Diane Huntress, 74, lives in Denver and says trying to get a COVID shot for her and her husband David is like applying for a job.
“I can't talk to anyone," she said. "There's no phone number and all the emails we get say, ‘Do not reply.’ And the problem is, where can I go, can I get there, and when are they going to have it?”
She says vaccines take up all the oxygen among her social circle, too: "I can't see anybody, an acquaintance on Zoom without the question, ‘Have you gotten the vaccine yet?’”
For Huntress and her husband, finding an appointment is just one part of the challenge. Getting there is also a question. They can’t afford a car and in the age of COVID, they are hesitant to take public transit or a group ride. Instead, they plan to use the nonprofit Colorado CarShare and pay $6.50 an hour plus mileage to borrow a vehicle. That option is available in Denver and Boulder so far.
But for rural residents scattered across the Mountain West, such a service may not be accessible. Plus, distances to vaccination sites are often considerably greater.
Shawnda Schroeder, associate director of University of North Dakota’s Center for Rural Health, says when states drew up their vaccination plans, “transportation was this forgotten variable.” It just wasn’t factored into all the barriers health officials were anticipating for the vaccine rollout, she said.
Schroeder says the opportunities available to some patients before the pandemic hit are not necessarily an option now.
“We have rural and older communities and we have older rural community members and they often rely on nonprofits and volunteers for transportation,” she said. “And if they are a high-risk individual relying on a volunteer to potentially transport them for 45 minutes in a vehicle, that might not be the safest option in terms of COVID transmission.”
If the pandemic has taught us anything, though, it’s rapid innovation.
Dr. Richard Zane, chair of emergency medicine at University of Colorado, is spearheading ways to get under-served communities vaccinated, like pop-up clinics in rural areas.
“And it may be that there are only 500 people in that community that need to be vaccinated, in which case we'll just do it once or enough to get the entire community,” he said.
Still, some will have a hard time making it to those neighborhood sites. The Commonwealth Fund, a nonprofit focused on health access and equity, estimates 1.9 million Americans age 65 or older are fully or largely homebound — and more than 5 million face limitations that make leaving their homes a difficult task.
“Well, it's a huge issue. And it isn't just an issue with COVID,” said Mary Anne Harvey, executive director of Disability Law Colorado.
She points out that health care access for people who have mobility issues is a historically chronic problem, “particularly in rural areas of the state where there is not public transportation and people are widely dispersed.”
Harvey and other advocates meet monthly with Colorado Lt. Gov. Dianne Primavera to discuss these issues. The group is looking at models in other states, such as Delaware, where officials have enacted “reverse paratransit.” That means they are using paratransit to transport the vaccine and healthcare providers right to the patients who would have a hard time making it to vaccination sites or events.
For his part, Zane is working with local leaders in Colorado to address this. And he says a potential solution is on the horizon. “The game changer, we hope, is going to be the Johnson and Johnson vaccine,” he said.
That vaccine is only one dose and has at least a three-month shelf life, unlike the Moderna and Pfizer vaccines. Zane says those two-dose vaccines present key logistical challenges. He hopes his work on pop-up clinics and the relationships he has forged with community health providers will set a foundation once “a single-dose, highly effective, less logistically cumbersome vaccine” is available.
He sees the Johnson and Johnson shot allowing vaccinators in Colorado to take the vaccine right to people’s homes.
In the meantime, outreach falls on many local health departments in the region – and they are getting creative, too.
“We have rural populations that have transportation barriers. And in the wintertime, that's complicated even further, of course,” said Eric Merchant of Lewis and Clark Public Health in Montana.
That’s especially true in his sprawling, rural county. It’s more than three times the size of Rhode Island with a population of roughly 69,000 people. Nearly half those residents live outside the county seat and state capital of Helena. So Merchant and his team converted passenger vans into mobile clinics.
“We've reached out and done events in both Augusta and Lincoln, Montana — which are both more than an hour's drive from Helena over mountain passes,” he said.
Still, Merchant acknowledges there’s a long road ahead to reach everyone. And as Diane Huntress back in Denver proves, you don’t need to drive a mountain pass to find them.
Meanwhile, rideshare services Uber and Lyft have announced partnerships with cities and organizations to offer free rides. Representatives from both services say they will have more information on exactly how this will work in the Mountain West in the coming weeks.
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.