Despite the hubbub to speed up the US COVID-19 vaccination campaign and bring the country back to normal, the first three months of the rollout suggest that faster isn’t necessarily better.
A surprising new analysis found that states like South Carolina, Florida, and Missouri that were ahead of others in offering the vaccine to increasing numbers of people vaccinated a smaller proportion of their population than those who moved more slowly and methodically, such as Hawaii. and Connecticut.
The explanation, as experts see it, is that the rapid expansion of eligibility caused an increase in demand that was too great for some states and led to serious disorder. Stocks of vaccines proved inadequate or unpredictable, websites crashed and phone lines crashed, creating confusion, frustration and resignation among many people.
“The infrastructure was simply not ready. It kind of failed, ”said Dr. Rebecca Wurtz, infectious disease physician and health data specialist at the University of Minnesota School of Public Health. She added, “In the rush to please everyone, governors have pleased few and frustrated many.”
The findings could hold an important, slow lesson for the country’s governors, many of whom have announced dramatic expansions in recent days during their rollout after being challenged by President Joe Biden to make all adults eligible by May 1. vaccination.
“If you’re more purposeful and focused, you can do better,” said Sema Sgaier, executive director of Surgo Ventures, a health data nonprofit organization that conducted the analysis in conjunction with The Associated Press. “You can open it – if you have the infrastructure in place to vaccinate all those people quickly.”
Numerous factors hindered the performance of the state vaccination. Conspiracy theories, poor communication, and unreliable shipments slowed efforts after the first vials of costly vaccine arrived on December 14.
But the size of the eligible population was always under the control of government officials, who made vastly different decisions about how many people they invited to line up when there wasn’t enough vaccine to go around.
When the ride began, most states put health workers and nursing home residents first. In doing so, states adhered to national recommendations from experts who also suggested doing everything possible to reach everyone in those two groups before moving on to the following categories.
But faced with political pressure and public noise, the governors hurried ahead. Both the outgoing Trump administration and the incoming Biden team pushed to open up vaccinations to older Americans.
By the end of January, more than half of the states had opened up to older adults – some 75 and older, others 65 and older. Then the real problems started.
South Carolina expanded eligibility to people in Steven Kite’s age group on Jan. 13. Kite, 71, immediately booked a vaccination at a hospital. But the next day, his appointment, along with thousands of others, was canceled due to a vaccine shortage.
“It was frustrating at first,” said Kite. After a week of uncertainty, he resisted. He and his wife have now been vaccinated. “It worked out well in the end. I know they have had other problems. The dose delivery was very unreliable. “
In Missouri, shortages in major cities caused vaccine seekers to drive hundreds of miles to rural towns. Dr. Elizabeth Bergamini, a pediatrician in the suburbs of St. Louis, drove about 30 people to often-remote vaccination events after the state opened admission to those 65 and older on Jan. 18 and then expanded further.
“We went from vaccinating a few hundred thousand people in the St. Louis area to another half a million people, but we still hadn’t vaccinated that first group, so it was this crazy attack,” Bergamini said. “It’s just been a really hot mess.”
“It got a bit chaotic,” said Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. “We created much more demand than supply. That emphasized the system and that may have made the system less efficient. “
Plescia said the analysis suggests that “a more methodical, measured, judicious, priority-based approach – despite people’s perceptions – could actually be just as efficient or more efficient than opening things up and making them available to more people.”
In retrospect, health workers and nursing home residents were the easiest groups to vaccinate. Doses could be delivered where they lived and worked.
“We knew where they were and we knew who they were,” said Wurtz. Once states transcended those populations, it became more difficult to find the right people. Nursing home residents live in nursing homes. People aged 65 and older live everywhere.
West Virginia went against the trend with both high numbers of eligible residents and high vaccination coverage in early March, but the state started slow, building its capacity before expanding eligibility.
Likewise, Alaska maintained a high vaccination rate with a smaller eligible population, then threw shots open to everyone 16 and older on March 9. This large increase in eligible adults towards the end of the period studied led the AP and Surgo Ventures to omit Alaska from the analysis.
The analysis found that as of March 10, Hawaii had the lowest percentage of the adult population eligible for vaccination, at about 26%. Still, Hawaii had administered 42,614 doses per 100,000 adults, the eighth highest rate in the country.
Thirty percent of Connecticut’s adult population was eligible on the same date, and it had been administered doses at the fourth highest percentage in the country.
In contrast, in Missouri, the largest percentage of the adult population was eligible at about 92%. Still, Missouri had delivered 35,341 doses per 100,000 adults, ranking 41st among the states.
Seven states in the bottom 10 for overall vaccination performance – Georgia, Tennessee, Texas, Florida, Mississippi, South Carolina, and Missouri – had a greater-than-average proportion of their residents eligible for admissions.
Of the high-performing states, five in the top 10 for high vaccination coverage – New Mexico, North Dakota, Connecticut, Wyoming, and Hawaii – remained stuck on more restrictive eligibility. Two other top 10 high-performing states – South Dakota and Massachusetts – roughly averaged the number of residents eligible for vaccination.
“This is an in-depth analysis that shows a clear link between the breadth of eligibility and vaccination coverage across states,” said Dr. Mark McClellan, a former head of the Food and Drug Administration who was not involved in the new analysis, but reviewed it for AP.
The better-performing states could get results by paying more attention to the vaccine supply, thoroughly vaccinating high-risk groups, and then opening up more slowly to additional categories while they wait for the stock to build, McClellan said.
What happens next depends on how many states can improve their vaccine delivery systems and whether Americans remain eager for vaccination, even as the threat decreases as more people are protected and the number of cases decreases.
“Have states used this time wisely and fruitfully to establish the infrastructure needed to open it up to more people?” Sgaier asked.
Associated Press writer Heather Hollingsworth in Mission, Kansas contributed to this report.