We are in a new era of vaccine hesitancy, and that reality is intersecting with long-standing gaps in access across the country. Despite incredible progress in the manufacture and distribution of vaccines, there are still significant geographic areas in our country that have lagged in getting individuals vaccinated. These areas are typically rural, remote, and economically disadvantaged. These “vaccine deserts” are in fact an intersection of other significant accessibility issues, many of which have existed for decades. Where do you see vaccine deserts? The same places where you have healthcare deserts, pharmacy deserts, and internet deserts.
To successfully roll out vaccination efforts, you need places to store vaccines, effective ways to alert the public and let them sign up for appointments, and locations to hold clinics that meet the needs of the surrounding community, taking transportation into consideration. However, access to storage, communication, and distribution infrastructure is not equally available across all parts of the nation.
There are communities where residents must travel long distances to reach a hospital or healthcare facility. Some of these areas are remote by nature, while others have struggled to attract or retain providers. Individuals in rural communities without reliable transportation face a significant barrier to accessing even basic care. In many cases, these are Medically Underserved Areas, defined by too few primary care providers, high infant mortality, high poverty, or large elderly populations. These same factors also make it harder to access preventive services like vaccines. Mobile clinics, pop-up vaccination sites, and other flexible delivery models are essential to reaching these communities.
Pharmacies have become a major access point for vaccines, but not every community has one. Pharmacy deserts, often found in lower-income areas, lack the market conditions needed to support chain locations. Without nearby pharmacies, residents lose a key access point for vaccination. For many, simply booking an appointment at a retail pharmacy is not an option, especially if other barriers, like lack of internet access, are also present.
How do most people schedule vaccinations today? Typically through online systems, email notifications, and digital appointment platforms. But for those without reliable internet access, this process becomes far more difficult. Rural communities are significantly more likely to lack home internet service due to infrastructure gaps and lower investment in less densely populated areas. As a result, many individuals must rely on phone scheduling, which can require long wait times and may not be feasible during working hours. Even in connected areas, elderly populations or those unfamiliar with technology may struggle to navigate online systems without assistance. These internet deserts can leave entire communities behind.
Consider how these “deserts” overlap. They are often found in regions that have faced systemic health and social inequities for decades. These communities may experience higher rates of chronic conditions, fewer healthcare resources, and greater distrust of the medical system. All of these factors compound the challenge of equitable vaccine distribution.
If we want to improve vaccine uptake, we cannot look at hesitancy in isolation. Access matters just as much as attitude. And while vaccines are a choice in many cases, they should be a real, accessible option for everyone who wants them.