While much of the focus during the covid-19 pandemic has centered upon urban centers, the reality is that case incidence in rural America surpassed that in cities as early as September of 2020. And it's not an insignificant number of people who reside in these less populous areas, as 60 million people (or nearly 20 percent of the US population) call them home. With this rise in covid-19 cases has come increased morbidity and mortality, and a greater focus on the clear healthcare disparities that exist by virtue of geography, among other well-documented factors. 

These disparities are also playing out in emerging vaccination data. According to a new study released by the US Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, the agency's internal medical journal, US adults living in rural areas were vaccinated at a far lower rate than those living in urban centers (39 percent versus nearly 46 percent). Furthermore, of those who did manage to receive vaccinations outside of cities, 15 percent actually had to leave their county of residence in order to get a shot. These data were collected from 49 states and the District of Columbia at the county level between mid-December and early April (only Hawaii was entirely excluded due to data-sharing restrictions). 

These findings highlight a number of issues. Namely, there are multifactorial reasons contributing to lower healthcare access outside of urban centers, including lack of health insurance, frequency of medical comorbidities, aging populations, "and medical deserts" (which are regions with inadequate healthcare facilities and workforces to match the population). In particular, the fact that so many Americans had to travel to adjacent counties, or even further, is particularly startling. Of the many healthcare improvements needed in the US, decreasing this disparity of basic medical services for rural communities should be high on the list.

Emergent BioSolutions, the company embroiled in controversy surrounding safety violations during the manufacturing of Johnson & Johnson vaccines, is poised to release doses to the public, pending approval from the US Food and Drug Administration (FDA). According to its CEO, Robert Kramer, there may be as many as 100 million manufactured doses awaiting the green light from the FDA. 

During a congressional hearing on Wednesday, Kramer apologized for problems at Emergent BioSolutions' beleaguered Baltimore plant, which had resulted in contamination of a batch of Johnson & Johnson vaccines earlier this year. According to an FDA inspection, the plant was found unsanitary and unsuitable to manufacture shots. The FDA remains in the process of determining whether a number of remaining vaccines might be safe for release. 

"No one is more disappointed than we are that we had to suspend our 24/7 manufacturing of new vaccine," Kramer told the subcommittee. "I apologize for the failure of our controls." 

Even if the FDA gives the go-ahead, the timeline for when these millions of vaccine dose could begin to reach hospitals and clinics is unknown.