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Minnesota is vaccinating for COVID-19 more slowly than other states. Here’s why

And it doesn’t mean that vaccine is just sitting around or going to waste.

Steve Leslie administering a dose of the COVID-19 vaccine to Kelly Lind in Virginia, Minnesota. Both are public health nurse supervisors for St. Louis County.
Steve Leslie administering a dose of the COVID-19 vaccine to Kelly Lind in Virginia, Minnesota. Both are public health nurse supervisors for St. Louis County.
St. Louis County Public Health & Human Services Dept.

In the weeks since two COVID-19 vaccines became available, Minnesota has gotten flak from residents and lawmakers for data that show the state not vaccinating its population as quickly as other states.

As of Wednesday, federal data showed Minnesota is tied for 41st place for share of the population that has received a first dose of COVID-19 vaccine (3.7 percent). Worse, perhaps, Minnesota has ranked near the lower middle of states for the percent of shots distributed by the federal government that have been given, leading some to conclude there’s a stockpile of vaccines somewhere that isn’t being used.

That’s not the case, say state and health system officials and experts. Instead, they say, the reason data show Minnesota’s vaccination process isn’t going as quickly as some other states’ has to do with the state’s decision to ensure that those most at risk for severe cases of COVID-19, and those who care for them, are vaccinated first.

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Federal data

The data cited on vaccine distribution in most state-by-state trackers comes from the Centers for Disease Control’s vaccine tracker.

Earlier this week, the most recent CDC tracker data showed Minnesota with 519,600 distributed doses, and 251,535 doses administered — an administration rate of 48 percent. That doesn’t look great compared to other states. West Virginia and North Dakota had both administered more than 65 percent.

But it’s an oversimplification to say that Minnesota has administered 48 percent of the shots it has and is sitting on the other 52 percent.

“It’s a common misperception,” said Claire Hannan, the executive director of the Association of Immunization Managers, due in part to the way the CDC’s vaccine tracker measures the vaccine roll out.

Until Wednesday, doses distributed referred to the number of vaccines that have been recorded in the CDC’s tracking system as shipped to Minnesota since Dec. 13. That means some of them are in transit, either direct to Minnesota vaccination sites or, if they’re Pfizer vaccines that need ultra-cold storage, in transit from Minnesota’s hub sites, where such cold storage is available, to spokes, smaller facilities where the vaccines are being used.

In northwestern Minnesota, for example, Sanford Health in Bemidji is the hub site for vaccination sites in Baudette, Crookston, Park Rapids and other smaller towns across the region. Any vaccines that go to those sites are first shipped to Bemidji, then taken out of ultra-cold storage and brought to the smaller sites to be administered, where they have to be used within five days, said Matt Webb, director of pharmacy for Sanford Health of northern Minnesota.

Ideally, Hannan said, a state getting weekly vaccination shipments would show up at about 70 percent of vaccine shipped administered on the CDC’s vaccine tracker, because at the same time their providers are receiving shipments and giving shots, they’re waiting on the next week’s allotment of vaccines, marked as “shipped.”

“Because of the dynamic of the supply coming every week, you’re never going to be at 100 percent unless supply actually stops,” she said. There are also lags in the data associated with when vaccinations get reported to the federal government.

Also at issue has been the long-term care vaccination program, which is run by the federal government and administered by pharmacy chains (in Minnesota, it’s Walgreens, CVS and Thrifty White). States have been required to set aside doses for this program, which has been slow to get off the ground, and they can’t just reallocate those shots for other uses, Hannan said.

The exception is West Virginia, the lone state that didn’t sign onto the federal program to vaccinate long-term care. West Virginia officials have cited this as one reason their numbers look so good.

As the long-term care vaccination program moves forward (MDH said in a legislative hearing Wednesday that Minnesotans in 1A are expected to have their first shot done or at least scheduled by early February), states’ ratios of vaccines used out of those distributed are coming up. Taking out the number of doses allocated to the long-term care vaccination program, some states are up near 70 percent, and every state is improving, Hannan said.

