(ATLANTA) — The gap in COVID-19 vaccination uptake between rural and urban Americans is continuing to widen, a federal report published Thursday found.

As of Jan. 31, 2022, 75.4% of people aged five and older living in urban counties have received at least one dose of the vaccine, according to the Centers for Disease Control and Prevention.

By comparison, just 58.8% of those living in rural areas had been given at least an initial shot — a nearly 17% difference.

However, a previous report by the federal health agency found that, in April 2021, the gap was smaller with 45.7% of urban residents given at least one dose of the COVID vaccine compared to 38.9% of rural residents.

This means that in the span of nine months, disparities based on geographic location have more than doubled.

The authors say the large gap is likely due to less access to health care and increased vaccine hesitancy in rural areas.

“Addressing barriers to vaccination in rural areas is critical to achieving vaccine equity, reducing disparities, and decreasing COVID-19-related illness and death in the United States,” the authors wrote.

According to the new report, 46 states had higher COVID vaccine uptake in urban areas than in rural areas with just one state — Arizona — having higher coverage in rural areas.

Three states: Delaware, New Hampshire and Rhode Island, and Washington, D.C., have no rural counties so differences in vaccination coverage could not be evaluated.

In both rural and urban counties, women were more likely to be vaccinated than men.

Data showed 77.4% of urban women and 61.4% of rural women had received at least one dose by the end of January compared to 73.2% of urban men and 55.7% of rural men, respectively.

This is similar to the CDCs report looking at April 2021 vaccination rates, which also showed more women getting vaccinated.

Among all age groups, vaccination uptake was higher in urban counties with the largest difference being among 12-to-17-year-olds.

The report showed just 38.7% of rural teenagers had received at least an initial vaccine dose compared to 64.9% of urban teenagers.

However, the researchers found that there was relatively no difference in the percentage of people in rural or urban areas who received booster or additional doses, both being similarly low.

About 50.4% of fully vaccinated urban residents had received a booster shot as of Jan. 31, 2022 as had 49.7% of rural residents.

The CDC authors noted Americans living in rural counties tend to be aged 65 or older and have more pre-existing conditions.

This puts them at high risk of severe COVID-19 complications and is why rates of death from the virus are higher in rural areas than in urban areas.

Dr. Matt Feeley, part of ABC News’ Medical Unit, contributed to this report.

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(NEW YORK) — In the early days of the coronavirus pandemic, as hospitals became overrun, a group of doctors began touting an anti-parasitic medicine called ivermectin as a viable treatment for COVID-19, one going as far as calling it a “miracle cure” for the coronavirus, despite experts in the medical community urging caution and warning that science so far did not support its use in the treatment of COVID-19 outside of a clinical trial.

“There is a drug that is proving to be a miraculous impact, and when I say miracle, I do not use that term lightly,” Dr. Pierre Kory, a critical care physician, said at a congressional hearing in December 2020. “And I don’t want to be sensationalized.”

Major health institutions like the FDA and CDC issued warnings urging against the use of ivermectin as a COVID-19 treatment, even as a group called the Front Line COVID-19 Critical Care Alliance, co-founded by Kory, and another group called America’s Frontline Doctors, continued to promote the drug on their websites, on social media and at speaking engagements — making ivermectin one of the most controversial topics related to the pandemic.

The drug, commonly used for livestock and pets in an animal-grade formula, is also FDA-approved in a human formula to treat parasitic infections and skin conditions such as scabies. In 2020, as the medical community was furiously looking for ways to treat coronavirus patients, and vaccines still seemed like a distant dream, a study in Australia suggested that ivermectin could “stop the SARS-CoV-2 virus growing in cell culture” in a laboratory.

But what happened in that test tube didn’t prove that the drug could heal a person sick with COVID-19 or prevent COVID-19 in people, and the university website where the study is posted warns that “whilst shown to be effective in the lab environment, ivermectin cannot be used in humans for COVID-19 until further testing and clinical trials have been completed to establish effectiveness of the drug.”

Ivermectin advocates often cite “dozens” of studies that show benefits of ivermectin in combating COVID-19, but a closer look at the studies shows that some of them have been retracted for flawed or fabricated data and analysis, while many randomized trials have shown no benefits. There have been some small studies that did suggest positive effects of ivermectin on treating COVID-19 patients, but no large, rigorous, randomized controlled trial has shown that COVID-19 is effective at treating or preventing COVID-19, medical experts say.

The general consensus in the medical community now is that there’s not enough data to recommend ivermectin for routine use as a COVID-19 treatment, said Dr. Adrian Hernandez, professor of medicine and vice dean and executive director of Duke Clinical Research Institute, who is leading a nationwide clinical trial on potential treatments for COVID-19. And doctors point out that there are side effect risks with any pharmaceuticals, so using the medication for unintended purposes may be dangerous.

And even with the arrival of highly effective treatments and vaccines, support for ivermectin has continued among some vaccine skeptics, including Kory, who have championed the drug as a COVID-19 cure and a key part of early treatment, and have urged Americans to stock up on it.

In August, prescriptions for ivermectin jumped to nearly 25 times the normal rate, to 88,000 per week, up from just 3,600 per week before the pandemic, according to the CDC.

