Why West Virginia Leads the Country in Vaccine Roll-Outs

The much-feared holiday surge of COVID-19 cases finally arrived this week. Deaths from the disease 25 percent higher than in any other week since the pandemic began.

The devastating news comes as frustrations are mounting across the country about the distribution of vaccines. Just today, we found out that the “national stockpile” of vaccines Trump administration officials had talked about has been depleted, dashing hopes of governors and health officials that the federal government would release a surge of new doses of the scarce vaccines. States themselves, though, have struggled to distribute the shots they do have. Many have only administered a third of the doses that the federal government says they have received.

One notable exception has been West Virginia, where Gov. Jim Justice claims all the doses that the state has received are either already in the arms of a patient or scheduled to be in one soon. I spoke with Jim Hoyer, who recently stepped down as the state’s adjutant general to oversee the joint interagency task force charged with distributing the vaccine, about the keys to West Virginia’s progress.

That’s the story this week, or, as Hoyer put it on Friday, Day 308 of the coronavirus crisis.

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Onto the news…

“If you can imagine, this little state,” said Justice, the West Virginia governor, in a CNBC interview this week, “we don’t have vaccines in a warehouse sitting on a shelf.”

“Today, we have 100 percent of the vaccines that we’ve received … either in people’s arms or have a name tagged to the vaccination that they’re going to get and they’re going to get in the next couple of days. Now, what we need in West Virginia, we need more vaccines,” he said.

That puts West Virginia at the top of the list of states for percentage of their vaccine that’s been distributed, according to Bloomberg. The state’s 79 percent distribution rate is double the national average. (Other low-population states including North Dakota, South Dakota and Rhode Island were also among the national average.)

Hoyer, the former head of the West Virginia National Guard, said the state has improved its capacity to respond to crises, during a series of disasters that have struck the state over the last decade. There was massive flooding in 2016, a de recho storm last year that knocked out power around the state, and a chemical spill that contaminated drinking water in the Charleston area. Responding to those emergencies required the state to work with state and local governments, plus private entities.

Many of those same entities are at the table for the COVID-19 task force that Hoyer now leads. “It’s not just a whole-of-government approach, it’s a whole of West Virginia approach,” he says.

The governor set four priorities for the vaccine distribution process: reducing the number of COVID deaths in the state, reducing the number of hospitalizations, protecting the most vulnerable residents and making sure the health system and other emergency services continued to operate effectively.

What it meant in practice, is that the state has focused intensely on its oldest residents.

“This is all about age and age and age,” the governor said. “That’s just all there is to it.”

Nearly 78 percent of all the West Virginia residents who have died of COVID-19 were 70 years old or older. Another 14 percent were between 60 and 70 years old, Hoyer said.

The most vulnerable of the elderly population live in nursing homes and assisted living facilities, which is why the U.S. Centers for Disease Control and Prevention (CDC) have recommended that states start their vaccine rollouts by inoculating long-term care residents and staff.

That’s the approach West Virginia took too, but the state opted out of a national plan to distribute those vaccines through CVS and Walgreen’s. Half of the state’s pharmacies are independent, and many of them already provide services to the long-term care facilities. So West Virginia leaders decided to coordinate the distribution on their own, allowing not just the national chains, but local drug stores as well.

“If that relationship is in place, why would you exclude [local pharmacies] to go to build a new one?” Hoyer asked.

By using pharmacies that had existing relationships with the patients, the stores were able to start setting up appointments with their customers in early December, NPR reported.

Krista Capehart, the director of regulation for the state’s Board of Pharmacy, led West Virginia’s distribution plan. And the Board of Pharmacy was part of the statewide COVID-19 task force.

Hoyer said the approach sped up the process in West Virginia. While the federal pharmacy program is expected to issue first doses of the vaccines to all patients by Jan. 25, West Virginia will complete all of its second doses for its initial group by Jan. 28.

Meanwhile, the state is compiling a list of top priority patients who missed the first dose for various reason. That list has grown to 2,000 people.

As the focus shifts to the wider population, West Virginia is trying to both get more vaccines and to manage the demand for the shots it does receive. The governor says he wants 110,000 doses a week. That amount would enable the state to cover its 360,000 people who are over the age of 65 in a matter of weeks. But last week, West Virginia received just 23,600 doses.

Meanwhile, Hoyer’s team is working on building up a statewide call center to help residents schedule their appointments for their shots with county health departments. (Justice has said he didn’t want to see a melee like he had seen in Florida of older residents waiting for hours for the chance to get a vaccine.) Eventually, Hoyer said, the state wants to get medical providers to start calling their patients, rather than waiting for their patients to call them.  

For now, Hoyer says, “the biggest challenge is people clamoring for vaccine.” West Virginia has a higher percentage of older residents than the country as a whole, and people over 65 remember getting vaccinated as children to prevent polio. “It almost eradicated terrible disease,” Hoyer says, “so they’re pretty focused on when they’ll get their vaccines.”