Becker's Hospital Review

54 CMO / CARE DELIVERY Most successful vaccine rollouts in US: 4 state strategies By Maia Anderson, Mackenzie Bean and Gabrielle Masson S tates are rushing to administer the COVID-19 vaccines as fast as possible, and some states have been more successful than others. North Dakota had one of the best vaccination rates in the country in mid-January, according to data from the CDC. e state had admin- istered 73.76 percent of the vaccines it had received as of Jan. 12. West Virginia and Connecticut rank second and third, at 64.19 percent and 60.37 percent, respectively. South Dakota comes in at fourth, admin- istering 58.32 percent of distributed vaccines as of Jan. 12. Meanwhile, Alabama, Georgia and Arkansas had the worst vaccina- tion rates in the country as of mid-January. e states have adminis- tered 20.72 percent, 17.75 percent and 14.90 percent of the vaccines they've received, respectively, as of Jan. 12. Nationally, the U.S. had administered 33.68 percent of total vaccines distributed as of Jan. 12. e number of vaccines distributed to each state is dependent on pop- ulation size, so large states have a potentially more complicated task. Several of the most successful states strayed from the federal govern- ment's original recommendations for vaccine priority groups to inoc- ulate a broader range of populations beyond healthcare workers and long-term care residents or staff. e federal government changed its national vaccine distribution strategy Jan. 12, expanding eligibility to everyone age 65 and above, as well as people under age 65 with a comorbidity. Here are the vaccination strategies of the four most successful states as of Jan. 12. North Dakota Doses distributed to state: 53,525 Doses administered: 39,479 Percentage of distributed vaccines administered: 73.76 North Dakota has achieved a smooth early vaccine rollout, though health officials acknowledged the need to speed up vaccinations. e state followed original federal recommendations for the first phase of its plan, but departed from the guidelines for the second phase, which called for vaccinating front-line essential workers and people ages 75 and up. e state opted to include people 65 and up, adults with at least two high-risk conditions and front-line workers in schools or child care in this priority group, according to a Jan. 11 report from Kaiser Family Foundation. "I think so far things have gone well," state Immunization Director Molly Howell told the Grand Forks Herald. "I haven't been sitting here thinking 'Oh I wish we had done this,' or 'we could have done that.'" e state launched a robust provider education program to prepare for vaccine administration in partnership with the North Dakota State Uni- versity Center for Immunization Research and Education in Fargo. "Healthcare providers were trained regarding the COVID-19 vaccines before they were authorized for use in the U.S., which allowed for vaccines to be administered immediately," the North Dakota Department of Health said in a statement to Becker's. e department also maintains weekly vaccine updates for all COVID-19 vaccine providers, along with weekly office hours and a COVID-19 vaccine email where providers can ask questions. North Dakota also operates a state warehouse to store and handle its COVID-19 vaccines. "We are able to break down COVID-19 vaccine shipments into small- er quantities to get vaccines to rural areas of the state, where many healthcare providers are located," the department said. In the first phase of its vaccination plan, vaccines were distributed to providers statewide, not just hospitals and health systems. More than half of North Dakota's long-term care facilities are not par- ticipating in the CDC's Pharmacy Partnership for Long-Term Care Program — a federal program to vaccinate long-term care and assist- ed living facilities in partnership with CVS and Walgreens. A state law dating back to 1963 requires pharmacies to be owned and operated by pharmacists, which effectively bans chains from operating in the state. Only six CVS pharmacies have been grandfathered in under the law. "Fiy-eight percent of long-term care facilities are not participating in the program, so [the] vaccine was sent to public health, independent pharmacies or the long-term care itself for immediate vaccination," the health department said. West Virginia Doses distributed to state: 160,975 Doses administered: 103,330 Percentage of distributed vaccines administered: 64.19 In the race to quickly administer COVID-19 vaccines, West Virginia was outpacing many other states, reported NPR in January. e state successfully gave vaccines to health workers and finished administer- ing the first doses at all of its long-term care facilities. e state, as of Jan. 12, was focused on vaccinating individuals age 80 and older and teachers age 50 and older. West Virginia followed federal recommendations for vaccine prior- itization, except it added people over 80 to the first priority group alongside healthcare workers and nursing home residents and staff, according to KFF. e state's vaccination success can be attributed to numerous factors. While all 49 other states are part of a federal program partnering with CVS and Walgreens to vaccinate long-term care and assisted living facilities, West Virginia chose to deliver its vaccine supply to 250 phar- macies statewide, most of which are small, independent stores. ose pharmacies already had data for many patients, making it easier to schedule vaccination appointments earlier, secure consent forms and match doses to eligible patients — efforts that are confounding the vaccine rollout in many other states. West Virginia leaned heavily on its National Guard and a network of local pharmacies to administer the shots, West Virginia Gov. Jim Jus- tice told CNBC Jan. 11. While other states must navigate the bureau-

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