“Let me just say very clearly that ivermectin is not a recommended treatment for COVID-19,” U.S. Surgeon General Vivek Murthy said in August. “It is not a recommended drug to prevent COVID-19.”

At your doorstep within days

Despite the warnings from health agencies about unproven COVID-19 treatments, several physicians groups have partnered with telemedicine platforms and pharmacies to offer easy access to drugs like ivermectin. But the easy access comes at a cost, with a telemedicine visit and the cost of the prescription typically ranging from $90-$300.

ABC News was able to obtain 28 pills of ivermectin for a total of $339, including a $90 telemedicine consultation fee and a charge of $249 from an online pharmacy — which included a $25 shipping fee for overnight delivery — after filling out an application and providing a medical history through a telemedicine platform, and having a brief conversation with someone who claimed to have no knowledge about the drug or COVID-19.

It was an unusual process for obtaining a medicine: Georgia-based ABC News Senior National Correspondent Steve Osunsami first spoke with a woman who said she was calling from Alabama and described herself as a technical nurse, while a Florida-based nurse practitioner — who didn’t speak with Osunsami but had a license to practice in Georgia — sent the prescription for the pills to a New York pharmacy that then shipped the pills to Georgia.

Osunsami began the process by registering online, after which he was contacted by the woman in Alabama. “Which one of the medications are you interested in?” she asked Osunsami, who told her he was interested in ivermectin. The woman then asked him if he had high blood pressure or allergies, and took some additional information.

“All right, that’s all the information I need,” the woman said. “So let’s send this to the pharmacy.”

Asked if there was anything else to know about the drug, the woman directed Osunsami to the pharmacy that would fill his prescription.

“I don’t have any medical knowledge as far as medicine or even about COVID,” said the woman. “I don’t have any medical knowledge at all. I’m so sorry, but I really don’t.”

But no matter, because the prescription was already on its way.

Osunsami was not asked if he wanted a consultation with a doctor or a pharmacist. He did receive some guidance including how to use the medicine and what side effects to look out for with the drug.

‘Millions of dollars being made’

One year after his congressional testimony, Kory doubled down on the anti-parasitic drug, calling ivermectin the “single greatest solution to the pandemic” in a blog post earlier this month — even though top health agencies have said ivermectin is not yet proven to be effective against the coronavirus.

And just days ago, Kory launched his own telemedicine platform that offers ivermectin as part of its treatment protocols. For $250, his website offers a 15-minute “‘Meds on Hand’ Treatment Kit” consultation with a nurse practitioner through text or telephone — and for a premium of $950, you can even arrange a personalized visit with Kory himself. The website doesn’t say whether the platform sends the drugs to a pharmacy or it sells them directly. It says ivermectin is part of their treatment protocol.

The website offers ivermectin and a few other drugs like hydroxychloroquine, a once-promising COVID-19 treatment that had its FDA emergency authorization revoked after it failed to show a benefit in large studies, as part of its COVID-19 treatment protocols.

Neither Kory, representatives for his new telemedicine platform, or members of the Front Line COVID-19 Critical Care Alliance responded to ABC News’ multiple requests for comment regarding promoting the use of drugs for the treatment of COVID-19 that have not been proven to be effective treatments for the disease.

Critics say that at least one other group is capitalizing on the interest in ivermectin — apparently by leveraging a network of doctors available to write the prescriptions.

ABC News obtained an email sent by Encore Telemedicine, an entity that was connecting patients to telemedicine services for people seeking consultation through the physicians group America’s Frontline Doctors. In the email, Encore Telemedicine sought to entice physicians to “become part of an ivermectin ‘COVID-19 project'” with the potential to receive “tens of thousands of dollars per month” from prescribing ivermectin and hydroxychloroquine.

“We can send you as many patients per day at $30 per patient per encounter as you would like,” the email stated. “We have physicians making tens of thousands of dollars per month.”

Neither Encore Telemedicine nor America’s Frontline Doctors responded to ABC News’ requests for comment. Encore Telemedicine’s website has been down for several months.

The booming online industry of telemedicine offering unproven COVID-19 treatments like ivermectin has caught the attention of lawmakers, who have launched an investigation into America’s Frontline Doctors and SpeakWithAnMD.com, a telemedicine platform.

In a letter sent by the House Subcommittee on the Coronavirus Crisis to America’s Frontline Doctors, House investigators refer to Encore Telemedicine, the company that ABC News obtained the email from, as the parent company of SpeakWithAnMD.com.

The House probe, launched in October, is investigating the entities for allegedly “spreading misinformation and facilitating access to disproven and potentially hazardous coronavirus treatments, such as hydroxychloroquine and ivermectin.”

“Attempts to monetize coronavirus misinformation have eroded public confidence in proven treatments and prevention measures and hindered efforts to control the pandemic,” Rep. James E. Clyburn (D-S.C.), chairman of the House Subcommittee on the Coronavirus Crisis, wrote in a letter to Dr. Simone Gold, the leader of America’s Frontline Doctors, over the fall.

“We think there are millions of dollars being made by various groups selling misinformation,” Clyburn told ABC News. “[We’re] doing what we think is necessary to try to get to the bottom of this.”

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