Is Minnesota behind other states in vaccinating against COVID-19?

Minnesotans who keep tabs on friends and family in other states might have noticed something lately: their aunt in Texas, their friend’s mom in Florida or their childhood friend who’s a cop in South Dakota — none of whom would be eligible for the COVID-19 vaccine in Minnesota right now — are posting on social media about already having gotten their shots.

States’ different plans for vaccinating residents against the novel coronavirus have caused some confusion about whether some states are ahead of others in the effort to vaccinate their populations.

Some states are ahead of others in per capita terms, but states’ eligibility guidelines are also different, which means they differ not just in how many people have been vaccinated, but who has been vaccinated.

Minnesota falls in the middle as far as the number of  vaccines administered based on population. And when it comes to who gets vaccinated, well, perhaps in line with its reputation as a state full of rule followers, Minnesota is adhering to the guidelines set out by a CDC advisory committee. Is that causing Minnesota to fall behind?

Minnesota’s plan

Ever since it became evident that effective COVID-19 vaccines were on the horizon, Minnesota’s vaccination plan has been to stick to the guidelines made by the Centers for Disease Control’s Advisory Committee for Immunization Practices, a group that makes recommendations for all vaccinations in use in the U.S.

In December, the ACIP recommended the first, limited doses of COVID-19 vaccine go to health care workers and residents of long-term care. That group is referred to as group “1A.” Since the initial vaccine supplies were not expected to cover all of the estimated 500,000 people in this group, advisory group developed sub-priorities: first, the vaccine would go to skilled nursing and nursing home residents and health care workers most at risk of getting COVID-19; next, the vaccine would be extended to residents of other long-term care facilities and health care workers at lower risk of getting COVID-19.

As of Monday, 153,332 Minnesotans — 2.8 percent of the population — were reported to have received at least one dose of COVID-19 vaccine, according to data from MDH.

Vaccines are being administered through workplaces for health care workers and through a partnership with pharmacies to long-term care residents. Federal agencies with a presence in Minnesota, such as the Department of Veterans Affairs, and Indian Health Services, have received vaccine directly from the federal government and not through the Minnesota allocation program.

The number of doses administered has increased weekly since the week of Dec. 13, when the vaccine was first administered in Minnesota. That week, 4,363 doses were administered. Last week, 66,137 were administered. The department expects to have enough vaccine to get through first doses for 1A around the end of January, and expects the number of vaccinations administered by week to continue to increase as supply expands.

How Minnesota compares

As of Wednesday, Minnesota had administered 2,932 vaccinations per 100,000 residents, according to data from the CDC. While the CDC’s data lag a bit — providers do not report vaccinations in real-time — it is the best apples-to-apples comparison of states’ vaccination efforts available.

That puts Minnesota 33rd among U.S. states and the District of Columbia for vaccine administration. West Virginia, leading states in the CDC data, has administered 6,177 vaccines per 100,000 residents. Alabama has administered the least vaccinations per 100,000 residents at 1,714.

On a per-capita basis, Minnesota is behind Florida, which has vaccinated 3,284 of every 100,000 residents, and Texas, which has vaccinated 3,373 of every 100,000 residents.

Minnesota is also in the middle in terms of the share of vaccines that have been shipped that have been administered, said Jennifer Tolbert, director of state health reform at the Henry J. Kaiser Family Foundation: “Better than some states, not quite as good as other states.”

This week, MDH said two reasons this proportion may vary across states are how much time it takes to ship doses to states: “allocated” means any that have been marked as shipped and not necessarily just those that have arrived, as well as how quickly doses are getting to the locations where they will be administered.

Different policies

It’s not just the speed with which states are vaccinating people that differs, but also which people are getting vaccinated.

Minnesota’s vaccine data show the majority of people — 57.7 percent — who have received the vaccine in the state are in the 18 to 49 age range, while 13.7 percent are 65 or older.

In Florida, 56 percent of people who have received at least one dose of vaccine are over age 65, according to state data. In Texas, 27 percent are 65 or older.

That’s because the states have different policies surrounding who gets the vaccine, when.

The ACIP has recommended that group 1A include people in long-term care and health care workers, 1B include those 75 or older and essential workers and 1C include those 65 and older and younger people with high-risk medical conditions.

A review of states’ vaccination plans by the Kaiser Family Foundation found 35 states, including Minnesota, stuck closely to the ACIP’s plan for phase 1A, while 16 states diverged in some way.

“Overall, we find states are increasingly diverging from CDC guidance and from each other, suggesting that access to COVID-19 vaccines in these first months of the U.S. vaccine campaign may depend a great deal on where one lives. In addition, timelines vary significantly across states, regardless of priority group, resulting in a vaccine roll-out labyrinth across the country,” Kaiser’s report says.

In Texas, for example, vaccines are available to group 1A, which is the same as the ACIP recommendations, and 1B, which diverges from recommendations by including anyone 65 or older and younger people with underlying health conditions. As of now, groups 1A and 1B are also being vaccinated concurrently in Texas.

In Florida, group 1A included those recommended by the ACIP, plus anyone 65 or older and anyone hospitals deem highly vulnerable to COVID-19. There have been reports of people waiting in lines for vaccines, and reports of both Florida and Texas not having enough vaccine to meet vaccine eligibility or demand.

On Wednesday, Minnesotans in a Senate committee urged the state speed up the vaccination of older Minnesotans who live outside skilled nursing and nursing home facilities and who currently don’t know when they will be vaccinated.

Change of plans?

Minnesota had planned to announce sub-prioritization plans for group 1B, which under ACIP guidelines was to include essential workers and those over age 75, next week. But it’s unclear whether that plan will go forward.

On Tuesday, the Trump Administration’s Operation Warp Speed announced anyone 65 or older and younger people with health conditions that make them more at-risk of severe COVID-19 complications should be made eligible for the vaccine. The change comes in the wake of news that some states, including New York, were struggling to speed up vaccination efforts within their tight guidelines.

Later that day, MDH Infectious Disease Director Kris Ehresmann told reporters in a press call that the state had heard about the change in the news media and had received no written guidance from the federal government — and no additional vaccine allocations — to accompany it. Health officials have said those 65 and older and younger people with underlying conditions comprise about 1.3 million people, and expanding eligibility could delay vaccines for essential workers who would have been part of group 1B.

Health officials and Gov. Tim Walz have expressed doubt expanding eligibility criteria without the federal government making more vaccine doses available to the state would help make the process move more swiftly. Ehresmann said Minnesota is not having trouble finding enough people to be vaccinated under its guidelines, but rather that the state needs more vaccine to speed up the process.

She said Minnesota is is waiting for more direction, and more vaccine, to make changes. In the meantime, Minnesota will continue vaccinating group 1A.

“More vaccine becoming available to more people more quickly would be a welcome development, but we’ll follow the adage trust but verify,” she said. “A promise to deliver isn’t delivery, and we’ve learned to be patient when it comes to the federal government’s promises.”