With high death rates and low vaccination rates, rural Pennsylvania (PA) faces serious consequences of COVID-19.  Funded by the Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health, the Health Initiative for Rural Pennsylvania (HIRP) was established at the Pennsylvania Office of Rural Health to implement COVID-19 reduction strategies in rural Pennsylvania.  This work is accomplished by building cross sector county specific teams and developing and implementing action plans to align public health, healthcare and non-health interventions that decrease the risk for COVID-19.

The COVID-19 death rate in rural counties is 1.3 times higher than urban counties. Currently, 9 out of 10 Pennsylvania counties with the lowest COVID-19 vaccination rates are rural (31%-46% fully vaccinated). The gap in COVID-19 vaccination coverage between urban and rural areas has more than doubled since April 2021. Rural populations tend to be older and uninsured and are more likely to have underlying medical conditions and live farther from facilities that provide medical treatment, placing them at high risk for adverse COVID-19 outcomes (Centers for Disease Control and Prevention, 2022).

The HIRP’s progress to date includes:

  • Developed, convened or merged with existing COVID-19 Advisory Groups in 20 rural Pennsylvania counties (Map) identified at highest risk for COVID-19.
  • Implemented a cross-sector community development process with key stakeholders to engage in local COVID-19 needs assessments, problem identification, action planning, and implementation.
  • Funded local organizations to implement action plans.
  • Developed the Rural Pennsylvania COVID-19 Learning Collaborative including 250 cross-sector partners across rural PA. The learning collaborative serves as a communication vehicle to include COVID-19 news, programming and resources.
  • Compiled and shared local best practices/lessons learned across rural PA counties with the highest vaccination rates.
  • Experienced increases in vaccination rates in several rural counties, some by 8% or more.

With our work in local communities, several common problems were identified across the 20 counties relating to COVID-19 reduction strategies including: mis/dis-information, lack of local endorsement or local storytelling, overriding negativity, altered risk perceptions, differing political and faith-based influences, elevated levels of vaccine hesitancy and “dug in” thinking, overwhelmed health care systems and equity and access issues.

The current climate in rural Pennsylvania is generated by low case counts, reduced demand for vaccinations, lack of interest in mitigation strategies and overall COVID-19 fatigue. Given this change, HIRP efforts are shifting focus to support pandemic preparedness for future surges and pandemic recovery efforts to address the economic and mental health crisis.


CDC COVID Data Tracker

CDC COVID-19 Vaccination Field Guide

CDC COVID-19 Vaccination Field Guide Addendum: Rural Considerations for Vaccine Confidence and Uptake Strategies

DOH COVID-19 Data Dashboard

CDC COVID-19 Vaccination Field Guide Addendum: Rural Considerations for Vaccine Confidence and Uptake Strategies

Federal Government Free At-Home COVID-19 Tests

How to Become a Distribution Site for At-Home COVID-19 Tests

PA Unites Against COVID

Test to Treat Program


As we face the reality of an ongoing pandemic, the following toolkits offer innovative menus of effective ideas, options and strategies to assist rural school districts and churches in addressing COVID-19.  See below for several toolkits, two of which are available in Spanish.