BISMARCK — As federal officials conceded missed benchmarks in the initial phase of the COVID-19 vaccine rollout this week, public health leaders in North Dakota commended the state’s relative success while acknowledging a need to pick up the pace in January.

“I think so far things have gone well,” said state Immunization Director Molly Howell. “I haven't been sitting here thinking ‘Oh I wish we had done this,’ or ‘we could have done that.’”

Still, Howell noted, the state will aim to scale up moving into the New Year.

“That’s not to say that it’s been perfect, and moving forward I think there will be issues or bumps in the road,” she said.

As in other parts of the country, the first weeks of vaccine distribution in North Dakota have hit some unexpected delays. Based on an original allotment of 40,000 vaccine doses by the end of the year, Howell predicted in early December that North Dakota would be able to allocate first doses to all of its nursing home residents and a majority of its health care workers before the end of the month.

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But with vaccinations three weeks underway, she noted the state's goals have required some revision and said she was looking at mid-January as the goal post for completion of first doses in hospitals and nursing homes.

“I think we thought it was possible based on the estimations we received for allocation,” she said, noting that a nationwide shortfall in the supply of Pfizer and Moderna vaccines initially approximated by the federal government has required some adjustment of expectations in North Dakota. "But our allocations were decreased. So I think that is part of it. We’re receiving less doses than we expected to receive."

The disparity between the amount of vaccine originally estimated for North Dakota by the federal government and the actual allocation that the state has gotten so far is stark. North Dakota was hopeful for first shipments of 9,750 doses of the Pfizer vaccine per week. So far, they have only been allotted half of that, at 4,875 weekly doses. Allocations of the Moderna vaccine have also been shorter than expected, though Howell said the margins there are not as large.

“I think the biggest challenge is not having enough doses for (getting) everybody vaccinated who wants to be vaccinated,” said Howell, noting that revised federal estimates have designated about 10,000 total doses a week to North Dakota through January. “To allocate 10,000 doses across the entire state of North Dakota is extremely challenging. We’re trying to do that as equitably and fairly as possible.”

As the United States assessed its own vaccination performance in the last days of 2020, experts and federal officials agreed the first weeks of the national vaccination program were much too slow. By one estimate, it would take the United States around ten years to reach the 80% threshold needed for herd immunity if vaccination continues at its current pace.

But by the standards of this sluggish nationwide rollout, North Dakota’s efficiency has measured up well. According to a U.S. Centers for Disease Control and Prevention tracker, the state is near the top of the country in per capita vaccines administered at just over 1,800 doses per hundred thousand residents. By comparison, West Virginia, the national leader, has administered close to 2,200 doses per hundred thousand residents.

So far, North Dakota has administered more than 19,000 vaccine doses and received a total of 32,250.

“All things considered, I think the state is in a good place, and we’re doing okay,” said Kylie Hall, the project coordinator at North Dakota State University’s Center for Immunization Research and Education. “Obviously, I think there’s some things that could be going better.”

On the state level, Hall said, she would like to see a quicker turnaround from the point of receiving a vaccine to administering the first shots so that all doses are administered within one or two days of arrival in a hospital or long-term care facility.

“The vaccines don’t work if they’re sitting in the fridge,” she stressed.

Still, both Howell and Hall said some initial delays aren’t surprising as the state needed to get its sea legs with the newly approved vaccines.

“We’re not yet at capacity. We’re not even close to that,” Hall said.

On top of the state's smaller-than-expected federal allocation, Howell pointed to the need for the initial education of vaccine providers and general Christmastime lags as likely contributors to a slower start.

She said the rate of recent flu vaccination campaigns can offer a better picture of North Dakota's full immunization potential. In 2019, for example, the state administered around 45,000 doses of flu vaccine in its peak week, a threshold Howell said the state should easily clear once it has all of its engines running.

Hall agreed. “It’s not going to be that we’re vaccinating 500 or 1,000 people a day,” she said. “It’s going to be thousands of people a day.”

And so far, the administration of vaccines in health care facilities seems to be moving efficiently. "We have had zero delays in terms of the vaccine availability to getting it into somebody's arm," said Dr. Todd Schaffer, the vice president of clinics at Sanford Health in Bismarck. "That has been about as smooth as it possibly could be."

Schaffer noted Sanford has administered first doses to about 1,600 of its 3,000 Bismarck employees.

While administration of vaccines in nursing homes is partially contingent on a federal pharmacy partnership, about 70% of the vaccines being distributed directly through the health department have been administered so far, a percentage that isn't likely to ever hit 100 since new vaccine shipments are regularly arriving in the state.

Still, Schaffer suggested a somewhat wider target window for the completion of vaccinations in his hospital than the mid-January goal post set by the health department. Completing vaccinations at Sanford in Bismarck could reasonably stretch to the end of January, he said.

As North Dakota scales its vaccinations upward, the job is likely to get more challenging. Not only will the state have to reach much larger segments of the population in subsequent vaccination phases, but the target groups will also get more diffuse.

Reaching health care workers and nursing home residents is relatively simple given their confinement within set facilities. Later phases will call for a broader education campaign, exponentially more distribution, and logistics, logistics, logistics.

“That’s going to take coordination at the federal, state, (and) local level,” Hall said, describing a system that will also require buy-in from a large diversity of employment groups around the state. “It’s going to take so much coordination."

Readers can reach Forum reporter Adam Willis, a Report for America corps member, at awillis@forumcomm.com.