How States Can Improve COVID-19 Vaccine Distribution

The COVID-19 pandemic has been the greatest public health crisis of our lifetime—but fortunately, it has been met with a scientific response equally as strong. Multiple vaccines were created, tested, and approved for emergency use by the Food and Drug Administration (FDA) before the end of 2020. However, in order to stop the spread of the COVID-19 virus and end the pandemic, these vaccines must be distributed and administered in an expeditious manner, which has not occurred thus far.

Shortfalls of Operation Warp Speed

Operation Warp Speed, a COVID-19 vaccine production and delivery initiative under the Trump administration’s Department of Health and Human Services (HHS), was successful in facilitating vaccine production but failed to adequately develop its delivery component. The Trump administration set an ambitious target of 20 million Americans vaccinated by the end of 2020; in reality, only a few million doses were administered by that time[1]. As of January 28th, 2021, 26 million Americans have received their first dose of either the Pfizer or Moderna COVID-19 vaccine, despite the fact that about 48 million doses have been distributed by the federal government[2].

In the absence of a federal plan for vaccine administration, states have been left to determine their own strategies—with varying results. Some states, such as West Virginia, North and South Dakota, and Connecticut, have administered over 65% of their available doses. Other states, such as Alabama, Wisconsin and Kansas have only administered about 40% of their available doses.[3]

This difference in vaccination rates among states can be attributed to the different guidance that each state developed for vaccine distribution, compounded by a range of other factors. These include:

  • Narrow Eligibility Criteria: States that defined their vaccine-eligible populations in accordance with the Centers for Disease Control (CDC) recommendations often ended up with a vaccine supply greater than their number of allowable vaccine recipients. These surplus vaccine doses were prevented from being administered to individuals outside of the defined eligibility groups and went undistributed.
  • Time Sensitivity: Distribution of vaccine doses is a time-sensitive process because the doses must be stored at extremely cold temperatures.[4] Some states had trouble distributing these doses within the required time frame before they became unusable.
  • Saving Second Doses: Because each of the approved COVID-19 vaccines requires two doses (i.e., two shots given several weeks apart) for full effectiveness, some states kept a portion of their doses in reserve for use as secondary doses. This, in turn, limited the number of residents who received the first dose of the vaccine.
  • Public Messaging: The vaccine rollout has thus far lacked a centralized public messaging campaign from the federal government to educate people on the benefits of vaccination, which has added to the confusion and miscommunication surrounding the distribution process[5]. Public attitudes towards vaccination have improved in recent months, according to a December 2020 Kaiser Family Foundation survey; however, due to unclear federal communications under the previous administration, many people are confused about when and where they can be vaccinated.

The issues states have encountered thus far, as well as the variation in distribution outcomes between states, indicate a need for further guidance from the federal government to ensure a more standardized approach to vaccine administration across the country. A federal plan is necessary for the U.S. to achieve an efficient and successful distribution of COVID-19 vaccines to stop the spread of the virus.

Vaccine Distribution Success Stories

Despite these challenges in the initial round of U.S. vaccine administration, several states developed successful strategies that should serve as models for the rest of the country. Successful state strategies focused on distributing and administering as many doses as possible as quickly as possible, relying on local infrastructure, and deviating from CDC guidance to expand the eligible population for the initial vaccination phases. Those success stories include the following states:

North and South Dakota have two of the highest rates of vaccine dosage administration in the country because they broadened the vaccine-eligible population in their initial round of vaccinations.

Both states expanded the existing groups defined as high priority by the CDC to include everyone above the age of 65, as well as adults with multiple high-risk conditions. This allowed each state to vaccinate as many people as possible early on and utilize state-level resources to avoid the slow rollout that has plagued other states[6].

West Virginia also modified federal recommendations for its initial vaccine distribution by expanding the parameters of the eligible population to include people over 80 years old, healthcare workers, and residents of long-term care facilities.

This avoided wasting unused doses, and instead prioritized distributing as many shots as possible. The state also utilized its National Guard to increase the efficiency of dose distribution and leaned on its local pharmacy infrastructure for vaccine administration[7]. Doing so allowed each pharmacy to leverage its existing patient data to expedite the distribution process.  West Virginia has the third-oldest population of any state in the nation, with 20% of its residents at age 65 or older. This increased the urgency for state leadership to vaccinate its citizens and develop innovative solutions for vaccine administration[8].

Connecticut has been another early leader in vaccine dosage administration, and state officials attribute this success to a strong partnership between hospitals and the state.

Paul Kidwell, senior vice president of the Connecticut Hospital Association, said of this partnership, “There is a strong commitment to troubleshooting on a daily basis, and I think it’s been beneficial to getting the vaccine administered,”[9].

How Can We Improve Vaccination Rates?

As the US enters the third month of its COVID-19 vaccination rollout, there are several ways that the country can improve the process on a national level, instead of continuing to rely on inconsistent state-by-state responses.

The first and most important step will be for America to ramp up federal vaccine production. To this end, President Joseph Biden recently signed an executive order invoking the Defense Production Act to mandate that private manufacturers prioritize pandemic response and vaccine distribution resources over other projects. The Biden administration has also purchased 100 million more doses of both the Pfizer and Moderna vaccines to meet the goal of vaccinating the entire American population by the end of the summer[10].

Other suggestions to improve vaccination rates at the state level include:

  • Modeling North and South Dakota and West Virginia’s vaccine rollouts by expanding the eligibility criteria for the vaccine, relying more on local infrastructure as a key distribution partner, and utilizing all available resources in the distribution process.
  • Devoting resources toward a public messaging campaign that both encourages Americans to get vaccinated and clarifies when they will be eligible for vaccination.

Whatever strategies the Biden administration institutes, it is clear that greater urgency and additional resources are necessary to expedite the vaccine rollout process and achieve herd immunity faster. States would be wise to apply lessons learned from the first two months of vaccinations. They should also strongly encourage more federal assistance in the development and funding of the vaccine distribution process.



[2] Ibid


[4] The Moderna vaccine must be stored between -25 and -15 degrees Celsius for up to 30 days, while the Pfizer vaccine requires a storage temperature of -70 degrees Celsius for up to 30 days. See and for more details.



[7] Ibid




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