

Another physician's office is seeking authorization to start offering vaccines, Boudreaux said, while a regional health clinic may ramp up services in the coming weeks in the southern end of the parish.

"But the reality is, in these small rural areas, it's just not much available," he said. 

To start filling that gap, parish government offered its own one-day vaccination clinic at the parish community center in Napoleonville and vaccinated 186 people on Wednesday. More are planned, Boudreaux said. 

Other officials said they haven't run into as many hurdles so far, with strong cooperation among various local entities.

Chad Olinde, CEO of Pointe Coupee General Hospital, said his hospital had administered 508 doses, while the nearby Arbor Family Health clinic has administered another 300. Walmart and a local grocery store are also administering doses.

He said he believes it won't be a problem finding more people to vaccinate and isn't so sure that mass vaccinations would speed up the pace of administrations in a state that already ranks 11th best in the nation, given current supplies.

"I don't think it would make it any quicker. Overall, what's limiting us is Pfizer and Moderna. They are making those vaccines, and they're doing it for the whole world," Olinde said.

In St. James parish, the hospital and local government have set up a call center to take down names, offering an option for older residents who don't use the internet. St. James is also planning to deploy parish transit buses to bring residents to the distribution points set up on either side of the river, parish officials announced last week. 

Roussel said St. James leaders are working on plans to have community groups go door-to-door to push homebound older populations to sign up. 

Local medical and health officials also stressed the complexities in developing and maintaining a waiting list for vaccines. That list plays an important role in vaccine delivery and ensuring doses aren't wasted.

The Pfizer-BioNTech vaccine raises this concern most, these officials said, because it must be stored at ultra-cold temperatures to remain in long-term storage. Rural facilities don't have that refrigeration capacity.

So after vaccine is thawed and delivered, localities must find a way to have it injected in five days, which makes the waiting list essential.

Christi Hunt, CEO of RKM Primary Care, which has a network of 11 clinics in the region based in Clinton, said she has been conservative in ordering vaccine doses so none are wasted, though she would like to do more.

For her first order, her clinics received short notice from the state right after the holiday break. She kept her order at 400 given the time frame to prepare. Hunt said she had earlier been told her clinic wouldn't be getting the vaccines until the spring.

Though her clinics have since developed a list of 800 people, some of them aren't yet eligible. Others are on the list but might have already gone elsewhere for the vaccine.

For this latest order, Hunt said she had hoped to ramp up to 1,000 doses of the Moderna vaccine, only to learn she could receive 300 of the Pfizer vaccine.

Providers have 30 days to inject the Moderna vaccine once thawed and delivered. But, with the much shorter window available to inject the Pfizer vaccine, Hunt said she reduced her order 200: 100 for East Feliciana Parish and 100 for Livingston Parish.

"So it gets frustrating for us because it's a logistics nightmare," Hunt said.

The RKM clinics and one local pharmacy, which has gotten 100 doses so far, are the only locations in East Feliciana offering vaccines currently. The hospitals nearest to East Feliciana Parish are in Zachary and St. Francisville.

When Dr. Nagaratna Reddy, owner of the primary care clinic in Napoleonville, was told she would be receiving 200 Pfizer doses for last week's distribution, she initially thought about asking for fewer.

She too said she was worried she wouldn't have enough patients and staff to administer all the doses in time. But, once she got the offer of help from the National Guard, she said, she agreed to take the doses and worked to spread the word about the planned vaccinations. Far more showed up than expected. 

In St. James, hospital officials had to deal with last minute cancellations on their waiting list and some unexpected extra doses, so they called in a handful of people on the list who were younger than 70 to ensure all the doses were used. 

All 360 doses were administered, but hospital officials say it would be tough to replicate that kind of effort five days per week.

Gerard Steib, 65, a retired oil refinery supervisor from South Vacherie, said was one of the fortunate ones. He was called Tuesday to show up for his shot on Friday.

He said he was happy to get it for many reasons. He has children, grandchildren and other family he wants to keep seeing and has lost friends to COVID-19.

"And it's important that we eradicate this virus," Steib said.

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