There are just as many reasons for the successes\u00a0as for the failures.<\/p>\n
Leadership matters, particularly the ability to pull people together, ask hard questions and empower workers to solve problems,\u00a0said Dr. Bruce Gellin, president of Global Immunization for the Sabin Vaccine Institute.<\/p>\n
States that have done well\u00a0have frequent meetings<\/strong>that include decision-makers, so there is no waiting for authorization from on high. In some cases, officials meet<\/strong>several times a day\u00a0to figure out what’s working, what isn’t and what needs changing, Gellin said.\u00a0<\/p>\n That\u2019s been the case in West Virginia: Despite having one of the nation\u2019s highest rates of poverty, the state has\u00a0vaccinated\u00a018% of its population and consistently has been in the top tier for immunization.<\/p>\n The man running its Joint Interagency Task Force for COVID-19 Vaccines, retired Maj. Gen.\u00a0James Hoyer, said having support at the top is one of the secrets to his state\u2019s success.<\/p>\n It began early on, when West Virginia opted out of a federal program to use CVS and Walgreens to get vaccine to nursing homes and assisted living facilities, where the majority of deaths were occurring.<\/p>\n More than 50% of the state\u2019s pharmacies are\u00a0independent,\u00a0so large national chains wouldn\u2019t be a good fit in West Virginia, Hoyer told Gov. Jim Justice.<\/p>\n \u201cHe looked me in the eye and said, \u2018You believe this is the best way to protect our people?\u2019 I said I did,\u201d Hoyer recalled. “If the guy at the top is willing to pull the trigger and support the people who work for him, that gives us a big leg up on getting things done.\u201d<\/p>\n Hoyer ends every day with two calls:\u00a0one to\u00a0state health officials\u00a0and\u00a0one with the leaders of the task force. The question he asks\u00a0is simple:\u00a0“What do we got to fix today?\u201d\u00a0<\/p>\n West Virginia also stands out for its state vaccine appointment reservation system. People 18 or older can preregister online or dial an 800 number,\u00a0and they hear back with a call, email or\u00a0text when it’s their turn to make an appointment.\u00a0\u00a0<\/p>\n Because it has the nation’s third-oldest population, behind Maine and Florida, and many people live in rural areas with poor internet access, the\u00a0state invested $760,000 in a registration system from Everbridge. The statewide 800-number has been crucial to reaching people.<\/p>\n It’s been a model of efficiency compared with other states.<\/p>\n \u201cWe had people who wanted to talk to a real person, so we got them. I looked this morning, and we\u2019re down\u00a0to\u00a02:30 minute wait time,\u201d Hoyer said last week. That was down from eight minutes earlier in the month.\u00a0<\/p>\n Contrast that with Massachusetts, where the release of COVID-19 vaccine\u00a0appointments\u00a0resulted in initial<\/strong>wait times of<\/strong>more<\/strong>than\u00a040 hours and people reporting\u00a095,000 people ahead of them in line. By Monday, wait times were down to less than an hour, though few appointments were available.\u00a0<\/p>\n In a White House briefing Friday, Nancy Messonnier,\u00a0\u00a0director of the National Center for Immunization and Respiratory Diseases, acknowledged that getting vaccine out has been difficult.\u00a0<\/p>\n “We’re doing an unprecedented thing, trying to vaccinate the entire country in a really short period of time with vaccines that providers haven’t seen in years before, vaccines that are slightly complicated,”\u00a0she said. “So it’s not surprising that there have been bumps in the road.”<\/p>\n Flexibility and ingenuity\u00a0were key\u00a0for\u00a0Heidi Parker, executive director of Immunize Nevada, a nonprofit group that supports immunization<\/span>.\u00a0In January, when vaccines became more\u00a0available,\u00a0call volume to the agency skyrocketed\u00a0550%.<\/p>\n \u201cObviously, that wasn\u2019t sustainable,\u201d Parker said, so she picked up the phone herself and\u00a0found 20 college<\/strong>students at the state\u2019s two schools of public health to\u00a0do field study placements answering calls.<\/p>\n “They’re going to come out of this as vaccine champions, and they’re doing a fantastic job,”\u00a0Parker said.<\/p>\n Such hands-on approaches work well in\u00a0less populated states such as Nevada, where the public health community is relatively small.\u00a0The students Parker called in\u00a0came from a program run by Dr. Trudy Larson,\u00a0dean of the school of community health sciences at the University of Nevada-Reno in one of the state’s 16 counties.