Midweek this week, CDC changed the metric on its tracker from doses shipped to doses delivered to states, which cuts some of the shipping time out of the equation. The number of doses delivered as of Thursday was up to nearly 596,000, while the number of vaccines administered was 252,548. That puts the state’s ratio of vaccines administered to delivered at just 42 percent.

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Deliberate vaccination effort

Other factors are at play, too. The states with the highest ratios of vaccines administered per capita are, in order: Alaska, West Virginia and North Dakota. These states have a couple of advantages when it comes to vaccine distribution, Hannan said. One, their populations are smaller, so it’s easier to manage inventory, and two, they tend to have strong relationships with a smaller number of health providers.

That contrasts with states like Minnesota, which has to manage inventory across some pretty big health systems, she said.

Minnesota has also stuck close to CDC guidelines for vaccinations. Group 1A, the only one eligible for vaccination until this week, when Minnesota added those 65 and older plus small numbers of school and child care workers, included those living and working in long-term care and health care providers.

Some states opened up vaccinations to broader groups of people, such as older people not living in long-term care facilities or those with underlying health conditions that could put them at risk of severe COVID-19 complications, almost from the jump. In these places, Florida and Texas among them, a large swath of the population was made eligible for the COVID-19 vaccine even before the state finished vaccinating in long-term care settings and among health care workers.

While that strategy has allowed people who wouldn’t be eligible for vaccination yet in Minnesota to get shots, it hasn’t made everyone happy.

As of last week, Texas was vaccinating its 1A, which was much like Minnesota’s, and 1B, which includes those 65 and older and those younger with an underlying health condition, at the same time.

“Some states that opened [vaccines] up early, like Texas, seem to have more doses administered, but at the same time, I was just on a call and their Medical Association is very loudly saying a lot of health care workers got left behind,” Hannan said.

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Florida is still in 1A, but the state included those 65 and older and anyone hospitals deem to have an underlying health condition for whom COVID-19 poses extreme risk. The state has made some vaccinations available to those eligible on a first-come, first-served basis, a strategy that created long lines and demand that far outpaced supply.

“My dad’s in Florida and people in Florida are upset when people that are in assisted living and skilled nursing haven’t gotten their vaccines ahead of time,” MDH Infectious Disease Director Kris Ehresmann said. In the meantime, “People are flying into Florida to get vaccinated and their residents are frustrated.”

By contrast, Minnesota’s approach, which MDH calls “immunizing for impact,” has required an effort to make appointments for the more specific groups of people who qualify.

“I think they took a very deliberate approach, which is good, but you know, I think it results in some doses seemingly sitting on the shelf, which I don’t necessarily think is true. I think all of the doses are spoken for. They’re somewhere in that plan of scheduling, giving, reporting, all of that taking some time on the hospital side,” Hannan said.

Ehresmann used a State Fair analogy to illustrate how Minnesota’s approach differs from other states’, noting that it would take longer to fill a number of, say, seats at an event at the Fair with people wearing red shirts than it would to just fill them with anyone.

There’s some chance Minnesota’s efforts to more tightly control its COVID-19 vaccine rollout could hurt the state. Last week, the Trump administration indicated it would consider how fast states are vaccinating people when it distributes doses, giving more vaccine to states moving at a fast clip. On Wednesday, MDH Commissioner Jan Malcolm said it’s not clear whether the Biden administration will take the same tack.

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Officials say more vaccine is needed

While the data suggest a smaller share of Minnesotans have been vaccinated than residents of other states, MDH has stressed repeatedly that the biggest hangup in its ability to vaccinate Minnesotans more quickly is federal vaccine allocations.

Other states say the same thing. This week, some states, New York and Florida among them, were plagued with reports of canceled COVID-19 vaccination appointments because of a short supply.

Minnesota has been receiving about 65,000 doses of vaccine per week, and health systems across Minnesota say they are administering doses efficiently as they come in.

“The greatest limitation continues to be the amount of vaccine Minnesota is receiving and that we are then being allocated, which is nowhere near enough to meet demand,” Allina Health said in a statement to MinnPost Tuesday.

“We have not had any problem filling our appointments and we have used all of the doses received. Our system was designed to administer doses efficiently, and we have the capacity to administer 10K/week if we had enough supply,” said Bob Nellis, spokesperson for Mayo Clinic, in an email.