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Map: 1 in 5 young kids have gotten their first Covid vaccine. See which states are leading the effort.

The vaccination rate among urban children is twice the rural rate.

Nearly 20 percent of children ages 5 to 11 in the United States have received their first dose of a Covid-19 vaccine since the shots were approved for them in early November.

Several New England states are leading the vaccination effort for young children, with vaccinations in Vermont, Massachusetts and Rhode Island all above 35 percent — far higher than the nationwide average of 19 percent, according to an NBC News analysis of data from the Centers for Disease Control and Prevention.

But at the county level there’s a disparity. Fewer than 10 percent of children in rural counties are vaccinated, half the rate of their urban counterparts.

About 6 percent of vaccinations went to 5- to 11-year-olds in rural counties, even though 13 percent of kids in that age group live in rural areas, according to the analysis. About 94 percent of vaccinations for kids 5-11 come from urban areas, while 87 percent of young kids live in urban areas.

Dr. Nusheen Ameenuddin, a community pediatrician at the Mayo Clinic, said the divergence between rural and urban counties could be due to access to the vaccines.

"We found that if we were able to reach people where they are and answer questions they have using accurate information, we are much more likely to be successful," Dr. Ameenuddin said.

Pediatricians have found success combating influenza by offering flu shots at schools, for example.

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The CDC's website notes caveats with county-level data. For example, Vermont leads the nation for vaccinating young kids, with half of their 5-11 year-olds vaccinated, but their location data within the state is incomplete, and was omitted from county-level analysis.

Not all rural counties are lagging in child vaccinations. Parts of Arizona, Alaska, Minnesota and New Mexico are vaccinating kids faster than some urban areas. And some urban areas have fallen behind rural counties, including parts of Virginia, Tennessee and Louisiana.

Steve Elliott, communications director for the Arizona Department of Health Services, said more than 98,800 kids 5-11 have received at least their first dose of the Pfizer-BioNTech vaccine as of last Wednesday. He said the state has created ads, social media campaigns and worked with local groups to get kids vaccinated.

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In Washington state, which ranks 13th among states with the highest pediatric vaccination rates, health officials have set up clinics at schools, and school districts have worked in partnership with local pharmacies to get kids vaccinated against Covid, said Michele Roberts, acting assistant secretary at the state Department of Health.

State health officials there are working to educate more parents about the shots, with a particular focus on family vaccination events.

“A lot of parents, even a lot of parents that are vaccinated themselves, potentially have a higher bar when they’re thinking about their kids and really want to make sure they are making the right decision,” Roberts said. "We really want to normalize this. Parents should be thinking through this. Parents should understand the decision they’re making."

In Vermont, the state with 49 percent of kids with one dose, vaccination clinics are set up around the state, including in schools, said Ben Truman, a public health communication officer for the Vermont Department of Health.

In some areas of the state, health officials are "proactively" working to reach Black Americans, Indigenous groups, refugees and people experiencing homelessness, he said.

"Our efforts include materials in multiple languages, targeted clinics and other work to provide ready access to testing, vaccination and treatment," Truman said.

Massachusetts had the second-highest proportion of young kids with their first dose, with more than 179,000 children having received at least one shot, according to data shared by the state.

Kayla Rosario-Muñoz, a spokesperson for the Executive Office of Health and Human in Massachusetts, said pediatric vaccines have been widely available at hundreds of locations across the Commonwealth, including pediatricians’ offices, pharmacies and local clinics and over 350 back-to-school clinics.

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