<\/p>\n \u201cCan you imagine if you have 100 counties and you\u2019re the state agency and you have to coordinate with 100 county health departments?\u201d Larson\u00a0said.<\/p>\n Allowing counties to tailor their approaches\u00a0has helped.\u00a0During the pandemic lockdown,\u00a0Nye County, Nevada,\u00a0put together a call list of all of its senior citizens to check in on them. When vaccinations rolled around, the county used it to call everyone and make sure they’d\u00a0signed up.\u00a0<\/p>\n There are exceptions, but in general, smaller and more rural states\u00a0have fared better than many large, urban ones. For some,\u00a0close contact with local health departments and a strong central system helped get the vaccine out.<\/p>\n Health care workers in North Dakota prepare COVID-19 vaccines for a clinic Feb. 26. (Photo: North Dakota Department of Health)<\/span><\/p>\n In North Dakota, which has immunized 20% of its population,\u00a0vaccine is delivered to a state warehouse\u00a0where<\/strong>vials are repackaged in small numbers. A\u00a0courier drives them to providers who may need as few as 20 doses, said Molly Howell, immunization director for the state\u2019s Department of Health.<\/p>\n Last<\/strong>week, her staff drove nine Pfizer vaccine routes that made 40 stops, delivering a total of 678 vials, containing about 3,390 doses.<\/p>\n \u201cWe knew people wanted to have access to as close to where they live as possible. We have 400 providers signed up, and we put them on a rotation,\u201d she said.<\/p>\n North Dakota uses every available means to reach those who are eligible. Howell got the\u00a0AARP chapter to send cards to everyone 65 or older and\u00a0does open calls with members. Early this month, she plans to send\u00a0letters to everyone over 65, just to make sure they haven\u2019t missed anyone.<\/p>\n Another major challenge for states\u00a0is the need to balance equity and speed.<\/span><\/p>\n Most states have struggled to distribute vaccine equitably\u00a0because of challenges with transportation, internet service and other social issues that make it harder for low-income people to access reservation systems and mass vaccination sites.<\/p>\n \u201cYou can line people up in football stadiums and vaccinate 7,000 people a day and increase your numbers. But if you\u2019re not getting the most vulnerable populations \u2013 over 65, over 75, people with comorbidities, African Americans and Latinx \u2013 you\u2019re not going to save that many lives,\u201d said Bloom, the former Harvard\u00a0dean.<\/p>\n There\u2019s no standard public health infrastructure to identify who\u2019s at risk, said Dr. Eric Schneider, senior vice president for policy and research at the Commonwealth Fund, a private philanthropy group that studies health care policy and practice.<\/p>\n \u201cThe U.S. health care system is really finely tuned to delivering health care services to people with means,\u201d he said.<\/p>\n Addressing these\u00a0inequities requires a tailored approach. Some residents of\u00a0Santa Clara County, south of San Francisco,\u00a0are\u00a0highly tech-savvy and\u00a0comfortable going through their health insurance company or\u00a0using the internet. Others\u00a0have less access\u00a0and less confidence in the system.<\/p>\n To make sure vaccine\u00a0reaches everyone,\u00a0contact tracers\u00a0are retrained as vaccine navigators to help people through the process of signing up to be immunized.<\/p>\n The navigators call people who in the past year had a possible\u00a0exposure to COVID-19 to tell them when they\u2019re eligible to get vaccinated. If they may have been exposed, they’re likely in a high-risk group, said Dr. Sarah Rudman,\u00a0public health director for the Santa Clara County Public Health Department.<\/p>\n That effort is ramping up\u00a0this week as the county broadens its vaccine eligibility group to include\u00a0essential workers in\u00a0child care and education, agriculture and food service and emergency services workers,\u00a0Rudman said.<\/p>\n To ensure people in the\u00a0hardest-hit communities get appointments, \u201cwe make those calls first,\u201d she said.<\/p>\n \u201cWe\u2019ve had a hugely positive response,\u201d Rudman said.<\/p>\n Calling to tell people they may have been\u00a0exposed to COVID-19 and need to quarantine for two weeks was never easy. The calls they\u00a0make now are joyful.<\/p>\n \u201cWe\u2019ve had folks who are in tears, she said, “people who never thought this day would come.\u201d<\/p>\nSmaller states tend to fare better<\/h2>\n
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<\/p>\nEquity vs. speed<\/h2>\n