When children ages 5 to 11 were approved for Pfizer's lower-dose pediatric covid-19 vaccine in November, Annie Edwards was eager to get her daughter Hannah, then 5, the shot because of underlying health conditions she has stemming from her premature birth.
"She was on a ventilator for the first month of her life. Throughout this whole covid ordeal, I just keep thinking of those memories," Edwards said.
Many parents in more urban areas of Montana quickly found the vaccine when it became available. The search was more challenging for Edwards, who lives in rural Dawson County, where just 38% of the eligible population in the eastern Montana county of 9,000 residents is fully vaccinated.
She called the Dawson County Health Department, but officials said they were waiting for more parents to show interest before scheduling a clinic for kids to get the shots. The local hospital wasn't offering the vaccine for younger kids either.
Waiting wasn't an option for Edwards. So she and her daughter made the nearly 500-mile round trip to Billings while visiting family for Thanksgiving weekend. They are scheduled to return Dec. 19 for the girl's second dose.
"How many people can say, 'Yeah, I'll make two trips to Billings?' That's a lot of miles," Edwards said, acknowledging that she was fortunate to have the means to do so.
Dr. Lauren Wilson, a Missoula-based pediatrician and the vice president of the Montana Chapter of the American Academy of Pediatrics, has heard from parents like Edwards across the state who can't find the shot in their hometowns.
"I think availability of the vaccine in rural areas is absolutely a factor in Montana's struggle to vaccinate as quickly as other states," she said.
The state and many local public health agencies have not produced targeted campaigns to educate people about where children ages 5 to 11 can get vaccinated, making it that much harder on parents. Wilson said a lack of access and a lack of promotion are both playing a role in Montana's lagging vaccination rate for younger kids.
So far, about 15% of the estimated 90,000 children in that age group statewide have received a first dose of the pediatric covid vaccine. Montana ranks 33rd among states on vaccination rate for younger children, and its rate lags behind the national one of nearly 17%, according to a KFF analysis of federal data.
Twenty-two of Montana's 56 counties had vaccinated fewer than 5% of kids ages 5 to 11 as of Dec. 10, according to data gathered by the state health department.
A half-dozen counties reported vaccinating no children younger than 12: Carter, Daniels, Dawson, Garfield, McCone and Wibaux. All six are in rural eastern Montana, where driving distances between towns are great.
In both McCone and Wibaux counties, health officials said that they aren't offering the shot because of low demand and that it would be difficult to go through the minimum order of 100 doses within the 10-week period that shots can be stored in a regular freezer or refrigerator. The shots can be stored longer in special ultracold storage units that are few and far between in rural areas of Montana.
Parents in McCone and Wibaux counties who want their young children to be vaccinated must drive 40 to 100 miles round trip.
Despite storage issues and low demand, some rural health departments, like the one in Richland County, are offering the pediatric shot. Public health nurse Kathy Helmuth said she's seen parents from parts of eastern Montana where the pediatric shot isn't available make the trek to vaccine clinics she has put on at local schools.
In November, Helmuth vaccinated nearly 40 kids, more than she expected. Some shots had to be thrown out, she said, because the demand was too low to get through a 10-dose vial.
"I keep having to remind myself everyone we get vaccinated is important and that's more important than the dose or doses I might be wasting," she said.
Local health departments that are struggling to provide vaccines because of storage or low demand are encouraged to reach out to state health officials, according to Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services.
Ebelt declined to answer questions about what areas the department had identified as vaccine deserts or whether any local health departments had reached out for help.
Jennifer Kates, senior vice president of global health and HIV policy at KFF, said the number of kids being vaccinated nationally had slowed by the Thanksgiving holiday and has continued to decline.
"If it's not very easy, very accessible and top of mind, they're not going to do it for reasons that are complicated," she said.
Kates said politics may be affecting people's willingness to get their children vaccinated in deeply conservative states like Montana. According to KFF's latest survey data, about half of Republicans said they won't get their 5- to 11-year-olds vaccinated, and an additional 10% said they'd do so only if required.
Kates said educating parents about how the pediatric vaccine is safe and effective will take more effort than was necessary for earlier rollouts for older kids. That burden will largely fall to state and local health departments, she said.
Montana's state health department has said it will continue to promote covid vaccines for everybody who is eligible but doesn't plan to promote the shots for kids, as Utah has done.
The Montana Medical Association is planning a statewide campaign directed at families. And Matt Kelley, CEO of the Montana Public Health Institute, said his organization is working with local health departments to promote the shot for kids.
"It's a chicken-and-an-egg thing. You need to have a certain amount of demand to have a clinic be sustainable, but in order to have a demand, you have to have that access out there," Kelley said.
Kelley said mobile vaccine clinics can be part of the solution.
Pharm406, a Billings-based mobile pharmacy, has been offering vaccine clinics in eastern and central Montana throughout the pandemic. Owner Kyle Austin said he's put on about 15 pediatric vaccine clinics. He said that turnout was low for his clinic in Glasgow but that he vaccinated 60 kids in Red Lodge.
"It's really hard to tell where the demand is," Austin said.
In Sanders County, on the western edge of Montana, getting to the closest pediatric shot requires a 70-mile round trip into Idaho or a drive of more than 100 miles to and from western Montana's larger communities.
So far, 99% of the county's children ages 5 to 11 have yet to receive a first dose.
"We most certainly will see lower vaccination rates because of that barrier," said Nick Lawyer, a local medical provider and the county's former health officer.
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.