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How fast was too fast?

When it came to COVID vaccine eligibility, states that took their time expanding the pool of people who could get the shots have done a better job actually getting shots into arms than the states who rushed to broaden their list.

Despite the clamor to speed up the U.S. vaccination drive against COVID-19 and get the country back to normal, the first three months of the rollout suggest faster is not necessarily better.

A surprising new analysis found that states such as South Carolina, Florida and Missouri that raced ahead of others to offer the vaccine to ever-larger groups of people have vaccinated smaller shares of their population than those that moved more slowly and methodically, such as Hawaii and Connecticut.

The explanation, as experts see it, is that the rapid expansion of eligibility caused a surge in demand too big for some states to handle and led to serious disarray. Vaccine supplies proved insufficient or unpredictable, websites crashed and phone lines became jammed, spreading confusion, frustration and resignation among many people.

“The infrastructure just wasn’t ready. It kind of backfired,” said Dr. Rebecca Wurtz, an infectious disease physician and health data specialist at the University of Minnesota’s School of Public Health. She added: “In the rush to satisfy everyone, governors satisfied few and frustrated many.”

The findings could contain an important go-slow lesson for the nation’s governors, many of whom have announced dramatic expansions in their rollouts over the past few days after being challenged by President Joe Biden to make all adults eligible for vaccination by May 1.

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In retrospect, health 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 went beyond those populations, it got harder to find the right people. Nursing home residents live in nursing homes. People 65 and older live everywhere.

West Virginia bucked the trend with both high numbers of eligible residents and high vaccination rates in early March, but the state started slow and built its capacity before expanding eligibility.

Similarly, Alaska maintained a high vaccination rate with a smaller eligible population, then threw shots open to everyone 16 and older March 9. This big increase in eligible adults near 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 its adult population eligible for vaccination, at about 26%. Yet 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 as of the same date, and it had administered doses at the fourth-highest rate in the country.

In contrast, Missouri had the largest percentage of its adult population eligible at about 92%. Yet Missouri had dispensed 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 larger-than-average shares of their residents eligible for shots.

Among high-performing states, five in the top 10 for high vaccination rates — New Mexico, North Dakota, Connecticut, Wyoming and Hawaii — stuck with more restrictive eligibility. Another two high-performing states from the top 10 — South Dakota and Massachusetts — were about average in how many residents were eligible for vaccine.

I’m sure we’re all shocked to see Texas at the wrong end of the list. Focusing on older people made sense in that they are at a higher risk of death, but a lot of them also had issues with the online tools they had to use to get an appointment. I still think that an approach of putting grocery workers and restaurant employees and school staff in Group 1B would not only have been a better prioritization of the risks, but also would have resulted in a higher percentage of people getting vaccinated, for the same reason as with the health care workers and nursing home patients: We know where they are, and we can deliver it to them via their workplace. That’s not the approach that Texas and many other states took, and the end result was that people with better Internet skills and/or more robust health care providers wound up getting ahead of everyone else. Not much we can do about what has already happened, but we really should keep it in mind as we move forward. Otherwise, we’ll just get more of the same.

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  1. […] DSHS has more on Twitter. Great news for those who have not yet been eligible, though as we have previously discussed it’s not necessarily great for the distribution effort or for vaccine equity. All states were […]