VIRGINIA CITY, Mont. 鈥 While many businesses in this southwestern Montana 鈥済host town鈥 reel in tourists with its mining and Wild West vigilante past, one businessman arrived offering a modern product: covid-19 vaccines.
Kyle Austin, a traveling pharmacist, set up his mobile clinic in Virginia City on a recent Saturday, the latest stop on his circuit of Montana鈥檚 vaccine deserts.
鈥淚n any business, going to the people is better than waiting for the people to come to you,鈥 the 38-year-old pharmacist said.
While many businesses scaled back at the height of the pandemic, Austin saw covid as an opportunity. He opened his own shop, Pharm406, in Billings 鈥 a nod to Montana鈥檚 lone area code. Then when the covid vaccine became available, and thousands of people across Montana were stuck on waitlists, he hit cities large and small in a school bus turned vaccine clinic, offering shots with no appointment needed.
鈥淲hen they started talking about covid coming out I was like, 鈥楢ll right, we’re gonna create a vaccine, there’s gonna be a big demand for it, and Montana doesn’t have a lot of access,鈥欌 he said. 鈥淚 hate to say it, but I literally took advantage of covid-19 to open up and push forward.鈥
Now, with demand at a trickle and the nation grappling with how to finish distributing vaccines, collecting stragglers is part of Austin鈥檚 business model as he rotates among towns. He sees it as a service to rural Montana that could also pay off for him.
In some parts of the state, Austin is the only person administering Pfizer-BioNTech vaccines, the sole shot approved for those ages 12 to 17. When the mobile clinic leaves, local leaders must figure out how to fill the gaps between his visits.
Dressed in blue scrubs, Austin talks like a businessman who knows rural Montana. He鈥檚 from Havre, a Montana town about 35 miles south of the U.S.-Canada border, population roughly 9,000. For years, he traveled across the state as a relief pharmacist for drugstores. That work stalled when covid arrived.
Austin then wanted to create a mobile pharmacy, but a brick-and-mortar base was required to obtain a state pharmacy license. So, in July 2020, he opened his own shop in Billings, Montana鈥檚 largest city.
There he offered rapid covid tests, which had been in short supply. He also expanded beyond what鈥檚 found in typical drugstores: After trying cryotherapy once himself, he bought a machine to add to his pharmacy鈥檚 list of services. When he noticed in town, he began selling them. Then he used flu shots to conduct a test run of his vaccine tour last fall on the slogan 鈥淕et a brew, not the flu,鈥 partnering with breweries to give a free drink to anyone getting a shot. In April, he hit the road with covid vaccines, leaving his team of seven employees to keep his Billings drugstore running.
His mobile clinics have been the easiest way to turn a profit. He doesn鈥檛 have to rent space or staff an entire pharmacy for the trips. Health departments advertise the clinics for him, and locals provide space for him to park and patients to wait. When the weather is nice, he keeps costs low by camping along the way.
And covid vaccines have had more demand and higher reimbursement rates than any other vaccine he could have used to propel his business. In most cases, Austin said, he can break even by giving as few as 20 doses a day. So far, the government has supplied the shots for free, and he estimated he gets paid roughly $30 on average to administer a dose between payments from insurance companies and federal reimbursements 鈥 as opposed to the $17 he said he saw last year for flu vaccines.
Some days he gives out 200 shots, other days five, but said that adds up. He said it鈥檚 financially possible because he doesn鈥檛 pay another pharmacist to do the work.
鈥淚f I paid someone to do it, I would probably be upside down,鈥 Austin said.
Austin鈥檚 recent trip to Virginia City to offer a second round of doses came at the request of the town and local health department. This time he drove a Jeep, leaving his school bus behind, because he expected only about 15 customers.
But in a town of 120 year-round residents, in a county of fewer than 9,000, a few shots can make a difference. 鈥淓ven an incremental increase in uptake could have a big effect on our statistics,鈥 said Emilie Sayler, county health director.
Virginia City is at the center of Madison County, where 43% of those eligible for the covid shot are fully vaccinated 鈥 compared with 49% statewide and 59% nationally.
Teenagers remain the county鈥檚 age group with the biggest vaccine shortfall.
Virginia City doesn鈥檛 have a pharmacy. The county鈥檚 vaccine providers are two hospitals that don鈥檛 stock Pfizer doses. At the beginning of the rollout, Sayler said, the one-nurse health department couldn鈥檛 handle both vaccines and contact tracing. And as demand dwindled, she worried they wouldn鈥檛 be able to use up doses 鈥 especially Pfizer鈥檚. That brand comes in shipments so large that most rural towns can鈥檛 or won鈥檛 offer it.
Now the department is balancing educating people about vaccines without coming off as aggressive. It鈥檚 a county where many locals call incentives 鈥 like a free beer or ice cream cone for a jab 鈥 a bribe.
Brothers Nicholas and Jacob Johnson, 17 and 16, showed up first to Austin鈥檚 recent clinic, coming for their second shots. Their next option was going to Bozeman, at least a 100-mile round trip.
鈥淎nd we would have needed to do it for two shots,鈥 Nicholas said, adding he has a summer job and is busy with football and lacrosse.
鈥淚 just wanted to get it over with,鈥 Jacob added. 鈥淚 trust the science.鈥
Some of the county鈥檚 vaccination gap can be attributed to lack of time. Dr. Douglas Young, chair on the county鈥檚 Board of Health and a veterinarian, came for his shot straight from tending to a sick mule. Young said he always planned to get vaccinated but held off in case it triggered a reaction that knocked him out of work for a few days during the busy spring.
鈥淚 didn鈥檛 want to be down and out during calving season,鈥 Young said.
Virginia City Mayor Justin Gatewood, a 44-year-old farmer in a pink pearl-snap shirt and work-stained jeans, stood outside the Pharm406 tent and greeted locals by name and occasionally answered questions for tourists, such as where to find Wi-Fi.
The season of visitors is booming, Gatewood said. That鈥檚 a relief for the town that survives on tourism. But that traffic is also a concern as the delta variant sparks new covid surges nationwide.
鈥淣ow we鈥檙e dealing with this pandemic of the unvaccinated,鈥 said Gatewood, before nodding toward the clinic. 鈥淭his brings it back into the consciousness of folks, just makes them aware and, hopefully, maybe, minds are changing.鈥
About a block from the covid vaccine clinic, Adam Root, 41, said he hadn鈥檛 known about the clinic but wouldn鈥檛 have gone anyway. He hasn鈥檛 liked the federal pressure to get vaccinated.
鈥淚’m not vaccine-hesitant, it’s just a hard 鈥榥o鈥 for me,鈥 Root said. 鈥淚 don’t like being told what to do, for one thing, and, two, I believe health comes from how you take care of your body.鈥
By the time Austin headed back to his campsite along the Madison River, he had vaccinated 20 people 鈥 adding five people who got first doses. He planned to return to give them their second shots and pick up any new takers.
He鈥檚 already booked for much of the fall and expects to see an uptick as schools start.
In the meantime, Gatewood said, he can direct adults in Virginia City to the county鈥檚 hospitals and families with teens to locations outside the county. Otherwise, he hopes he can get people to show up when Austin returns.
鈥淚 can鈥檛 stab people myself,鈥 Gatewood said.
