Rurality Versus Readiness: The Relationship Between State-Level Connection and Capacity Variables and the Management of Medical Stockpiles for a Public Health Emergency

This study investigates what factors contributed to the score a state received for managing its medical countermeasures stockpile pre-COVID-19. It is particularly interested in the relationship between a state’s level of rural population and its countermeasure management capacity. A fixed-effects regression analysis was run using data from 2016 to 2019 to test for a relationship between the percentage of rural population in a state and the states’ countermeasures management score, while controlling for other relevant social, economic, and political variables such as level of social associations, the segregation index, and the level of income inequality. Rurality and physicians per capita proved to be significant and negative. A subsequent analysis found that states with higher levels of rural populations have lower levels of COVID-19 vaccinations, even accounting for effective countermeasure management. This points to rural states having challenges in regard to medical countermeasures that cannot be completely solved with technocratic solutions.