Why Are Colorado’s Rural Counties Vaccinating People Faster Than Urban Ones?

Feb 24, 2021

In a twist from the typical narrative of urban-rural disparities, many rural Colorado counties have the highest rates of getting vaccine administered. State officials also believe size matters when understanding why rural counties are more successful at getting vaccine administered. San Juan County, for example, will be at a "standstill" in its vaccine progress until the state opens up more eligibility criteria.

Across much of the Front Range and Colorado’s other biggest counties, securing a coronavirus vaccine remains an arduous endeavor. Overloaded websites. Lengthy wait lists. Hair-pulling frustration.

But, in southwest Colorado, the state’s smallest county has a different problem: It’s run out of people to vaccinate, at least for now.

Barely two months after shots started going into arms, San Juan County, with a single incorporated town — Silverton — as its seat, has inoculated nearly 80% of those currently eligible. The 230 individuals fully vaccinated may not be a lot in terms of raw numbers, but they account for about 32% of the county’s population.

“Anyone who was eligible within (the current) criteria so far in our community, and has wanted it, has received it,” county spokeswoman DeAnne Gallegos said, noting that the county is still finishing the second round of shots for those currently eligible.

More than 1 million Coloradans have received at least one vaccine dose, and disparities in who’s getting vaccinated have begun to emerge. People of color and those from low-income communities are getting vaccinated at far lower rates than white Coloradans. But in a twist from the typical narrative of urban-rural disparities, many rural Colorado counties have the highest rates of getting vaccine administered.

The Colorado Sun analyzed data on vaccine administration provided by the Colorado Department of Public Health and Environment. To ensure the numbers didn’t show just a one-time blip, The Sun first asked for data on Feb. 9 and then asked again last week.

The numbers consistently show rural counties leading in the number of doses administered per 1,000 people, with San Juan in first place both weeks, followed by the southwestern county of Mineral County in the southwest and Sedgwick County in the far northeast. Hinsdale, Kiowa, Chaffee, Archuleta, Costilla, Las Animas and Huerfano counties, all rural, rounded out the top 10 in both datasets.

Those 10 counties averaged roughly 425 doses administered per 1,000 people in last week’s data. By comparison, Denver, the state’s largest county, ranked 44th with 190 doses administered per 1,000 people. The seven counties in the Denver metro area averaged 192 doses administered per 1,000 people.

“We’re so little,” Gallegos said of San Juan County, “so it’s a little petri dish. We can accomplish things a little easier than larger communities.”

Vaccine Supply Remains Constrained

State officials also believe size matters when understanding why rural counties are more successful at getting vaccine administered.

“It all boils down to population,” said Brig. Gen. Scott Sherman, the Colorado National Guard officer leading the state’s vaccine campaign. “That’s just plain and simple.”

The reason partially has to do with shipping logistics. The smallest amount of vaccine the state can ship somewhere is 100 doses — that’s 10 vials of the Moderna vaccine, which fit into a carton smaller than a shoebox.

For a clinic in a large, urban area that may be looking to vaccinate thousands of people a day, that’s a drop in the bucket. But for vaccine providers in small communities, those doses can make a big dent in the demand.

“They actually have more vaccine on hand than they have for a particular population,” Sherman said.

Because the quantities needed in rural areas are tiny compared to the need in urban counties, the state also has sent vaccine in bigger, one-time chunks. That allows the small counties to be more flexible in how it gets distributed or to move more quickly to get people vaccinated when a new eligibility phase opens up.

“We are able to work it out with them, so we will give them a disproportionate amount so they can have their clinic but they might not get any the next week,” CDPHE executive director Jill Hunsaker Ryan last month told lawmakers about the state’s distribution efforts in rural counties.

The strategy sometimes even leaves rural counties with a surplus of vaccine — untapped vials and no arms at the ready. Then the state has had to step in and move those doses to different counties that aren’t as ahead in their vaccinations.

“We’re like, ‘Hey, time out, we actually need to move that vaccine to other locations that don’t have their 70 and above population done,’ because there’s just not enough vaccine,” Sherman said.

“One person at a time”

But there’s also another explanation for why rural areas are succeeding. It’s about the bonds of their communities.

