Share on Pinterest
Many states have had a slow rollout of the COVID-19 vaccine. Sean Locke/Stocksy United
  • The states with the top vaccination rates include North Dakota, West Virginia, and New Mexico.
  • All three states have given more than 65 percent of the vaccines they have been allotted.
  • Comparatively, California has given only about 37 percent of the vaccines it’s been allotted.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.

What’s the secret to a successful vaccine rollout? To find out, ask North Dakota.

The state has put more than 80 percent of the COVID-19 vaccines it has received as of Jan. 21 into people’s arms, according to a Bloomberg tracker.

That’s well above the rate for the lowest-performing state — California, at nearly 37 percent — and the country at large, which has used about 49 percent of the shots it has distributed.

North Dakota isn’t the only place that has risen above the rest, though. The top four also include West Virginia, Washington, D.C., and New Mexico, which all have rates above 65 percent.

Let’s take a closer look at what’s going right in these states and the vaccination strategies other governors might consider implementing in their rollout plans.

It’s a simple formula: The broader the groups that states allow to be vaccinated, the more available arms there are for shots.

All states and D.C. had initially followed federal recommendations to vaccinate healthcare workers and people at long-term care facilities first, while a few included additional groups in that initial vaccination phase, according to the Kaiser Family Foundation.

But now that states are pushing forward to other prioritization groups, most have diverged from the national guidelines.

Some states that have chosen to broaden, rather than limit, the eligible groups may be having an easier time doling out the shots they’ve received and avoid throwing out precious doses, which happened in New York after medical workers couldn’t find people who fit the state’s strict criteria for vaccination.

North Dakota, for example, now offers vaccines to people age 65 and older. Also included are people with at least two high-risk health conditions, and workers at schools and childcare centers. Likewise, people age 75 and older can now get the vaccine in New Mexico, which will soon make all adults with high-risk medical conditions eligible.

“Being rigid about which groups can come in can slow the process down,” said Dr. Saralyn Mark, an endocrinologist, geriatrician, and women’s health specialist, who serves as the COVID-19 lead for the American Medical Women’s Association. “Medicine is an art and a science, and this is where art comes into play. If you can’t get the vaccine into one group, you need to move on to the next group.”

West Virginia is the only state that has opted out of a federal partnership with CVS and Walgreens to vaccinate people at facilities that provide long-term care and assisted living services.

Instead, West Virginia worked with small, local pharmacies — a strategy that helped it become the first state to finish offering the first round of vaccinations at these facilities on Dec. 30, per AARP.

On a similar note, a law that effectively bans chain pharmacies with a few exceptions in North Dakota forced many of the state’s long-term care facilities to work with other entities, including independent pharmacies, to get residents vaccinated against COVID-19.

Administering the vaccines through independent pharmacies has helped speed up the process in a few ways.

Smaller pharmacies have far less bureaucracy that could potentially slow down the vaccination process than their brand-name counterparts, said Dr. Purvi Parikh, an allergist and immunologist with the Allergy & Asthma Network, who is also a principal investigator on COVID-19 vaccine trials at New York University Langone Health’s Vaccine Center.

“A large system requires approval from many people before something can be rolled out,” she explained. “These smaller, independent pharmacies are more nimble. There’s no corporate bureaucracy or hurdles or red tape.”

The long-standing relationship people have with their neighborhood pharmacists may also play an important role in getting vaccines into people’s arms quickly. The degree of trust someone has in the person who’s offering them a vaccine can make all the difference in whether they ultimately choose to accept it, added Parikh.

Also, these pharmacies were often already working with nursing homes to provide coronavirus testing during the pandemic, so they could leverage those existing relationships to streamline vaccinations, NPR reported.

People eligible in many states have struggled to get appointments. Slots fill up quickly, phone lines to health departments get jammed, and people need to toggle between multiple websites to see availability.

Some states have fared better in this area than others, though. New Mexico says it created the first online vaccination sign-up portal in the country, helping people find appointments at some hospitals, pharmacies, doctor’s offices, and other sites. Washington, D.C., has also launched a similar website.

These digital portals may be playing a role in speeding up the vaccine rollout in some places.

“Streamlined online portals in any type of distribution, whether it’s buying concert tickets, making reservations, or getting a vaccine appointment, can lower friction. We’ve discovered that having people make appointments for both their vaccines online has been much more streamlined,” said Dr. Richard Zane, professor and chair of emergency medicine at the CU School of Medicine and chief innovation officer at UCHealth, where he is helping guide the healthcare system’s COVID-19 vaccine rollout.

Plus, a streamlined approach to scheduling appointments that works consistently well could help eliminate challenges that might otherwise cause someone to give up on getting the shot altogether.

“If a system keeps crashing, and you’re on the fence about getting the vaccine, you might say, ‘I won’t do it,’” Mark said. “We need to make sure it’s as easy, flexible, and user-friendly as possible.”

Though different strategies certainly impact how quickly states can get shots into arms, it’s the number of available vaccines dictating the pace of vaccination, Zane said.

“There’s no such thing as a state that hasn’t had a misstep, but the single biggest barrier is the vaccine supply,” he said.

The best thing we can do right now is cultivate patience as we wait for supply to catch up with demand, Zane added.

“I have every confidence that the vast majority of the population that wants to be vaccinated will be vaccinated by the summer, and that’s the most important point,” he said.