Snag a vaccine appointment, then face the next hurdle: How to get there?

The airport says a lot about Cortez, Colorado: The single-engine planes that fly into its one-room airport seat nine passengers at most. The city of about 9,000 is known largely as a gateway to beautiful places like Mesa Verde National Park and the Four Corners Monument. But covid vaccines have made Cortez a destination in its own right.

"We had a couple fly in to get their vaccine from Denver that couldn't get it in the Denver metro area," said Marc Meyer, director of pharmacy services and infection control for Southwest Health System, which includes clinics and a community hospital in Cortez. Others have come from neighboring states and as far away as California, Florida and the Carolinas. "They all come back for their second dose," he said. "Because it's so hard to get in the cities."

With vaccines now becoming available to the general public in much of the country, the privilege of easy access is coming into sharper focus. On the most extreme end, vaccine tourists with means can nab inoculations, as Forbes has reported, in places such as Israel, the United Arab Emirates and even Cuba, where ads offered "mojitos and vaccine." On the flip side, some people have found it hard to get to a vaccine appointment a few miles away.

In fact, around the same time people were flying into Cortez to get their shots, Meyer said, some locals couldn't get to vaccine locations. That was particularly true for people who are homebound or homeless.

So Meyer and his colleagues came up with a vaccine SWAT team of sorts, composed of paramedics and a handful of ambulances stocked with vaccine vials. The team visited about 40 homebound people. For 30 or so people who are homeless in the area, Meyer snagged leftover doses of the single-dose Johnson & Johnson vaccine from a nearby county.

But he said he doesn't know if his team got to everyone who wanted vaccines. "The problem with health disparities in rural areas is there's no data," he said. "It would be really helpful to know how many people have transportation issues."

A KHN analysis of Colorado health department data shows that by the end of March about 43% of Coloradans who had received their first doses, and had addresses on file, got those shots outside of their home county. At least 60,000 Coloradans — about as many people as live in Grand Junction, the biggest city in western Colorado — got their first vaccine dose 50 or more miles away, as the crow flies, from their home ZIP codes.

And the state vaccinated more than 20,000 people from out of state — tourists, traveling nurses, cross-border dwellers and others whose primary residence is elsewhere — about 1% of the total number of people who had received first doses by April 1 in Colorado.

Other states have noticed similar migrations. Missouri, for example, saw an exodus of urbanites to rural areas in search of vaccines, leading critics to say doses had been misallocated in a way that neglected cities such as St. Louis.

But traveling for a vaccine requires money, flexibility with one's time and a vehicle. Transportation was a health issue even before the pandemic, said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials. Researchers writing in the American Journal of Public Health found that, in 2017 alone, 5.8 million people in the U.S. delayed medical care because they lacked transportation. This group was disproportionately poor and had chronic health conditions.

Access issues, Freeman said, are likely being mischaracterized as vaccine hesitancy. Even some who live in cities with robust public transportation and ride-hailing services have found themselves jumping through hoops to get to a vaccine appointment.

Bob McIntyre, 81, lives in Denver in an apartment close enough to a major highway that the traffic "sounds like ocean waves in the distance." But he doesn't have a car. "It's just too expensive," he said. Before the pandemic hit, McIntyre could walk or take public transit. With the coronavirus circulating, though, he'd rather not be closed in a box with a bunch of strangers. "So, I've been hermitized."

Ride-hailing companies Uber and Lyft have offered free rides to vaccine appointments, but McIntyre doesn't feel safe using those services. He eventually learned of A Little Help, a nonprofit that offers everything from free yardwork to rides for covid vaccine appointments. Volunteer drivers took him to both of his vaccine slots, which were about 15 minutes from his home but otherwise would have remained out of reach.

Maggie Lea, director of programs at Mile High Connects, worries others may not be as lucky. Her organization believes more affordable and accessible transportation is key to achieving a racially and economically equitable Denver — especially right now.

"There are people who may or may not be motivated already to get the vaccine," she said. "If they don't have access to transport, or it’s particularly expensive for them to get over there, or burdensome for them to get to a vaccine site, we’re noticing that they just won’t go."

Transit systems can use federal covid relief funding to help people get their vaccines, said Amy Conrick, director of the National Center for Mobility Management.

In West Texas, the SPARTAN public transit agency offers free rides to covid vaccine appointments, including many at its headquarters.

In Oxford, Ohio, older adults can get vaccinated by nurses aboard buses that accommodate oxygen tanks and wheelchairs. The city set up a hotline for residents to schedule their vaccine and transportation in one call.

"We live in a rural community where some people just don't have internet," said Assistant City Manager Jessica Greene.

Transit systems need to talk to public health officials, Conrick said. "Now is the time," she said. "Well, actually, yesterday was the time."

But many places lack decent public transit. For them, Freeman of NACCHO imagines covid shots waiting anywhere people congregate, even at NASCAR races, once the supply increases. "You should be able to just turn in any direction and be able to get a vaccine," she said.

For now, demand is so high that vaccines go into arms as soon as they are available, Freeman said, but soon public health officials will have plenty of vaccine but a shrinking group of people who want to bother getting it. "We will hit a hard stop where we're looking full face onto the universe of people that do not want to get the vaccine."

Then, she said, it will be even more important for vaccination to not only be possible, but for it to be easy.