Rural counties are used to pulling together to overcome big challenges, said Liane Jollon, the executive director of San Juan Basin Public Health, which includes La Plata and Archuleta counties (but, confusingly, not San Juan County). Fires. Floods. Blizzards.

“If there is a big event, we’re going to be pretty isolated,” she said.

When the pandemic hit, leaders in La Plata and Archuleta counties wasted no time standing up their emergency response. Starting the first week in March, they began holding stakeholder calls two to three times per week to talk about the logistics of responding to the virus. By the second week in March, government and school officials had added more regular calls to discuss policy challenges.

The collection of groups included in the emergency response kept growing — child care centers, nursing homes, community-service organizations. They developed testing plans. They worked on outreach to often-marginalized communities, such as people experiencing homelessness or those who don’t speak English. And, when the vaccine arrived, they quickly pivoted that work into getting everyone a shot when it was their turn.

There are now 15 providers signed up to administer vaccine across San Juan Basin’s two counties. They include hospitals and medical clinics. But they also include a small fire protection district in Bayfield, which is using its weekly 100-dose allotment to quickly get through the few thousand people in its area.

San Juan Basin worked with CDPHE and local leaders to set up a clinic in Ignacio, where the headquarters of the Southern Ute Tribe is located. The clinic vaccinated 514 people in a single day and followed a tribal clinic run earlier in the week. A volunteer group working with the health department runs a vaccine clinic every Saturday at the La Plata County fairgrounds.

Jollon said vaccine providers in the area are holding weekly calls to figure out how to divide up the work, and the health department is willing to help move around as little as a vial or two at a time to make sure vaccine gets to where it’s most needed.

The result is that more than 50% of the 65-and-older population in La Plata and Archuleta counties have already received their first dose of vaccine. And, when vaccinations opened to educators earlier this month, the counties were able to get 75% of them their first shot within a week.

“I really do think a smaller community appears to have some advantages here,” Jollon said. “But if we break everything down into small communities, this is how we’re going to do this, one person at a time.”

Playing the Hurry-Up-and-Wait Game

The success, though, has also created some challenges.

It’s not just residents who are getting vaccinated in San Juan County. Gallegos, the county spokesperson, said she’s heard of people driving from as far as Denver and Boulder — a six-hour trip in good conditions — because they can’t get an appointment closer to home. The county hasn’t yet started separating out data between residents and non-residents, and the state is not requiring proof of residence or other tracking information for those getting vaccinated, so as long as someone is eligible, they can theoretically get a shot wherever they can get an appointment.

“We have been touting to the community, no matter who you are, if you’re interested, call us,” Gallegos said.

However, state health officials have said they prefer counties with extra doses to send them to places that need more. That means until the state opens up more eligibility criteria, San Juan County will be at a “standstill” in its vaccine progress, Gallegos said. Many residents became eligible for the vaccine because they volunteer as firefighters or EMS workers, “because that’s how you roll in a small community,” Gallegos said.

But she said it would help to have more independence in choosing who can get the vaccine and when. As a tourist-driven county, with a weekly physician’s assistant clinic and no hospital, Gallegos said the county’s biggest coronavirus risks come from outsiders who interact with restaurants and recreation companies. Yet many of those workers won’t be eligible for the vaccine until the state opens up Phase 1.B.3, which is expected to happen in a few weeks. Gallegos says that may be too late; peak ski season is February and March.

“We don’t have medical infrastructure, so keeping COVID out of our community obviously has been an incredibly high priority,” Gallegos said.

If vaccines were in ample supply, the state would be happy to let counties who finish one phase move on to the next. But that’s not yet the case, Sherman said, and there are still plenty of people around Colorado who are eligible but haven’t received their vaccine yet.

At least 767,803 people had received one vaccine dose as of Friday, with 348,031 receiving both doses. And the state is more than four-fifths of the way to its goal of getting first doses to 70% of those 70 and older, officials said in a news conference Thursday.

“We’ve made some progress,” Sherman said. “It’s just keeping people focused on getting vaccine distributed to the right place at the right time.”


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Mark Duggan provided online production of this story for KSUT.

This story was written in partnership with the Colorado Sun, through a collaboration powered by COLab, the Colorado News Collaborative — a nonprofit formed to strengthen local public-service journalism in Colorado. KSUT joined this historic collaboration with more than 40 news organizations to share in-depth local reporting to better serve Coloradans.