Walgreens employees prepare for flu vaccinations at the 16th Street Mission BART Plaza. Similar public efforts have not yet been undertaken regarding Covid-19. Photo by Annika Hom.

“Happy families are all alike; every unhappy family is unhappy in its own way,” goes the quote, but when it comes to the vaccine rollout, every successful and unsuccessful state has a different story.

Though California has vaccinated the second-highest number of people behind Texas, the state ranks near the bottom of the 50 states in the percent of vaccine doses administered, with just 25 percent of its vaccines used and 2.1 percent of the population vaccinated. By comparison, West Virginia and North Dakota, the two states at the top of the list, have used over 60 and 70 percent of their doses respectively, resulting in over 5 percent of the states’ populations having received a shot.

What went wrong in California, and what makes other states more successful in rolling out the vaccine? Maybe it would be better for California to adopt a first-come, first-served model for vaccination — but there’s the risk of descending into Floridian chaos, where seniors camped out on lawn chairs overnight. (But still, Florida has used more of its vaccines than California.) 

Perhaps California’s software system to coordinate vaccine distribution, beset with technical problems, is partially responsible for the slow rollout. Or maybe it’s the availability of mass vaccination sites, the geography, whether a state has a “get it done” attitude, such as North Dakota, or put a former consultant in charge of their rollout, such as Connecticut. Or maybe it is simply money, or avoiding major pharmaceutical chains like CVS and Walgreens, like West Virginia is. The list goes on for factors experts have posited as determining a state’s success.

Dr. Mark Ghaly, California’s health and human services secretary, said at a Tuesday press conference that the state’s slower rollout might just be a byproduct of meticulous planning.

“I don’t want to speak for South Dakota, North Dakota or West Virginia,” he said. “But I will say that certain states that have put a great deal of effort into coming up with their priority groups, watching how we keep a keen eye on equity, have been in the same place where California is.”

Planning for equity, however, does not appear to have stymied Rhode Island. The state has administered nearly 50 percent of its doses and is in the top half of states for distribution, despite ongoing debates about whether to prioritize the next vaccination groups based on age, health conditions, occupation, where people live or a combination of those factors. Moreover, the state launched a pilot program in Central Falls last week, the state’s hardest-hit community, distributing about 1,500 doses to some of the area’s 20,000 residents. 


The Trump administration is urging states like California to pick up the pace, with Department of Health And Human Services Secretary Alex Azar blaming states with restrictive vaccine eligibility rules for some of the delays.

“Some states’ heavy-handed micromanagement of this process has stood in the way of vaccines reaching a broader swath of the vulnerable population more quickly,” he said.

California is adapting. On Monday, Gov. Gavin Newsom said the state will give public health departments more flexibility in moving between vaccination phases and tiers. The state’s previous focus was on vaccinating health care workers and long-term care facilities as part of Phase 1a of vaccination. Now, health departments can move to vaccinate groups of people, such as other essential workers or the elderly, before they finish 1a vaccinations. And on Tuesday, San Francisco announced it will start vaccinating residents 65 and older who are part of its clinic system this week.

“We don’t want to see any dose wasted,” Newsom said. “If there is a dose sitting there with no one queued up, based upon existing tiers, we want to be able to move to other priority groups, other priority phases, and tiers within those phases.”

Newsom also hopes to vaccinate 1 million people across the state by the end of this week — an ambitious goal. 

Here’s a look into the three states that have distributed the highest percentage of doses as of Wednesday.


Percentage of population vaccinated: 5.7 percent
Number of shots given: 50,712
Percentage of doses used: 57 percent

South Dakota has vaccinated all of its healthcare workers and residents in long-term care facilities, and is beginning Phase 1c inoculations, which includes almost 50,000 emergency medical service and front-line public health workers, as well as law enforcement and correctional officers. 

Dr. David Basel, an internal medicine physician/pediatrician in the state, told KOTA-TV that the state’s success is due to its ability to “cut through red tape, I think, so much more effectively than a lot of states are. We just get it done.” The state’s three big health systems, Avera, Monument and Sanford, are also partnering with the state to map out which system is vaccinating each county, a potentially more efficient way to get shots into arms than California’s plans to have people inoculated through their healthcare providers.


Percentage of population vaccinated: 5.3 percent
Number of shots given: 40,728
Percentage of doses used: 61 percent

By the end of the week, the state expects to wrap up offering the vaccine to everyone in the first phase of vaccinations, and over half of the people offered the vaccine have received it. Starting next week, the state anticipates beginning vaccinations of the elderly. Most North Dakota long-term care facilities are also not a part of a federal program connecting them with large pharmacy chains, like CVS and Walgreens, to receive the vaccine. (A state law requiring pharmacists to be owned and operated by pharmacists, effectively bans large chains from the state.) Instead, North Dakota has sent the vaccine to public health, independent pharmacies or directly to the long-term care facilities for vaccination. The state is also conducting vaccinations at centralized locations for people not connected to a health care system. 


Percentage of population vaccinated: 6.2 percent
Number of shots given: 110,709
Percentage of doses used: 69 percent

West Virginia is wrapping up a first round of shots for health care workers and long-term care facilities, and is now working through second doses, as well as administering first shots to people age 80 and over and teachers 50 and older. Like North Dakota, the state also opted to work with smaller, independent stores to distribute vaccines instead of larger pharmacies like CVS and Walgreens. The smaller pharmacies, which are already in partnership with health care providers and work with many residents, had more flexibility than larger chains to adapt to provide vaccines, Claire Hannan, executive director of the Association of Immunization Managers, told NPR (CVS and Walgreens dispute the idea that their rollout is slow). The state is also enlisting the National Guard to help deliver the vaccine to vaccine providers.

Follow Us

Kate Selig is an intern at Mission Local.

Join the Conversation


Please keep your comments short and civil. Do not leave multiple comments under multiple names on one article. We will zap comments that fail to adhere to these short and very easy-to-follow rules.

Your email address will not be published. Required fields are marked *

  1. You will never have an 1:1 correlation between available vaccines and people in any given tier or sub-tier wanting to get them. You will ALWAYS have either:
    1) Too many unused COVID vaccines or
    2) Too many people in a group that want them.

    There’s nothing wrong with seniors camping out overnight for a vaccine. If the clinic runs out, the seniors will be back. SF is in a weather dry spell; the seniors will be back the next day, I guarantee it.

    If the goal is to be to vaccinate as many people as quickly as possible, then the city should follow this quote:

    “It is better to have people waiting in line for vaccines than it is to have vaccines waiting in line for people.
    — Abraham Lincoln”

    Or somebody like that.