Perspective: Biden needs to give rural communities a seat at the table, instead of leftovers

“If there’s one leftover, you can have it.”

That is what my friend was told when she inquired about being vaccinated before she began vaccinating others. She is a pharmacist who works for a vaccine provider in rural Alabama and was fortunate to ultimately receive the vaccine. 

However, the “leftover” sentiment has long been a part of the rural identity. With persistently limited job availability, infrastructure and political power, rural residents and workers are often trapped between protecting their personal health or ensuring economic stability for their families and communities. 

The “leftover” sentiment has long been a part of the rural identity.”

The pandemic has exasperated the fragile system supporting rural communities. Paper and plastic manufacturing are major industries in the rural Southeastern United States — products which are in high demand due to online shopping during stay-at-home orders. My father worked at a toilet paper factory when I was a teenager. One of his job perks was free toilet paper, something we laughed about during the toilet paper shortage at the outset of the pandemic.

The reality, though, is not funny. In rural Alabama counties, which have the highest COVID cases per capita in the state, the largest employers include poultry, plastic, and paper companies. Of my friends and family who live or work in rural Alabama, all of them wear a mask, a majority are classified as essential and half of them have tested positive for COVID or had COVID-like symptoms.

Dr. Fauci stated the “cavalry is coming” in the form of a vaccine. However, government promises that do not align with the lived experiences of rural residents and workers are paper thin.

In Tuskegee, Alabama, the location of the often-cited Tuskegee Syphilis Experiment, residents report not knowing enough about the COVID vaccine to feel comfortable receiving it. The already deep-seated mistrust will persist without a commitment to communities no matter the level of health care infrastructure, health literacy, or wi-fi.

While the current COVID plan is ambitious, the Biden administration needs to give rural communities a seat at the table starting with these three things:

Change the discourse about science

First, the Biden administration needs to change the discourse about the role of science. Biden aims to “elevate the voices of scientists, public health experts, and first responders.” Health professionals come from a place of privilege that is viewed with suspicion by rural residents. Policymakers, scientists and medical doctors have contributed to a power dynamic between “expert” and “local.” In the case of coal miners who experience black lung disease, the doctors who diagnose the disease consult for the coal industry.

Instead of highlighting science as infallible or existing in a vacuum, a successful plan must acknowledge the people involved who share responsibility, have equal strengths to contribute and sometimes face unequal burden, especially in the context of vaccine production.

Build mutual trust

Second, building mutual trust must be prioritized. Biden’s COVID-19 plan calls for the public release of vaccine data, including written reports, explained in front of Congress, uncensored. While these steps are important, they reflect a one-way delivery of resources from the scientist to the community. Such a process reinforces existing silos of information and hinders effective action. The call to reach rural communities has been made many times. The Biden administration needs to launch a true dialogue that allows community members the space to share their knowledge and experience with public health professionals and each other.

Build a rural coalition

Third, Biden’s administration should build a rural coalition. Each region of the country is unique and must be represented to maximize effectiveness of any initiative. However, a shared characteristic among rural communities is that community action works. In one example, coal miners received more than $10 million in back pay and benefits through collective court action. Allowing members of rural communities to contribute to task forces at the highest levels can provide invaluable perspectives to meet rural communities’ needs across the nation.

To be certain, rural communities cannot be separated from other communities at high needs. However, I plead for this time to be different, for the Biden administration to involve rural communities in the decision-making process instead of left wondering when it is their turn.

Lindy Olive is a research coordinator at the Feinberg School of Medicine. She has a degree in rural sociology from Auburn University.