Nearly one in five of Montgomery County's 50,000 residents are older than 65. But the small, largely rural county between Albany and Utica receive only about 100 or 200 vaccine doses a week.

Rolling out the COVID-19 vaccine has been a challenge across New York. Officials in rural counties with an aging population are facing an especially demanding test to ensure shots get to older residents, some of whom may not have the ability to drive to different regions of the state where a mass vaccination site has been set up.

Thousands of county residents have gotten in line to get their shots. 

"We have over 5,000 people on the wait list," said Montgomery County Executive Matt Ossenfort in an interview. "It was at 6,000. We put a dent in it. Finally it's starting to come down a little bit. But for many weeks there, the wait list was growing faster than we could vaccinate."

Rural counties with older residents have faced an especially challenging time during the pandemic. Census data shows 19% of Montgomery County's residents are over the age of 65, qualifying them for the COVID-19 vaccine. 

The county has been required to prioritized the precious few doses they receive, first to essential workers. In the mean time, mass vaccination sites are hours of driving time away. 

"A teacher, for instance, might be able to drive to Plattsburgh or might be able to drive to Utica or might be able to drive to Albany to get that shot," Ossenfort said. "But an 85-year-old resident who might leave the house once or twice a month doesn't have that same luxury."

Transportation to receive one of two vaccine doses is a key issue facing older New Yorkers in rural areas. Assemblyman Angelo Santabarbara says there needs to be a solution, especially for older people who find long drives too difficult. 

"How do we get those vaccines to homebound seniors to people who perhaps don't have a vehicle?" he said. "You know, there's no [public transportation] out there."

The state last Friday announced plans to increase coordination with county governments to provide more vaccination sites and increase transportation options. The Johnson & Johnson vaccine, a one-shot dose that requires less stringent storage needs, has been approved by state and federal regulators. 

All told, more than 4 million first and second vaccine doses combined have been administered in New York, state officials on Monday said. More than 10 million people out of the state's 19 million residents qualify for the vaccine. 

The COVID-19 pandemic has been a trial for rural residents. Opioid overdoses have increased during the crisis and budgets are being strained. 

For older New Yorkers, there are the technological limitations for vaccine access which often require the use of the internet or a smartphone. 

"A lot of times it becomes access, it becomes transportation, but also technological," Ossenfort said. "It's a big ask to ask a 85-year-old person to download an app to get their COVID vaccine."

The county has stepped in to boost transportation options for older residents and schedule their vaccine appointments over the phone. But vaccine supply has remained the biggest hurdle. 

"The technological issue as well as the transportation are the greatest challenges," Ossenfort said. "The part that breaks your heart is we have those resources ready to go and we're not able to use them."