Despite the clamor to accelerate the US vaccination campaign against COVID-19 and get the country back to normal, the first three months of launch suggest that faster is not necessarily better.
A surprising new analysis found that states like South Carolina, Florida and Missouri, which have been ahead of others in offering the vaccine to larger and larger groups of people, have vaccinated smaller portions of their population than those that moved more slowly and methodically, like Hawaii and Connecticut.
The explanation, as experts see it, is that the rapid expansion of eligibility caused an increase in demand too great for some states to handle and caused serious disarray. Vaccine supplies were insufficient or unpredictable, websites crashed, and phone lines were blocked, causing confusion, frustration and resignation among many.
“The infrastructure just wasn’t ready. It was kind of counterproductive, ”said Dr. Rebecca Wurtz, an infectious disease physician and health data specialist at the University of Minnesota School of Public Health. He added: “In the rush to satisfy everyone, the governors satisfied few and frustrated many.”
The findings could hold an important lesson for the nation’s governors, many of whom have announced dramatic expansions in their implementations in recent days after President Joe Biden challenged them to make all adults eligible for vaccination sooner. May 1.
“If you’re more focused and more focused, you can do a better job,” said Sema Sgaier, CEO of Surgo Ventures, a health data nonprofit that conducted the analysis in collaboration with The Associated Press. “You can open it, if you’ve set up the infrastructure to vaccinate all those people quickly.”
Numerous factors hampered the performance of the state vaccination. Conspiracy theories, miscommunication, and unreliable shipments slowed efforts after the first vials of the precious vaccine arrived on December 14.
But the size of the eligible population was always under the control of state officials, who made widely varying decisions about how many people to invite to line up when there wasn’t enough vaccine for everyone.
When the campaign began, most states put healthcare workers and nursing home residents at the front of the line. In doing so, states followed national recommendations from experts who also suggested doing everything possible to reach everyone in those two groups before moving on to the next categories.
But in the face of political pressure and outcry from the public, the governors rushed forward. Both the outgoing Trump administration and the incoming Biden team urged opening vaccines to older Americans.
By the end of January, more than half of the states had opened up to seniors: some 75 or older, another 65 or older. That’s when the real problems started.
South Carolina expanded eligibility for people in Steven Kite’s age group. January 13. Kite, 71, immediately requested a vaccination at a hospital. But the next day, their appointment was canceled along with thousands of others due to vaccine shortages.
“It was frustrating at first,” Kite said. After a week of uncertainty, he rescheduled. Now he and his wife are vaccinated. “It ended up working well. I know they have had other problems. The delivery of the doses has been very unreliable. “
In Missouri, shortages in large cities caused vaccine hunters to drive hundreds of miles to rural cities. Dr. Elizabeth Bergamini, a pediatrician in suburban St. Louis, brought about 30 people to often-secluded vaccination events after the state opened eligibility for those 65 and older on January 18 and then expanded even more.
“We went from having to vaccinate several hundred thousand people in the St. Louis area to half a million more people, but we still hadn’t vaccinated that first group, so it’s been a mad race,” Bergamini said. “It has been a total disaster.”
“It got a little chaotic,” said Dr. Marcus Plescia, medical director of the Association of State and Territory Health Officials. “We create much more demand than supply. That stressed the system and that could have made the system less efficient. “
Plescia said the analysis suggests that “a more methodical, measured, judicious and priority-based approach, despite people’s perception, may actually be as efficient or more efficient than opening things up and making them available to more people. “.
In retrospect, health care workers and nursing home residents were the easy groups to vaccinate. Doses could be delivered to them where they lived and worked.
“We knew where they were and we knew who they were,” Wurtz said. As soon as states outnumbered those populations, it became more difficult to find the right people. Nursing home residents live in nursing homes. People 65 and older live everywhere.
West Virginia broke the trend with high numbers of eligible residents and high vaccination rates in early March, but the state got off to a slow start and built capacity before expanding eligibility.
Similarly, Alaska maintained a high vaccination rate with a smaller eligible population, then opened vaccines for everyone 16 and older on March 9. This large increase in eligible adults near the end of the study period led AP and Surgo Ventures to omit Alaska from the analysis.
The analysis found that as of March 10, Hawaii had the lowest percentage of its adult population eligible for vaccination, about 26%. However, 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 had dosed at the fourth highest rate in the country.
In contrast, Missouri had the largest percentage of its eligible adult population, about 92%. However, Missouri had dispensed 35,341 doses per 100,000 adults, ranking 41st among states.
Seven states in the bottom 10 for overall immunization performance (Georgia, Tennessee, Texas, Florida, Mississippi, South Carolina, and Missouri) had higher-than-average percentages of their residents eligible for vaccines.
Among high-performing states, five of the top 10 with high vaccination rates (New Mexico, North Dakota, Connecticut, Wyoming and Hawaii) were left with more restrictive eligibility. Two other high-performing states in the top 10, South Dakota and Massachusetts, were average for the number of residents eligible for the vaccine.
“This is a comprehensive analysis that shows a clear association between the breadth of eligibility and vaccination rates across states,” said Dr. Mark McClellan, former chief of the Food and Drug Administration who was not involved in the new analysis, but he revised it for AP.
Better-performing states could be seeing results by paying more attention to vaccine supplies, thoroughly vaccinating high-risk groups and then opening up to additional categories more slowly while waiting for supplies to build up, McClellan said.
What happens next will depend on how much states can improve their vaccine delivery systems and whether Americans remain eager for vaccination, even as the threat decreases with more people protected and the number of cases falls.
“Have states used this time wisely and fruitfully to establish the necessary infrastructure to open it up to more people?” Sgaier asked.
Associated Press writer Heather Hollingsworth in Mission, Kansas, contributed to this report.