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She told Dairy News that at the beginning, the roll-out was designed for an urban setting with large vaccination centres. She says such a plan simply didn't work for rural people.
Bolden says some of the tools for managing Covid in the community, such as what's happening in Auckland, are developed from an urban perspective and don't fit neatly into the vastly different rural environment.
Bolden says the reason for low vaccination rates in rural areas is complex. She says some of this is due to the distance that people may have to travel to get a jab; others still haven't got that message that Covid will eventually come to their area.
She says looking at the present situation, some of the statistics about vaccination rates in rural regions are misleading and fail to capture key problems such as the low Māori vaccination rates.
"Although your overall rate in a region may not look too bad, there are pockets and clusters in some areas that have very low vaccination rates and these are often in the more isolated areas, which again can affect Māori and the rural workforce," she says.
Bolden says the community care programme is based around wellbeing and social support to help people who have Covid and who are isolating at home.
"The difficulty is how is that going to happen in rural areas and who is goint to coordinate that and how that will be funded and how will people be supported in rural areas?
"What happens if people have to go into an MIQ facility? We know there are no MIQ facilities in rural areas and we have heard that these are unlikely to be developed. So therefore we need extra help for homecare and from the DHBs and nursing support to be able to particularly help older people who are isolating at home on their own with Covid. That is a huge issue," she says.
The news that the Rotorua DHB has only four ICU beds is terrifying, she says, and means that GPs are going to have to manage the majority of people who catch Covid.
She says the low vaccination rates in many rural communities mean that, in a major Covid outbreak, unvaccinated people are going to get more severely ill and this will stretch health facilities in many places.
She has concerns about holidays times if Covid-stricken visitors come into rural areas.
Caring for the Carers
Dr Fiona Bolden says she also has concerns for health professionals in rural areas and to that end wants rapid antigen tests made freely available.
She says this is so that rural health providers who are asymptomatic can be tested to stop any spread of Covid in health teams and in the community.
Bolden says we still need to push the rural vaccination message. She says it’s more important than anywhere else in the country that we get good coverage in rural because we don’t have the capacity to manage really sick people in the community.
“Covid is going to go through everybody and we can reduce the chance of getting it if we are vaccinated. But people can still get it even if they are vaccinated – they are just less likely to get severely ill –that’s why it’s so important for people in rural areas to get vaccinated, because the chances are you won’t have access to significant health resources,” she says.
