Vaccination Distribution Better in Some States


Which states are doing the best job of vaccinating their people? That’s the most important question that should be on the minds of the Biden administration.

Job One for Joe Biden is dealing with the Covid pandemic that is still widespread in our nation. If he fails to get the pandemic under control, the rest of his agenda will be meaningless. Therefore, making sure vaccine is getting into the arms of most Americans must be his first priority.

Distribution has been following the federalism model, which allows states to make their own decisions after the federal government makes recommendations. The CDC initially recommended healthcare workers and nursing home residents receive the vaccine first. There was not much argument over that, but the next priority group began the bickering.

According to The Wall Street Journal, after six weeks since the first distribution of vaccines were shipped, the U.S. has administered some 53% of the distributed vaccines. The gap continues to grow between states that are getting shots into arms, and those arguing over who gets what and when.

North Dakota has administered some 84% of its supply as of January 23, and West Virginia about 83%. Compare that to states like California (45%) or Alabama (47%) and you see that federalism is showing what works and what doesn’t work. WSJ says President Biden is fortunate to inherit Operation Warp Speed. Biden says he’ll trigger the Defense Production Act to expand vaccine production, but doesn’t say how he’d build on the existing plan.

The most successful state rollouts have been those that departed from overly prescriptive federal rules. North Dakota stuck with the initial recommendations to vaccinate healthcare workers and nursing home residents, but then opened the program to anyone age 65 and up, as well as adults with underlying health risks. Florida did the same. This makes perfect sense since we should be vaccinating those at greatest risk first and age is the number one determinant of risk.

South Dakota added law enforcement and corrections staff to its initial tiers, and then moved quickly to inoculate 65 and older adults and school workers. The states with the highest per capita vaccination rates are all rule-breakers: (as of January 23)

  • Alaska – 12,885 per 100,000
  • West Virginia – 11,321 per 100,000
  • North Dakota – 9,602 per 100,000


Compare those numbers with the states with the lowest vaccination rates:

  • California – 5,568 per 100,000
  • New York – 5,816 per 100,000


The best performing states also showed creativity about how best to distribute and administer the vaccines, even if that meant departing from federal advice. North Dakota began planning its vaccine rollout last summer and chose to distribute vaccine supplies to healthcare providers statewide – not only to hospitals or public health systems. West Virginia opted out of a federal program putting CVS and Walgreens in charge of vaccinating most nursing homes, which has proved especially slow. Instead, the state used a network of 250 local pharmacies, most of which had existing relationships with patients, which sped up scheduling and paperwork. It also used the National Guard to help deliver vaccines to the state’s long-term care facilities.

Federalism benefits most when using the “laboratories of democracy” in each state to learn valuable lessons about what works and what doesn’t. Those states with the poorest vaccination rates should pay attention to those most successful if they want to vaccinate their people faster and more efficiently.


  1. Enjoyed your article on distribution in the different states. I wondered how you thought Florida was doing?

    Comment by Caren Bell on January 29, 2021 at 10:05 am

  2. Florida’s Governor DeSantis has done a superb job of prioritizing who gets the vaccines first, recognizing the elderly are at the highest risk and putting them first along with healthcare workers. The Florida distribution of the vaccines has been hampered by lack of vaccine supplies and also by an overly complex registration process in some counties that challenges the computer skills of even those elderly with great experience. Simplification of this registration process and greater supplies of vaccine are needed to improve the Florida vaccination experience, although it has been much better than many other states.

    Comment by Robert Roberts on January 31, 2021 at 5:01 pm