Wisconsin’s vaccine rollout consistently among slowest nationwide. What’s working in other states?

Wisconsin ranks near bottom nationwide; Rollout blasted by Republicans

Vaccination rates per state tracked by the Centers for Disease Control and Prevention have consistently ranked Wisconsin near the bottom for shots in arms per 100,000 in population. On Sunday, Wisconsin registered as 7th from the bottom at about 5.3% of every one hundred thousand in population with a shot — up from 5th from the bottom on Friday.

State officials and health experts caution that CDC data tracker isn’t the most precise measurement for states, however. Healthcare providers have 72 hours to report administered doses to federal, state and local agencies; further discrepancies can occur between state and federal reporting based on what times of day each update–and other factors. For example, the tracker lists Wisconsin as having administered 308,290 shots as of Sunday; data on the DHS website — last updated on Jan. 21 — reports about 2,000 more than the CDC.

Republicans, who have blocked COVID-19 legislation in the legislature through most of 2020, have ramped up criticism of the administration’s rollout in recent weeks. In a Thursday press briefing, Gov. Tony Evers defended the state’s response, saying the state wasn’t getting the number of doses needed from the federal government.

“I think we’re doing as best as we can considering the ramifications of the vaccines and the numbers of vaccines,” Evers said, when asked if he would change anything about the state’s process. “We’re moving in the right direction, but the bottom line is we have to have vaccine in order to vaccinate.”

Federal government controls state supply

States don’t buy the vaccines themselves. When New York Gov. Andrew Cuomo sent a letter to Pfizer this week asking to do just that, it prompted disagreement from the incoming Biden administration.

The DHS estimated that the state would need to receive three times its current allotment of doses in order to reach 80% of the state’s residents vaccinated by June of this year. Of Wisconsin’s more than 1,200 enrolled vaccinators, about half have actually received vaccine.

But in a press briefing last Thursday, deputy secretary Julie Willems Van Dijk said that talks with the federal government have indicated that the state can’t expect an increase to its roughly 70,000 weekly doses for at least three to four weeks. Nationwide, states are begging the federal government for more supply.

“The biggest thing they want and need is doses,” said Claire Hannan, executive director of the Association of Immunization Managers. The non-profit group includes managers from public health agencies across the country, providing a forum to share challenges, best practices and lessons learned.

“Part of this has been really not knowing week to week how many doses you’re getting,” Hannan said. “And not seeing an increase when you broaden out.”

Top states have small populations and locally-dependent rollout programs

West Virginia has consistently found itself in national headlines and at or near the top of the CDC’s vaccination tracker after it was the only state to turn down the federal pharmacy program for vaccinating its long-term care population. They completed vaccinations of their long-term care population early on in the rollout after partnering with local pharmacies across the state to schedule and administer the shots.

Most recently, Alaska has also topped national charts for its rollout, which the state’s chief medical officer attributes in part to its higher populations of military, veterans and Indigenous people. States get additional allotments for the Department of Defense, Department of Veteran Affairs and the Indian Health Service — and are tracked as separate entities than the states themselves. Additionally, the state implemented a thorough process for getting vaccines to its rural, hard-to-reach populations.

Alaska, West Virginia, North Dakota, Connecticut and South Dakota were the five states topping national charts on Friday. All but Connecticut fall into the bottom ten states by population, nationwide.

But experts caution that rollout models used in other states are highly customized and dependent on local relationships and programs that aren’t necessarily replicable in other states.

“They are rural,” Hannan said. “They have a smaller number of providers.” With small populations and closer relationships with their existing health care providers, many of the top-performing states have relied on existing local partnerships to speed up their rollouts.

“West Virginia is a good case study, but I don’t know as it’s necessarily transferable to other states,” explained Prof. Ajay Sethi, director of UW-Madison’s Masters of Public Health program. “It’s very hard to say that what’s working in one state will be guaranteed to work in another state if we use that same strategy.”

‘It’s a marathon, not a sprint’

Some states initially pulled ahead in vaccination rates because of opening up broad groups of people by age, while other states like Wisconsin stuck with initial CDC guidance recommending prioritizing health care workers and long term care populations before moving into the next phase.

While the broader categorizations meant more shots in arms, they also led to delays for vaccines for health care workers and long lines in states like Florida where seniors lined up at times overnight to get their shots.

Prof. Sethi says the vaccine rollout shouldn’t be judged by its frontrunners in the first month.

“We’re kind of just around that first turn if this were a horse race,” he explained. “Some horses do come out of the gate a little fast; that does not guarantee they’ll be crowned the winner.”

Other states announced their candidates for the next phase earlier than others. Illinois announced on Jan. 6 that the state would vaccinate people 65 and up in their next phase, while Wisconsin waited until much later in January to do the same. But announcing the next phase without the capabilities to begin vaccinating that group has caused bottlenecks and confusion, with people trying to schedule appointments for shots that aren’t yet available.

“There’s that initial euphoria that you’ve signed up for the vaccine, you’ve preregistered,” he explained. “But the devil’s in the details. When  are you actually going to get the vaccine?”

To some extent, that’s also been a factor in Wisconsin over the past few days since they announced eligibility for people aged 65 and older. Health care providers have experienced a deluge of incoming calls asking for appointments; patients, now, are often asked to wait for their provider to reach out to them instead once supply expands. Only about half of Wisconsin’s vaccinators have even received doses, according to the DHS last week.

“This is going to take time,” Willems Van Dijk said. “I know that asking for more patience is frankly a lot to ask. So today I’m going to ask for something a little bit different; today we’re asking for perseverance.”

Officials eye upcoming vaccine candidates for expanded supply

Health officials are cautiously hopeful about the upcoming Johnson & Johnson COVID-19 vaccine candidate, which expects to be ready for consideration by the U.S. Food and Drug Administration within weeks.

According to CNN, the vaccine could result in millions more vaccine doses as soon as March, potentially boosting available national supply.