Everybody who hasn’t been living under a rock these past few weeks has heard talk of vaccination for the Coronavirus. 329,000,000 people are living in the United States, and the Pew Institute estimates that 60% of the general public intends to get a vaccine. That’s almost 200,000,000 people who need complete vaccination, so it is easy to see why the process will take a little while. Yet beyond the challenge of vaccinating so many Americans, we are seeing delays that are predictable and avoidable. Although a change of federal administration means that vaccine production will likely be ramped up, speedy production is only effective when paired with the smart and efficient distribution. 

Attached is a diagram outlining Operation Warp Speed, the federal government’s plan for vaccine distribution. There are currently two American suppliers of the vaccine, Pfizer and Moderna. The distribution process is slightly different for each, but basically, the vaccines end up being transported by services like UPS and FedEx to vaccination sites such as doctor’s offices, hospitals, clinics, and nursing homes. These vaccination sites are determined by the states, which also determine the allocation of vaccines to each site. But the federal government determines the number of vaccines that each state can count on allocating. 

Unfortunately, the vaccine rollout has been slower than expected, and it isn’t too difficult to pinpoint why. One might guess that there are problems with the federal government’s allocations to the states, but this doesn’t seem to be the case. Although the federal government until very recently only used adult population data to make its decisions, a more specific (yet still simple) model based on senior citizens and healthcare workers reveal that even states with high senior citizen populations like Florida are not being short-changed by very much. So if the major problem isn’t with the federal government, it must be with the states. 

There is a large disparity between the states when it comes to vaccination speed. The slowest state, Alabama, has administered a mere 43% of its available shots, whereas West Virginia, the fastest state, has already burned through 81% of its supply. It is better to move faster through a vaccine supply, so West Virginia’s system seems to be the best. 

So what exactly is that system? First, West Virginia decided to prioritize nursing homes, partnering them with local pharmacies around the state. This gave the state an early head start because many other states opted to take advantage of the far less efficient federal nursing home vaccination program that relied on the big chain pharmacies CVS and Walgreens. West Virginia also heavily utilized the national guard early in the distribution process, with some other states the following suit only after West Virginia had a lead. The national guard was extremely helpful in planning and streamlining the distribution. Finally, West Virginia has a very simple age-based vaccination plan compared to some less successful states. As we will see, overcomplication can lead states astray. 

The state of Wisconsin is ranked 48th in the race to distribute vaccines. Just as states can look to West Virginia as a model for what to do, they can use Wisconsin as a good example of what not to do. For starters, Wisconsin, unlike West Virginia, relied on the aforementioned federal vaccination program for assisted living facilities up until just a few days ago. Only once CVS and Walgreens asked for help did the state health department step in and involve more local pharmacies. Additionally, there was some disagreement and uncertainty about which populations to include in which phases that made it hard to plan. While West Virginia was prioritizing the elderly immediately, leaders in Wisconsin were considering whether to vaccinate prison inmates and mink farmers. 

From a scientific perspective, it makes much more sense to vaccinate older folks than it does to vaccinate inmates first (mink farmers aren’t worth worrying about because they represent such an insignificant fraction of the population). Older individuals are at a greater risk of contracting and dying from Coronavirus than the general population, but the median age of prisoners is 36. Also, vaccinating correctional officers only would be more productive and prevent the spread of the virus from prisons to the outside or from the outside to prisons (because many prisons are on lockdown during Coronavirus). Perhaps it would make sense to vaccinate older prisoners at the same time as similarly-aged members of the general public, but that was not what was being pushed for in Wisconsin. The sad truth is that certain officials believed that fulfilling the needs of the law-abiding elderly should come second to vaccinating incarcerated populations. 

To be clear, the fault is not only on the states; the federal government has also fallen short. Vaccine production has been slow, as state public health experts have been quick to note. One Wisconsin county official, when asked how he would grade the vaccine rollout, said that he would give Wisconsin a B for “handling what [they] got,” but that he would give the federal government a D for slow “flow of vaccines from the feds to the state.” But these states forfeit their right to point fingers when they have administered less than half their allotment of vaccines. And there is absolutely no way that the state of Wisconsin deserves a B for its vaccine distribution. It’s in the bottom 5%! 

At the end of the day, we can learn a lot from the successes and failures of states in distributing Coronavirus vaccines. The federal government is doing a lot: getting contracts with the pharmaceutical companies, waiting for the vaccines to be manufactured, and then allocating them to the states. While it is true that this process has been imperfect, the states need to step up. Some states have, but others have not and are blaming the federal government in an attempt to conceal their inefficient and illogical internal distribution processes. West Virginia was able to become the leader in Coronavirus vaccinations by utilizing local pharmaceutical connections and streamlining its process to prioritize those most in need. Now, it’s time for other states to do the same.