Minnesota's COVID-19 vaccine providers defend performance

Medical providers in Minnesota are burning through weekly COVID-19 vaccine shipments and seeking more, despite comparative statistics suggesting that the state has too many doses sitting unused.

While Minnesota's vaccine tracker shows that the state has administered only 40% of available vaccine, Sanford Health has provided first doses to 70% of health care workers in its northern Minnesota region and is ready to expand. Hennepin County Public Health has injected 1,670 of an initial supply of 3,000 doses, and the rest will be gone by week's end.

"We would love to get twice as much vaccine," said Susan Jarvis, president of Sanford Health of Northern Minnesota, "and we could get it in people's arms quickly."

Minnesota leaders have recently found themselves on the defensive, trying to explain why a state that helped write the national playbook on COVID-19 vaccination ranked average at best in its rate of doses administered. On Saturday, it ranked 29th among states while the Dakotas ranked among the best.

Minnesota's ranking, per the U.S. Centers for Disease Control and Prevention's website, could be temporary given rapid changes in the pandemic — with the Pfizer and Moderna COVID-19 vaccines being approved only last month. Minnesota was criticized this summer for having twice as many COVID-19 deaths as Wisconsin, but now both states report roughly 5,800.

Minnesota's total of 5,887 fatalities includes 37 reported by the state Department of Health on Saturday. The state also reported 1,529 newly diagnosed infections, bringing its total to 445,047.

State officials nonetheless feel pressure, especially given the Trump administration's plan to change allocations of doses and reward states with faster vaccination rates. While the incoming Biden administration might not employ that strategy, state leaders urged medical providers to add more vaccine appointments, including on weekends, and tap any reserve supplies.

"Initially the approach was: 'Be sure you save some!' We've thrown that out the window," said Dr. George Morris, who is leading the COVID-19 response for CentraCare.

Minnesota has stuck to recommendations by the federal Advisory Committee on Immunization Practices (ACIP) to give scarce initial doses to health care workers at elevated risk of infection and to long-term care residents at greater risk of severe illness.

The state is administering about 13,000 doses on weekdays and remains on track to secure and offer vaccine to everyone in that priority group by the month's end.

"That's a really great administration rate, currently, and it has certainly improved," said Margaret Roddy, a state Health Department coordinator of COVID-19 vaccine operations.

State leaders are expected this week to announce whether they will stick with the next phase to the second ACIP priority group — people 75 and older and workers in front-line essential industries — or make a broader range of people eligible.

While the initial phase consisted of 500,000 people working in health care facilities and living in nursing homes, the next phase could include more than 1 million people spread across Minnesota. Providers said they have secured sites and workers to provide larger-scale vaccination events.

The federal government has allotted 626,925 doses of COVID-19 vaccine to Minnesota, including 513,750 doses that were in transit as of Saturday or had arrived in the state. Of that supply, at least 174,110 people have received first doses and 32,131 have completed the two-dose course.

The notion that 60% of Minnesota's vaccine doses are sitting unused is incorrect, state officials said. The total allotment includes 451,075 first doses — including 68,625 that won't arrive until next week — and 175,850 second doses that must be reserved. Both vaccines are considered 95% protective if given on schedule — with the Pfizer doses given three weeks apart and the Moderna doses given four weeks apart.

While all states have those statistical dilemmas, some have gotten more doses in arms. South Dakota has administered 61% of its 96,375 doses, according to CDC data.

The performance gap between the Dakotas and Minnesota surprised leaders at Sanford, which conducts COVID-19 vaccinations for its workers in all three states.

The Dakotas had a head start by several days even though first shipments of the Pfizer vaccine arrived at the same time in mid-December, Jarvis said. Minnesota required providers to complete online training to ensure that vaccine was handled safely and not wasted.

Some of the difference could be merely statistical. The small populations of the Dakotas could exaggerate their per-capita rates of vaccinations in the same way they give both states two of the highest per capita COVID-19 death rates in the U.S.

More than half of the vaccine sent to the Dakotas has been Moderna doses, which can be stored at regular freezer temperatures that allow for easier storage and transport.

Nearly 60% of Minnesota's supply is Pfizer vaccine, which must be kept in special freezers at -70 degrees Celsius and used within six hours once thawed and formulated. That slows distribution of doses to rural sites until providers are ready for them.

South Dakota nonetheless chose a distribution strategy that has proved efficient — assigning counties to the five major health systems in the state and making them responsible for vaccine distribution.

Minnesota's system is similar, but with the extra administrative layer of eight regional health care coalitions that decide each week on the local distribution. Most doses of Pfizer vaccine have gone to hospitals and clinics in those regions while Moderna vaccine has been used at long-term care facilities and by local public health agencies on paramedics and first-responders.

One advantage is that regional providers meet regularly and help one another, Morris said. CentraCare has offered to help public health agencies short on vaccine to give shots to people remaining on their priority lists. It also can go back and give shots to people at nursing homes who initially refused them.

"We're less worried about, 'this is mine, that's yours.' The vaccine doses we have in our region, we just want them in people's arms so we can protect our population," he said.

Minnesota officials said the pace of vaccination was slowed at first by a federal program in which chain pharmacies such as CVS, Thrifty White and Walgreens provide shots to residents in long-term care. Minnesota diverted more than 100,000 doses to that program, while West Virginia opted out and used local pharmacies to administer first doses to that population. That state has ranked among the best for its vaccination rate.

Vaccination of this population appears to be quickening in Minnesota, though. CVS launched its own state-by-state tracker and on Friday reported that it had provided 14,390 first-dose vaccinations in 118 of 120 assigned nursing homes. It has moved on to 478 assigned assisted-living facilities, completing 80 clinics and vaccinating 3,881 residents.

"Shots in arms are increasing daily," said CVS spokesman Charlie Rice-Minoso, "at an impressive rate."

Jeremy Olson • 612-673-7744