One thing that does appear to be unique about South Dakota’s vaccination effort is the extent to which it has been outsourced to the state’s three big hospital systems, Sanford Health and Avera Health of Sioux Falls and Monument Health of Rapid City, which together with a couple of smaller health-care providers have divvied up all the state’s counties and taken responsibility for vaccine provision in every one. It seemed telling that, when Sioux Falls Mayor Paul Ten Haken held his regular Covid briefing early this week, he quickly handed the microphone over to doctors from Sanford and Avera, saying he’d “leave it to the docs to talk about vaccines.” Prominent Johns Hopkins University surgeon and medical researcher Marty Makary argued this week that “hospitals should stop giving excuses and start showing some leadership” on Covid vaccination efforts rather than waiting for orders from state public health officials. In South Dakota, that was the plan from the beginning.
In North Dakota the state health department has been more visible, after participating with three other states (California, Florida and Minnesota) in a CDC Covid-vaccine-planning pilot program this fall. But Sanford Health, the leading player in its two most-populous metropolitan areas, Fargo and Bismarck, as well as some smaller communities, also seems to have played a crucial role by using its network of 180 couriers in Dodge Caravans to begin delivering the BioNTech-Pfizer vaccine to rural medical outposts in the Dakotas and Minnesota even as other rural areas around the country waited on the easier-to-store Moderna vaccine.
In general, states with a high percentage of the population in rural areas seem overrepresented on both charts above, perhaps an indication that having lots of people far from hospitals forces a more pro-active approach. States with small populations are overrepresented too, almost certainly an indication that it can be easier to get stuff done when there are fewer people and organizations to consult and coordinate.
One thing that I expected to see in the top-performing states — but didn’t — was more-relaxed rules about who could get the vaccines. New York City Mayor Bill de Blasio complained loudly last week that the state’s strict eligibility rules were holding back vaccination, and after they were relaxed this Monday there were complaints that the sign-up system was incomprehensibly complex. But New York’s vaccination rates put it in the middle of the pack among states, while top performers West Virginia and the Dakotas don’t seem to have been any less strict about eligibility in the first wave of vaccinations. Meanwhile, the state with the lowest vaccination rate by both the measures used above, Alabama, has been giving counties flexibility to ease eligibility rules if they have excess vaccine. An ability and a desire to push vaccines out quickly to those eligible for them seems to have been more important, in the early weeks at least, than the eligibility rules themselves.
On the theory that all happy families are alike while each unhappy family is unhappy in its own way, I didn’t spend much time looking at the vaccine laggards. Also it’s early yet, and it may turn out that some of the differences we’re looking at now have more to do with vaccination reporting systems than actual vaccinations. The Covid-19 pandemic has repeatedly made fools of those declaring victory prematurely. Still, states are inevitably learning from their own vaccination mistakes. Might as well try to learn from others’ successes too.
Justin Fox is a Bloomberg Opinion columnist covering business. He was the editorial director of Harvard Business Review and wrote for Time, Fortune and American Banker. He is the author of The Myth of the Rational Market.