Despite demands to speed up the COVID-19 vaccination program in the United States and return the country to normal, the first three months of the launch indicate that faster is not always better.
A recent study showed that states like South Carolina, Florida, and Missouri, which rushed ahead of others to deliver the vaccine to ever-larger groups of people, vaccinated a smaller share of their population than states like Hawaii and Connecticut, which operated more slowly and methodically.
According to analysts, the rapid expansion of eligibility triggered an increase in demand that was too much for certain states to manage, resulting in severe chaos. Vaccine stocks were in short supply or unpredictable, websites crashed, and phone lines were congested, causing widespread confusion, dissatisfaction, and resignation.
“The technology just wasn’t up to the challenge. Dr. Rebecca Wurtz, an infectious disease physician and health data specialist at the University of Minnesota’s School of Public Health, said, “It sort of backfired.” “In their hurry to please all, governors delighted few and disappointed many,” she continued.
The results could serve as a cautionary tale for governors around the country, as many have announced dramatic expansions in their rollouts in recent days in response to President Joe Biden’s challenge to make all adults eligible for vaccination by May 1.
“You can do a better job if you’re more targeted and focused,” said Sema Sgaier, executive director of Surgo Ventures, a nonprofit health-data company that partnered with The Associated Press on the report. “If you have the infrastructure in place to vaccinate all those people easily, you can open it up.”
Several factors hampered state vaccination efforts. After the first vials of precious vaccine arrived on Dec. 14, conspiracy theories, inadequate coordination, and unreliable shipments hindered progress.
However, state officials had complete discretion over the size of the qualifying population, who made widely differing decisions over how many people they invited to get in line when there wasn’t enough vaccine to go around.
When the campaign first started, most states prioritized health-care professionals and nursing-home residents. States did so in line with national guidelines from experts, who also recommended doing everything possible to meet everybody in those two categories before moving on to the next.
Governors, however, hurried forward due to political pressure and public outcry. Both the outgoing Trump administration and the new Biden administration called for encouraging older Americans to obtain vaccines.
By late January, more than half of the states had opened their doors to senior citizens — some aged 75 and up, others aged 65 and up. That’s when the real issues began.
People in Steven Kite’s age group are now qualified in South Carolina. 13th of January Kite, 71, promptly arranged a vaccine appointment at a nearby hospital. However, his appointment was cancelled the next day, along with thousands of others, due to a vaccine shortage.
“At first, it was aggravating,” Kite admitted. He rescheduled after a week of confusion. He and his wife have also been immunized. “It all worked out in the end. I’m sure they’ve had other issues. The doses have been administered in an inconsistent manner.”
Vaccine seekers in Missouri drove hundreds of miles to small towns due to shortages in big cities. After the state opened eligibility to those 65 and older on Jan. 18 and then expanded further, Dr. Elizabeth Bergamini, a pediatrician in suburban St. Louis, drove about 30 people to sometimes out-of-the-way vaccine events.
“We went from having to vaccinate several hundred thousand people in the St. Louis region to needing to vaccinate an additional half-million people, but we still hadn’t vaccinated the first group,” Bergamini said. “It’s all been a complete disaster.”
Dr. Marcus Plescia, chief medical officer of the Association of State and Tribal Health Authorities, said, “It got a little chaotic.” “We generated much more demand than supply,” says the author. This put a strain on the system, and it may have made it less efficient.”
According to Plescia, the results indicate that “a more methodical, calculated, judicious, priority-based approach — contrary to common opinion — can potentially be as effective, if not more efficient, than opening it up and making it accessible to more people.”
In retrospect, the easiest classes to vaccinate were health professionals and nursing home patients. Doses could be sent to their homes and workplaces.
Wurtz said, “We knew where they were and who they were.” It became more difficult to find the right people as states became larger than those populations. Residents in nursing homes remain in nursing homes. People over the age of 65 can be found almost everywhere.
In early March, West Virginia defied the trend by having both a large number of eligible residents and high vaccination rates, but the state took it slowly and developed capacity before extending eligibility.
Similarly, Alaska retained a high vaccination rate for a smaller eligible population before opening vaccinations to all 16 and older people on March 9. Because of the huge rise in eligible adults towards the end of the study period, the AP and Surgo Projects agreed to leave Alaska out of the research.
According to the report, Hawaii had the lowest percentage of adult population registered for vaccination, at about 26%, as of March 10. Despite this, Hawaii had the eighth-highest dose rate in the world, with 42,614 doses per 100,000 adults.
As of the same date, 33% of Connecticut’s adult population was eligible, and the state had given out doses at the fourth-highest rate in the world.
Missouri, on the other hand, had the highest percentage of adult population qualifying, at about 92 percent. Despite this, Missouri ranked 41st among the states with 35,341 doses per 100,000 adults.
Georgia, Tennessee, Texas, Florida, Mississippi, South Carolina, and Missouri — all in the bottom ten for overall vaccine results — had higher-than-average shares of their people qualified for vaccines.
Five of the top ten states for vaccination rates — New Mexico, North Dakota, Connecticut, Wyoming, and Hawaii — continued to have more stringent eligibility requirements. South Dakota and Massachusetts, two other top-performing states, were around average in terms of how many people were registered for vaccine.
Dr. Mark McClellan, a former head of the Food and Drug Administration who was not involved in the new research but reviewed it for AP, said, “This is a detailed report showing a strong correlation between scope of eligibility and vaccination rates across states.”
According to McClellan, the better-performing states could be achieving outcomes by paying more attention to vaccine availability, thoroughly vaccinating high-risk populations, and then steadily expanding to new categories while waiting for supplies to develop.
What happens next will be determined by how much states will develop their vaccine delivery systems and whether Americans are still willing to get vaccinated, even though the danger fades as more people are covered and case numbers decline.
“Have states used this time wisely and productively to lay the groundwork for the infrastructure that will enable more people to use it?” Sgaier inquired.