Throughout January, Kevin Boozel, a commissioner in Butler County in Southwest Pennsylvania, said his office fielded as many as 70 calls and emails a day from residents frustrated that they don’t have information about where to get a vaccine. “I think people believe that we as county commissioners are holding back the vaccine,” said Boozel, who is also president of the County Commissioners Association of Pennsylvania.

Many counties have worked with their local emergency service departments to put plans together for community vaccination clinics, and they’re brainstorming ways to reach people living in public housing and to use plans developed during previous emergencies, such as the H1N1 flu outbreak, Boozel said. “We stand ready to help as we continue to work through this pandemic,” he said. None of their plans can be enacted until the state tells counties how many doses they will receive, where they’ll go, and when those shipments will arrive, he said.

Warren General Hospital, an 85-bed community hospital in Warren County, has been vaccinating about 600 to 1,000 people a week, Richard Allen, hospital CEO, said during a state House health committee hearing Wednesday. It is not equipped to handle a larger volume of people while still running the hospital. As more become eligible to receive the vaccine, the hospital will need help, Allen said. “In the face of these uncharted pandemic waters,” Allen said, there is “a void in terms of coordinated direction, authority, and resources.”

Primary Health Network, which serves residents in rural counties throughout the state, recently acquired a mobile health unit that will be used for both coronavirus testing and vaccines, said George Garrow, chief medical officer for the network. But even as the system gears up to vaccinate people who aren’t able to reach a vaccination site, it has had to close offices — which are sometimes as small as three people — if staff are exposed to the coronavirus, Garrow said during a January hearing with the Center for Rural Pennsylvania. “As this situation progresses, I do see it necessary to engage with the National Guard to assist in vaccinating mass quantities of communities,” he said.

Mobilizing vaccination efforts in rural areas takes more than just someone to give the shot.

After it got word from the state that a clinic could be held in Sullivan County, local officials decided it should be held at the Sullivan Elementary School in Laporte — a familiar, central location that often doubles as a space for community events. Public transportation is limited: The county got its first public bus route in October, and getting around requires “a car, or a relative who has one,” Commissioner Darlene Fenton said.  The plan was to vaccinate 500 eligible people on Jan. 29 and Jan. 30.

Information was posted on the local government website earlier that week, said Hoffman, the commissioner. By the time the local weekly newspaper, the Sullivan Review, ran a summary outlining details of the event in its Jan. 27 edition, all of the appointments had been filled. “The demand for vaccines was definitely more than our available supply,” he said. The local Area Agency on Aging, which works with the county’s older residents to connect them with personal care resources, helped them register. Other eligible people heard through their local emergency medical services and fire department, including Keen. Five older residents who received vaccines Friday relied on a special service provided by the local tri-county transit system to make it to their appointments. Four are already scheduled to use the service when they return for their second dose in late February.

It took a team of at least 54 people — including local volunteers in color-coded vests to check in residents, medical workers, county employees, and state Health Department staff — to keep the clinic running, according to figures provided by Sullivan officials. Inside, however, it felt more like a gathering than a vaccination site, with laughter and neighbors catching up with each other for the first time in months. “We’re a small county,” Hoffman said. “So a lot of people already know each other and already worked together on other things.”

Maryanne Karpovich, an 85-year-old from Dushore, has a pulmonary disease and a pacemaker — “two strikes against me,”   She said. Before scheduling with the clinic, she tried to track down an appointment elsewhere but was told she’d have to wait weeks. “You won’t be as afraid,” Karpovich said after receiving her shot. “But you still have to wear the mask.”

After being told by his doctor he’d have to wait until April, Keen received his first dose of the Moderna vaccine Jan. 29. “I feel great,” he said afterward.