Montana, Idaho, Utah, Nevada and Wyoming Lag in Vaccinations

The Mountain West has emerged as one of the most vaccine-hesitant regions of the United States. Along with the South, it is lagging far behind the national vaccination pace.

In both Idaho and Wyoming, fewer than 40 percent of people have received at least one dose so far, ranking those states among the bottom five in the nation, according to a New York Times database. Montana, Utah and Nevada are doing a bit better, but remain well below the national average of 54 percent. None of the five states is on track to meet President Biden’s goal of at least partly vaccinating 70 percent of adults by July 4, and the White House acknowledged this week that the president doesn’t expect the nation as whole to meet that target.

Health officials in the region say that their efforts have been hampered by sparse populations in their wide-open areas and by the deep-rooted brand of political conservatism that is common among rural residents. But there is more to the story than that.

As in other parts of the country, the unvaccinated in the Mountain West can be divided largely into two camps, experts say.

“There are those who are kind of the wait-and-see folks, and then we have the absolutely, definitely not,” said Greg Holzman, who was Montana’s state medical officer until April. Rampant misinformation makes it difficult to change minds, he said, and so does the logistical difficulty of providing convenient access in small, widely scattered communities.

There are crosscurrents beneath the statewide trends. For example, Native Americans in Montana, after some initial hesitancy, have embraced the vaccines while white residents in rural areas have been less accepting.

Garfield County, in eastern Montana, illustrates some of what health officials are up against. The county was the scene of a lengthy standoff in 1996 between the F.B.I. and an anti-government militia called the Montana Freemen. These days, “the life philosophy is pretty much the same, and that’s no government intervention, no way, no how,” said Dr. Randall Rauh, medical director of the Garfield County Health Center, a critical access facility and nursing home.

Just 21 percent of eligible county residents have been fully vaccinated, the lowest rate in Montana, according to state figures.

Dr. Rauh said that after the center vaccinated all of its nursing home residents, he was accused by an employee of experimenting on old people, and the facility received little support from local officials. The county health department will only administer vaccine doses when 10 or more people show up to get them, Dr. Rauh said, so “it’s very difficult for people unless they can make the trip to a surrounding county to get vaccinated.”

In Utah, home to the Church of Jesus Christ of Latter-day Saints, the church’s leadership has voiced strong support for vaccination. Even so, a recent survey found that about half of Mormon respondents were hesitant or unwilling to get vaccinated.

Misinformation appears to be a factor among Mormon women, in a state with one of the nation’s highest birthrates, said Dr. Emily Spivak, an infectious diseases specialist at the University of Utah Hospital in Salt Lake City. “I’ve had a lot of questions about fertility,” and whether the vaccines affect menstruation, she said. There is no current evidence that the vaccines impact fertility.

Idaho tends to have lower immunization rates in general, according to Maggie Mann, the district director for Southeastern Idaho Public Health. Many people have told her that their schedules are too busy to fit in the appointment.

The eight counties Ms. Mann oversees are dotted with communities that have not been severely hit by the pandemic, she said, and “it’s hard for people when they haven’t been personally affected to be highly motivated to get that vaccine.”

Only one county in Nevada has fully vaccinated more than half of its residents 12 and older, according to the Times database. Experts say many people in the state’s rural areas simply do not see the need.

Matthew Walker, chief executive of William Bee Ririe Critical Access Hospital and Rural Health Clinics in Ely, Nev., said that health care workers try to win over skeptics by appealing to their sense of self-reliance.

“We try to really push that if you get sick, regardless whether it’s the flu or Covid, and you have to be laid up in bed for a few days, or worse, what’s going to happen?” he said. “You can’t take care of yourself, you’re an hour or two away from a medical facility, you’ve got kids or family — who’s going to take care of your ranch? And oftentimes, that will get people.”