Despite the clamor to speed up the US vaccination campaign against COVID-19 and get the country back to normal, the first three months of implementation suggest that faster is not necessarily better.
A surprising new analysis found that states like South Carolina, Florida and Missouri, which ran ahead of others to offer the vaccine to ever-larger groups of people, vaccinated smaller portions of their population than those that moved more slowly. and methodical, like Hawaii and Connecticut.
The explanation, in the opinion of the experts, is that the rapid expansion of eligibility has caused an increase in demand that is too big to be administered by some states and has led to great disorder. Vaccine supplies have proved insufficient or unpredictable, websites have failed and telephone lines have become congested, spreading confusion, frustration and resignation among many people.
“The infrastructure was simply not ready. The shot backfired, ”said Dr. Rebecca Wurtz, an infectious doctor and health data specialist at the University of Minnesota School of Public Health. She added: “In their haste to satisfy everyone, governors satisfied few and frustrated many.”
The findings may contain an important lesson for the country’s governors, many of whom have announced dramatic expansions in their implementations in the past few days after being challenged by President Joe Biden to make all adults eligible for vaccination by May 1.
“If you are more focused and focused, you can do a better job,” said Sema Sgaier, executive director of Surgo Ventures, a nonprofit health data organization that conducted the analysis in collaboration with The Associated Press. “You can open it – if you have set up the infrastructure to vaccinate all of these people quickly.”
Numerous factors have hindered the performance of the state vaccination. Conspiracy theories, poor communication and unreliable shipments have slowed efforts after the first vials of the precious vaccine arrived on December 14.
But the size of the eligible population has always been under the control of state officials, who made widely varying decisions about how many people invited to join the queue when there was not enough vaccine for everyone.
When the campaign began, most states put health professionals and nursing home residents on the front lines. In doing so, states followed national recommendations from experts who also suggested doing everything possible to reach all two groups before moving on to the next categories.
But, in the face of political pressure and public outcry, governors rushed ahead. Both the Trump administration that is leaving the government and Biden’s new team have recommended vaccinating older Americans.
By the end of January, more than half of the states had opened up to older adults – about 75 or older, another 65 or older. That’s when the real problems started.
South Carolina expanded eligibility for people in the Steven Kite age group on January 13. Kite, 71, immediately booked a vaccination at a hospital. But the next day, his appointment was canceled along with thousands of others because of a lack of vaccine.
“It was frustrating at first,” said Kite. After a week of uncertainty, he rescheduled. He and his wife are now vaccinated. “It ended up working. I know that they had other problems. The delivery of doses has been very reliable. “
In Missouri, a shortage in large cities meant that vaccine candidates drove hundreds of miles to rural cities. Dr. Elizabeth Bergamini, a pediatrician in the suburb of St. Louis, took about 30 people to vaccination events often out of the way after the state opened eligibility for those aged 65 and over on January 18 and then expanded further. most.
“We went from having to vaccinate several hundred thousand people in the St. Louis area to another half million people, but we still hadn’t vaccinated that first group, so it was a crazy race,” said Bergamini. “It was a big mess.”
“It got a little chaotic,” said Dr. Marcus Plescia, medical director of the Association of State and Territorial Health Officers. “We create much more demand than supply. This stressed the system and may have made the system less efficient. “
Plescia said the analysis suggests that “a more methodical, measured, judicious and priority-based approach – despite people’s perceptions – can actually be just as efficient, or more efficient, than opening things up and making them available for more. people”.
In retrospect, health professionals 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 who they were,” said Wurtz. Once the states went beyond these populations, it became more difficult to find the right people. Residents of nursing homes live in nursing homes. People aged 65 and over live everywhere.
West Virginia countered the trend with high numbers of eligible residents and high vaccination rates in early March, but the state began to slow down and built its capacity before expanding eligibility.
Similarly, Alaska maintained a high vaccination rate with a smaller eligible population, then opened its doors to all 16 and older on March 9. This large increase in eligible adults towards the end of the study period led AP and Surgo Ventures to omit Alaska analysis.
The analysis found that on March 10, Hawaii had the lowest percentage of its adult population eligible for vaccination, around 26%. Still, Hawaii 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 administered doses at the country’s fourth highest rate.
In contrast, Missouri had the highest percentage of its adult eligible population at around 92%. Even so, Missouri distributed 35,341 doses per 100,000 adults, ranking 41st among states.
Seven states in the top 10 for overall vaccination performance – Georgia, Tennessee, Texas, Florida, Mississippi, South Carolina and Missouri – had higher than average percentages of their residents eligible for vaccination.
Among the high-performing states, five in the top ten for high vaccination rates – New Mexico, North Dakota, Connecticut, Wyoming and Hawaii – remained with more restrictive eligibility. Two other high-performing states in the top 10 – South Dakota and Massachusetts – averaged how many residents were eligible for the vaccine.
“This is a complete analysis that shows a clear association between the breadth of eligibility and vaccination rates across states,” said Dr. Mark McClellan, a former head of the Food and Drug Administration who was not involved in the new analysis, but revised it for the AP.
The best-performing states could achieve results by paying more attention to vaccine delivery, vaccinating high-risk groups completely, and then opening up to additional categories more slowly while waiting for supplies to increase, McClellan said.
What happens next will depend on how much states can improve their vaccine delivery systems and whether Americans remain anxious about vaccination, even if the threat decreases with more people protected and the number of cases decreases.
“Did the states use this time wisely and profitably to establish the necessary infrastructure to open it up to more people?” Sgaier asked.
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Associated Press writer Heather Hollingsworth in Mission, Kansas, contributed to this report.