The COVID-19 vaccination operation at the Flathead County fairgrounds in northwestern Montana can dole out 1,000 doses in seven hours. But demand has plummeted recently, down to fewer than 70 requests for the shots a day. So, the county dropped its mass vaccination offerings as May began — from three clinics a week to two. Though most of those eligible in the county haven't yet gotten the jab, the takers are few.
"It's a trickle," says Flathead City-County Health Officer Joe Russell. "Not enough people will get vaccinated to reach herd immunity — not in Flathead County and maybe not in Montana."
Daily COVID-19 vaccination rates are falling nationwide, and gaps in vaccine uptake are starting to show, especially in rural America. That leaves many communities grappling with an imperfect pandemic endgame.
Flathead stands out as one of Montana's most populated counties to fall behind. There, 25% of people eligible had been fully vaccinated by May 10. That compares to nearly 33% of Montanans fully vaccinated, and closer to 35% nationwide.
Flathead County is a medical destination for the top corner of the state, a gateway to Glacier National Park and neighbor to two tribal nations. It's Montana's fourth-largest county by population with more than 103,000 people, yet it's rural — 18 people per square mile. It's also conservative, with the majority of residents voting for former President Donald Trump last year. National polling has shown rural Americans and Republicans to be among the most resistant to getting vaccines.
Russell says he hopes at least 40% of Flathead County residents eventually get the shots. That's well below the 70% to 80% believed to be needed to create widespread protection from the pathogen that has stalled normal life.
Public health experts worry about reservoirs of the virus fueling outbreaks. That possibility further strains year-old tensions in places such as Flathead County, where strangers and family members alike can be split on whether the virus is a threat and the decision to wear a mask marks where people stand. COVID-19 vaccines are the latest phase of that divide.
Cameron Gibbons, who lives outside Kalispell, has worried about how COVID-19 could affect her 13-year-old son. He's had coughs turn into lung infections that landed him in the emergency room for trouble breathing, so the family has played it safe during the pandemic.
"We haven't seen family in a long time because they haven't chosen to be careful — which is OK, as long as when we get back to normal we can all set our differences aside," Gibbons says. "Now there's this judgment of 'Oh, you got the vaccine.'"
Some of Montana's most vaccinated places overlap with tribal nations. Chelsea Kleinmeyer, the health director of the Confederated Salish and Kootenai Tribes, said the tribes' members seemed to largely accept vaccines after the pandemic disproportionately sickened and killed Native Americans. But the reservation crosses four counties, including Flathead.
"We travel to those counties every single day," Kleinmeyer says. "It goes back to: Are we really protected against this virus, these variants, if we don't achieve herd immunity?"
States are shifting from mass clinics to bringing shots to where people are, but that strategy, too, can be unpredictable. The same day of the county's final Thursday clinic, the local health system hosted a walk-in clinic in the middle of the Flathead Valley Community College campus in Kalispell. Most of the chairs for people to wait 15 minutes post-shot remained empty and, by early afternoon, the clinic had to send 200 of its vaccine doses to the county health department to avoid wastage.
Although organizers had hoped to vaccinate at least 100 people that day, Audra Saranto, a registered nurse who heads Kalispell Regional Healthcare's vaccination team, says she counts the college event as a success — 50 people got vaccines who might otherwise not have.
The health system may host similar clinics at major job sites, like for a lumber company. A mobile team will offer shots in busy places like farmers markets, even if it means risking people not following up for a second dose.
It's not surprising that the vaccinations aren't universally accepted yet in this divided county. Flathead's board of health deadlocked over mask rules and crowd size limits amid the area's worst COVID-19 outbreaks. Two top county health officials resigned in the past year. Thousands of people have signed dueling petitions to remove or keep one board of health member who had stirred doubt over COVID-19 cases and opposed mask rules.
And the city of Kalispell is home to state Sen. Keith Regier, a Republican who repeated false claims on the Senate floor last month that COVID-19 vaccines might contain microchips to track people. Regier said in an interview he was "offering caution in how we progress with this vaccination."
Meanwhile, Whitefish, roughly a 20-minute drive from Kalispell, has maintained a mask ordinance that has outlasted the statewide mandate. Banners downtown show local leaders asking people to mask up so people can pray together and keep schools open. Even so, the rule isn't always followed there.
At a recent Flathead county vaccination event, John Calhoun, 67, undid his pearl snap shirt to get his second shot and joked with the nurse, "I'm doing this so Joe Biden doesn't throw me in jail."
Calhoun says he hopes being vaccinated will help him ease tensions the next time someone tells him to wear a mask. He believes COVID-19 is real but doesn't think it's as serious as health officials claim, even though he has diabetes, a risk factor for complications from COVID-19.
"Nothing seems to bother me all that bad," Calhoun says. "I had a horse fall on me, broke my hip, and once stabbed myself with a hunting knife. All that caused me a bit of a problem, but other stuff just doesn't bother me."
He decided to get the shot after an old high school friend with a degree in biochemistry told him it was important — an opinion Calhoun trusted over those of government-paid experts and liberal politicians who he said have used the pandemic to grab more power.
Calhoun says he's still trying to talk his wife, Lola, into getting vaccinated to play it safe: "She's one of those ladies that you don't talk her into much."
Lola Calhoun, 59, says she got her shingles vaccine within the past year because she trusts the protection it offers. When it comes to COVID-19, she says, she'd rather risk the virus than be injected with vaccines that feel too new, despite decades of research underpinning their unprecedented development.
"The COVID vaccine to me is experimental and we are the case studies," she says. "Maybe a year from now — I'll see what happens to these people who got the vaccine."
On a recent evening, Ray Sederdahl, 63, sat on his girlfriend's Kalispell porch while his grandkids picked dandelions. The Air Force veteran said even if he wasn't skeptical of the vaccines, he thinks of COVID-19 as an illness that's much like the flu.
"The VA keeps trying to get me to schedule an appointment and I just say, 'At this time, I'll pass,'" Sederdahl says. "A lot of the older vets I talk to, they didn't get it either, and they're not gonna get it."
To Sederdahl, things feel normal enough. Businesses are open and he doesn't have to wear a mask most places.
Erica Lengacher, an intensive care unit nurse in Kalispell who has worked in COVID-19 units and at vaccine clinics, says she's sad but not surprised that vaccine rates are slowing. But, she says, the overall feeling at the county's vaccine clinics is hopefulness — people are still showing up, even if the crowds are smaller.
Lengacher says Flathead was hit so hard this winter, she hopes some natural immunity that arose among community members infected with the virus then, along with growing vaccination levels, will be enough to hold off further outbreaks over the next few months.
"Just given our lifestyle — single-family homes, no public transportation, a few people per square mile — we may get away with it," Lengacher says. "But there's a big question mark of how variants show up here. There are just a lot of big question marks."
As of May 10, the county had 116 confirmed active cases of COVID-19 — up from 71 on April 23.
Kaiser Health News is a nonprofit, editorially independent national newsroom funded by the Kaiser Family Foundation, KHN is not affiliated with Kaiser Permanente.