Most successful vaccine rollouts in US: 4 state strategies

States are rushing to administer the COVID-19 vaccines as fast as possible, and some states have been more successful than others. 

North Dakota has one of the best vaccination rates in the country, according to data from the CDC. The state had administered 73.76 percent of the vaccines it had received as of Jan. 12. West Virginia and Connecticut rank second and third, at 64.19 percent and 60.37 percent, respectively. South Dakota comes in at fourth, administering 58.32 percent of distributed vaccines.

Meanwhile, Alabama, Georgia and Arkansas have the worst vaccination rates in the country. The states have administered 20.72 percent, 17.75 percent and 14.90 percent of the vaccines they've received, respectively. 

Nationally, the U.S. had administered 33.68 percent of  total vaccines distributed as of Jan. 12. 

The number of vaccines distributed to each state is dependent on population size, so large states have a potentially more complicated task. Several of the most successful states strayed from the federal government's original recommendations for vaccine priority groups to inoculate a broader range of populations beyond healthcare workers and long-term care residents or staff.

The federal government changed its national vaccine distribution strategy Jan. 12, expanding eligibility to everyone 65 years old and above, as well people under age 65 with a comorbidity. Vaccine doses will now be released based on each state's pace of administration and the size of its population age 65 and older. 

Here are the vaccination strategies of the four most successful states. 

North Dakota

Doses distributed to state: 53,525
Doses administered: 39,479
Percentage of distributed vaccines administered: 73.76

North Dakota has achieved a smooth early vaccine rollout, though health officials  acknowledged the need to speed up vaccinations in January. The state followed original federal recommendations for the first phase of its  plan, but departed from the guidelines for the second phase, which called for vaccinating front-line essential workers and people ages 75 and up. The state opted to include people 65 and up, adults with at least two high-risk conditions and front-line workers in schools or child care in this priority group, according to a Jan. 11 report from Kaiser Family Foundation.

"I think so far things have gone well," state Immunization Director Molly Howell told the Grand Forks Herald. "I haven't been sitting here thinking 'Oh I wish we had done this,' or 'we could have done that.'"

The state launched a robust provider education program to prepare for vaccine administration in partnership with the North Dakota State University Center for Immunization Research and Education in Fargo.

"Healthcare providers were trained regarding the COVID-19 vaccines before they were authorized for use in the United States, which allowed for vaccines to be administered immediately," the North Dakota Department of Health said in a statement to Becker's.

The department also maintains weekly vaccine updates for all COVID-19 vaccine providers, along with weekly office hours and a COVID-19 vaccine email where providers can ask questions. 

North Dakota also operates a state warehouse to store and handle its COVID-19 vaccines. 

"We are able to break down COVID-19 vaccine shipments into smaller quantities to get vaccines to rural areas of the state, where many healthcare providers are located," the department said. In the first phase of its vaccination plan, vaccines were distributed to providers statewide, not just hospitals and health systems. 

More than half of North Dakota's long-term care facilities are not participating in the CDC's Pharmacy Partnership for Long-Term Care Program — a federal program to vaccinate long-term care and assisted living facilities in partnership with CVS and Walgreens. A state law dating back to 1963 requires pharmacies to be owned and operated by pharmacists, which effectively bans chains from operating in the state. Only six CVS pharmacies have been grandfathered in under the law.

"Fifty-eight percent of long-term care facilities are not participating in the program, so [the] vaccine was sent to public health, independent pharmacies or the long-term care itself for immediate vaccination," the health department said.

West Virginia

Doses distributed to state: 160,975
Doses administered: 103,330
Percentage of distributed vaccines administered: 64.19

In the race to quickly administer COVID-19 vaccines, West Virginia is outpacing many other states, reports NPR. The state has successfully given vaccines to health workers and has finished administering the first doses at all of its long-term care facilities. It is currently focusing on vaccinating individuals age 80 and older and teachers age 50 and older.

West Virginia followed federal recommendations for vaccine prioritization, except it added people over 80 to the first priority group alongside healthcare workers and nursing home residents and staff, according to KFF.

The state's vaccination success can be attributed to numerous factors. While all 49 other states are part of a federal program partnering with CVS and Walgreens to vaccinate long-term care and assisted living facilities, West Virginia chose to deliver its vaccine supply to 250 pharmacies statewide, most of which are small, independent stores. Those pharmacies already had data for many patients, making it easier to schedule vaccination appointments earlier, secure consent forms and match doses to eligible patients — efforts that are confounding the vaccine rollout in many other states.

West Virginia leaned heavily on its National Guard and a network of local pharmacies to administer the shots, West Virginia Gov. Jim Justice told CNBC Jan. 11. While other states must navigate the bureaucracy of large national chains, West Virginia has more direct control of its vaccine flow to long-term care facilities, Claire Hannan, executive director of the Association of Immunization Managers, told NPR.  

CVS and Walgreens both say their immunization schedule is on track, reports NPR, and that the chains will complete initial doses of all long-term care facilities by Jan. 25, about a month after West Virginia did the same.


Doses distributed to state: 250,775
Doses administered: 151,395
Percentage of distributed vaccines administered: 60.37

As Connecticut completes its first phase of vaccinations, the state is set to begin phase 1B next week, Gov. Ned Lamont said Jan. 11, according to the Hartford Courant. Under phase 1A, most healthcare workers, nursing home staff and residents and medical first responders have been offered a COVID-19 vaccine.  

Phase 1B will include people 75 and older, essential front-line workers, and individuals and staff in congregate settings.

Communication and coordination between the state and hospitals hasn't been a problem, Thomas Balcezak, MD, chief clinical officer of Yale New Haven (Conn.) Hospital, told The Wall Street Journal. Statewide, hospitals are working well together too, with his facility receiving a couple hundred doses from another hospital, Dr. Balcezak said.

Paul Kidwell, senior vice president of policy at the Connecticut Hospital Association, said hospitals laid the groundwork for a good relationship with the state at the start of the pandemic, sharing data and coordinating a response to the health emergency.  

The federal effort to vaccinate nursing home staff and residents led by CVS Health and Walgreens hasn't run into any major problems in Connecticut, said Chris Cox, senior vice president of pharmacy at CVS, adding that the company's relationship with the state "has been seamless."

South Dakota 

Doses distributed to state: 83,500
Doses administered: 48,698
Percentage of distributed vaccines administered: 58.32

South Dakota broke from federal guidelines when defining its first vaccine priority group, adding law enforcement and corrections staff. The state also added people 65 and up, adults with at least two or more medical conditions and front-line workers in schools and colleges to its second priority group, according to KFF.

Mike Wilde, MD, Sanford Health's chief medical officer, told KOTA-TV, an ABC affiliate in Rapid City, S.D., that the state's success in its vaccine distribution is "a testament to the resources we have within our healthcare system, our electronic medical record, being able to also identify populations that don't work at Sanford or Avera that also qualify for the vaccine," referring to Avera Health, a Sioux Falls, S.D.-based health system. 

"As soon as that vaccine comes in, we're getting it given to people, whereas you see national news, a lot of times they say it's sitting in freezers somewhere. That’s not happening in our state, whether that's Sanford, Monument out west or us with Avera. We're getting it done," David Basel, MD, an internal medicine physician/pediatrician at Avera Health, told KOTA-TV. 

He added that he attributes South Dakota's success to partnerships at the city and state level. 

"We're able to cut through the red tape, I think, so much more effectively than a lot of states are. We just get it done," Dr. Basel said.

More articles on pharmacy:
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according to a Jan. 11 report from Kaiser Family Foundation.

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