Rapid vaccine rollout backfired in some states, analysis finds

Despite the clamor to speed up the U.S. vaccination drive against COVID-19 and get the country back to normal, the first three months of the rollout suggest faster is not necessarily better.

A surprising new analysis found that states such as South Carolina, Florida and Missouri that raced ahead of others to offer the vaccine to ever-larger groups of people have vaccinated smaller shares of their population than those that moved more slowly and methodically, such as Hawaii and Connecticut.

The explanation, as experts see it, is that the rapid expansion of eligibility caused a surge in demand too big for some states to handle and led to serious disarray. Vaccine supplies proved insufficient or unpredictable, websites crashed and phone lines became jammed, spreading confusion, frustration and resignation among many people.

“The infrastructure just wasn’t ready. It kind of backfired,” said Dr. Rebecca Wurtz, an infectious disease physician and health data specialist at the University of Minnesota’s School of Public Health. She added: “In the rush to satisfy everyone, governors satisfied few and frustrated many.”

The findings could contain an important go-slow lesson for the nation’s governors, many of whom have announced dramatic expansions in their rollouts over the past few days after being challenged by President Joe Biden to make all adults eligible for vaccination by May 1; Michigan is doing so by April 5.

When the drive began, most states put health care workers and nursing home residents at the front of the line. In doing so, states were abiding by national recommendations from experts who also suggested doing everything possible to reach everyone in those two groups before moving on to the next categories.

But faced with political pressure and a clamor from the public, governors rushed ahead. Both the outgoing Trump administration and the incoming Biden team urged opening vaccinations to older Americans.

By late January, more than half the states had opened up to older adults — some 75 and above, others 65 and up. That’s when the real problems started.

In retrospect, health workers 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 we knew who they were,” Wurtz said. As soon as states went beyond those populations, it got harder to find the right people. Nursing home residents live in nursing homes. People 65 and older live everywhere.

The analysis found that as of March 10, Hawaii had the lowest percentage of its adult population eligible for vaccination, at about 26%. Yet Hawaii had administered 42,614 doses per 100,000 adults, the eighth-highest rate in the country.

Thirty percent of Connecticut’s adult population was eligible as of the same date, and it had administered doses at the fourth-highest rate in the country.

In contrast, Missouri had the largest percentage of its adult population eligible at about 92%. Yet Missouri had dispensed 35,341 doses per 100,000 adults, ranking 41st among the states.

Seven states in the bottom 10 for overall vaccination performance — Georgia, Tennessee, Texas, Florida, Mississippi, South Carolina and Missouri — had larger-than-average shares of their residents eligible for shots.

Among high-performing states, five in the top 10 for high vaccination rates — New Mexico, North Dakota, Connecticut, Wyoming and Hawaii — stuck with more restrictive eligibility. Another two high-performing states from the top 10 — South Dakota and Massachusetts — were about average in how many residents were eligible for vaccine.