Have vaccines, will travel: On the road with a COVID entrepreneur

VIRGINIA CITY, Mont. — While many businesses in this southwestern Montana "ghost town" 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's vaccine deserts.

"In any business, going to the people is better than waiting for the people to come to you," 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 — a nod to Montana's 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.

"When they started talking about COVID coming out I was like, 'All 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,'" he said. "I hate to say it, but I literally took advantage of COVID-19 to open up and push forward."

Now, with demand at a trickle and the nation grappling with how to finish distributing vaccines, collecting stragglers is part of Austin's 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's 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's largest city.

There he offered rapid COVID tests, which had been in short supply. He also expanded beyond what's found in typical drugstores: After trying cryotherapy once himself, he bought a machine to add to his pharmacy's list of services. When he noticed people could rent electric scooters 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 "Get a brew, not the flu," 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't 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 — 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's financially possible because he doesn't pay another pharmacist to do the work.

"If I paid someone to do it, I would probably be upside down," Austin said.

Austin's 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. "Even an incremental increase in uptake could have a big effect on our statistics," 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 — compared with 49% statewide and 59% nationally.

Teenagers remain the county's age group with the biggest vaccine shortfall.

Virginia City doesn't have a pharmacy. The county's vaccine providers are two hospitals that don't stock Pfizer doses. At the beginning of the rollout, Sayler said, the one-nurse health department couldn't handle both vaccines and contact tracing. And as demand dwindled, she worried they wouldn't be able to use up doses — especially Pfizer's. That brand comes in shipments so large that most rural towns can't or won't offer it.

Now the department is balancing educating people about vaccines without coming off as aggressive. It's a county where many locals call incentives — like a free beer or ice cream cone for a jab — a bribe.

Brothers Nicholas and Jacob Johnson, 17 and 16, showed up first to Austin's recent clinic, coming for their second shots. Their next option was going to Bozeman, at least a 100-mile round trip.

"And we would have needed to do it for two shots," Nicholas said, adding he has a summer job and is busy with football and lacrosse.

"I just wanted to get it over with," Jacob added. "I trust the science."

Some of the county's vaccination gap can be attributed to lack of time. Dr. Douglas Young, chair on the county's 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.

"I didn't want to be down and out during calving season," 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's 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.

"Now we're dealing with this pandemic of the unvaccinated," said Gatewood, before nodding toward the clinic. "This brings it back into the consciousness of folks, just makes them aware and, hopefully, maybe, minds are changing."

About a block from the COVID vaccine clinic, Adam Root, 41, said he hadn't known about the clinic but wouldn't have gone anyway. He hasn't liked the federal pressure to get vaccinated.

"I'm not vaccine-hesitant, it's just a hard 'no' for me," Root said. "I 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."

By the time Austin headed back to his campsite along the Madison River, he had vaccinated 20 people — adding five people who got first doses. He planned to return to give them their second shots and pick up any new takers.

He's 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's hospitals and families with teens to locations outside the county. Otherwise, he hopes he can get people to show up when Austin returns.

"I can't stab people myself," Gatewood said.