How some states are administering Covid-19 vaccines at twice the speed of others

One month after the first dose was administered in the United States, Covid-19 vaccinations lag far behind early promises from the federal government.

Yet, despite reports of technology hiccups, changes to allocated supply and other logistical hurdles, some states have risen as clear leaders in efficient Covid-19 vaccination efforts.

More than 31 million Covid-19 vaccine doses have been distributed to states and other jurisdictions in the United States, but only 12.2 million – 39% – have actually been administered, according to the latest data from the US Centers for Disease Control and Prevention.

However, nine states have managed to administer more than half of the doses they’ve received: North Dakota, West Virginia, South Dakota, Connecticut, Texas, Louisiana, Kentucky, Colorado and Montana, as well as Washington, DC.

In this Jan. 4, 2021, file photo, motorists queue up to take a coronavirus test in a parking lot at Dodger Stadium in Los Angeles, a site that used tests produced by Curative. The U.S. Food and Drug Administration is warning patients and health care providers that a coronavirus test developed by California company Curative may produce false results. (AP Photo/Ringo H.W. Chiu, File)

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North Dakota and West Virginia lead the nation, having administered more than 65% of distributed doses.

In comparison, Alabama and Georgia have administered only 23% of their doses and five other states have administered 30% or less.

When it comes to efficient Covid-19 vaccination, “there’s no magic bullet,” Claire Hannan, executive director of the Association of Immunization Managers, told CNN.

In the states moving faster, strategic planning and communication, reliance on strong local partnerships and states taking ownership of the process have each played a role.

In South Dakota, conversations about vaccine planning started as early as August and have continued on a daily basis, Daniel Bucheli, director of communications for the state health department, told CNN.

“Preparation not panic has been the key,” he said. “There’s daily communication, with the opportunity for partners to share feedback on what’s working and what’s not. Open lines of communication are ongoing.”

Efforts to build a unified system also started over the summer in Colorado, bringing hospital systems, emergency management, technology leaders and more together for a “whole state approach,” Scott Bookman, Covid-19 incident commander for the state’s health department, told CNN.

Los Angeles, CA - January 07: A nurse Cherry Costales prépares Pfizer-BioNTech COVID-19 vaccine at St. John's Well Child & Family Center on Thursday, Jan. 7, 2021 in Los Angeles, CA. (Irfan Khan / Los Angeles Times via Getty Images)

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According to Bookman, all vaccine providers in the state must administer doses they’ve received within 72 hours. If they don’t, the state will step in and move the unused doses somewhere else.

“You’ll hear 72 hours in Colorado all the time,” he said. “We have moved vaccine from one place to another. And we are at a point now where providers understand our expectation and how seriously we take it.”

Setting expectations early and often among all involved has been key, he said.

“We have made this a top priority. We have set expectations that we are going to get this done, that we are going to save lives and return Colorado to normalcy.”

In Colorado, nearly all long-term care facilities – including nursing homes and assisted living – opted into a federal program that partnered with CVS and Walgreens to administer vaccine doses to the top-priority group.

But nationwide, the federal program has had mixed feedback, with some nursing home directors and other health care providers blaming poor logistics and bureaucracy for the slow rollout.

POMPANO BEACH, FLORIDA - DECEMBER 16: Vera Leip, 88, receives a Pfizer-BioNtech COVID-19 vaccine from Christine Philips, RN Florida Department of Health in Broward County, at the John Knox Village Continuing Care Retirement Community on December 16, 2020 in Pompano Beach, Florida. The facility, one of the first in the country to do so, vaccinated approximately 170 people including healthcare workers and elder care people. (Photo by Joe Raedle/Getty Images)

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While Bookman says the program has not moved as quickly as expected or hoped for in long-term care facilities in Colorado, Walgreens and CVS have been great partners and the state has stepped in where needed to provide additional support staffing and technology support.

West Virginia, meanwhile, has taken full ownership of vaccine administration. Hannan of the Association of Immunization Managers credits some of West Virginia’s success to its decision to opt out of the federal long-term care facility program.

“The biggest thing that we’ve done is backed away from the (federal) standardized program,” West Virginia Governor Jim Justice told CNN.

More than 40% of pharmacies in West Virginia are not chain-affiliated, and the state wanted to prioritize existing relationships, the governor said in a press briefing on December 16.

“We have instead partnered with all the pharmacies in West Virginia. We felt like that, from a state perspective, would be limiting our ability to rapidly distribute and administer the vaccine to the population in need if we had gone with the federal program,” he said.

By acting independently, West Virginia started vaccinating in long-term care facilities about a week before other states started.

The state also broke from federal guidance on groups prioritized to receive the vaccine first, emphasizing speed over specifics.

A nurse wearing personal protective equipment (PPE) including a personal air purifying respirator (PAPR) looks through a door into a patients room in a Covid-19 intensive care unit (ICU) at Martin Luther King Jr. (MLK) Community Hospital on January 6, 2021 in the Willowbrook neighborhood of Los Angeles, California. - Deep within a South Los Angeles hospital, a row of elderly Hispanic men in induced comas lay hooked up to ventilators, while nurses clad in spacesuit-looking respirators checked their bleeping monitors in the eerie silence. The intensive care unit in one of the city's poorest districts is well accustomed to death, but with Los Angeles now at the heart of the United States' Covid pandemic, medics say they have never seen anything on this scale. (Photo by Patrick Fallon/AFP/Getty Images)

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“There’s a real sleeping giant that is a problem, and that is one thing alone: we, as other states, are going to mound an inventory beyond belief because everybody is trying to devise a program on how to administer vaccines,” Justice told CNN.

On Tuesday federal leaders asked states to move people 65 and older and those with high-risk health conditions to the front of the line. West Virginia, however, had already announced a program to vaccinate older residents – Operation S.O.W.: Save Our Wisdom – about a week earlier.

Notably, many of the states administering their vaccine distributions most efficiently are among the most rural states in the country.

Fewer health systems responsible for larger shares of the population may play a role in success, some say.

Hannan notes that in North Dakota, the state works closely with providers to distribute the supply that’s needed and redistribute if necessary. The same is true in South Dakota, where a few large health systems cover much of the population.

“They have strong relationships with providers that cannot be replicated in larger states,” she said.

In anticipation of Covid-19 vaccine emergency use authorization, Monument Health in South Dakota started to build databases of individuals under their care that would be eligible to receive the vaccine and proactively reach out to them, Dr. Shankar Kurra, vice president of medical affairs, told CNN.

As one of three major health care providers in the state, Monument Health covers nearly half of the state’s population and their spreadsheets and outreach reflected such.

“There are several reasons for success,” Kurra said. “The department of health and how well they’ve communicated when vaccine will be available, three health systems in the state makes it a lot simpler logistically, and the third factor is key: Even with just three systems, we took it upon ourselves to make it a mission to administer doses within a week of when we get them.”

CNN’s Nadia Kounang contributed to this report.