Despite the clamor to speed up the U.S. vaccination drive against covid-19 and get the country back to normal, the first three months of the rollout suggest faster is not necessarily better.
A new analysis found that states such as South Carolina, Florida and Missouri that raced ahead of others to offer the vaccine to ever-larger groups of people have vaccinated smaller shares of their population than those that moved more slowly and methodically, such as Hawaii and Connecticut.
The explanation, as experts see it, is that the rapid expansion of eligibility caused a surge in demand too big for some states to handle and led to serious disarray. Vaccine supplies proved insufficient or unpredictable, websites crashed and phone lines got jammed, spreading confusion, frustration and resignation among many people.
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"The infrastructure just wasn't ready. It kind of backfired," said Dr. Rebecca Wurtz, an infectious-disease physician and health data specialist at the University of Minnesota's School of Public Health. She added: "In the rush to satisfy everyone, governors satisfied few and frustrated many."
The findings could contain an important go-slow lesson for the nation's governors, many of whom have announced dramatic expansions in their rollouts over the past few days after being challenged by President Joe Biden to make all adults eligible for vaccination by May 1.
"If you're more targeted and more focused, you can do a better job," said Sema Sgaier, executive director of Surgo Ventures, a nonprofit health-data organization that conducted the analysis in collaboration with The Associated Press. "You can open it up -- if you have set up the infrastructure to vaccinate all those people fast."
Numerous factors stymied state vaccination performance. Conspiracy theories, poor communication and undependable shipments slowed efforts after the first vials of vaccine arrived Dec. 14.
But the size of the eligible population was always within the control of state officials, who made widely varying decisions about how many people they invited to get in line when there wasn't enough vaccine to go around.
When the drive began, most states put health care workers and nursing home residents at the front of the line. In doing so, states were abiding by national recommendations from experts who also suggested doing everything possible to reach everyone in those two groups before moving on to the next categories.
But faced with political pressure and a clamor from the public, governors rushed ahead. Both the outgoing Trump administration and the incoming Biden team urged opening vaccinations to older Americans.
By late January, more than half the states had opened up to older adults -- some 75 and above, others 65 and up. That's when the real problems started.
In Missouri, big-city shortages sent vaccine seekers driving hundreds of miles to rural towns. Dr. Elizabeth Bergamini, a pediatrician in suburban St. Louis, drove about 30 people to often out-of-the way vaccination events after the state opened eligibility to those 65 and older Jan. 18 and then expanded further.
"We went from needing to vaccinate several hundred thousand people in the St. Louis area to an additional half-million people, but we still hadn't vaccinated that first group, so it has been this mad dash," Bergamini said. "It has just been a whole hot mess."
West Virginia bucked the trend with both high numbers of eligible residents and high vaccination rates in early March, but the state started slow and built its capacity before expanding eligibility.
Similarly, Alaska maintained a high vaccination rate with a smaller eligible population, then threw shots open to everyone 16 and older March 9. This big increase in eligible adults near the end of the period studied led to the omission of Alaska from the analysis.
The analysis found that as of March 10, Hawaii had the lowest percentage of its adult population eligible for vaccination, at about 26%. Yet Hawaii had administered 42,614 doses per 100,000 adults, the eighth-highest rate in the country.
Thirty percent of Connecticut's adult population was eligible as of the same date, and it had administered doses at the fourth-highest rate in the country.
In contrast, Missouri had the largest percentage of its adult population eligible at about 61%. Yet Missouri had dispensed 35,341 doses per 100,000 adults, ranking 41st among the states.
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Seven states in the bottom 10 for overall vaccination performance -- Georgia, Tennessee, Texas, Florida, Mississippi, South Carolina and Missouri -- had larger-than-average shares of their residents eligible for shots.
Among high-performing states, five in the top 10 for high vaccination rates -- New Mexico, North Dakota, Connecticut, Wyoming and Hawaii -- stuck with more restrictive eligibility. Another two high-performing states from the top 10 -- South Dakota and Massachusetts -- were about average in how many residents were eligible for vaccine.
"This is a thorough analysis showing a clear association between breadth of eligibility and vaccination rates across states," said Dr. Mark McClellan, a former head of the Food and Drug Administration who was not involved in the analysis but reviewed it.
The better-performing states could be getting results by paying closer attention to vaccine supply, thoroughly vaccinating high-risk groups and then opening to additional categories more slowly as they wait for supplies to build, McClellan said.
What happens next will depend on how much states can improve their vaccine delivery systems and whether Americans remain eager for vaccination, even as the threat eases with more people protected and case numbers dropping.
TROUBLE IN FLORIDA
Meanwhile, Miami Beach officials declared a state of emergency and implemented a curfew Saturday in response to large, unruly crowds of spring break visitors refusing to wear masks, destroying restaurant property and fighting in the streets.
During a last-minute meeting Sunday, city officials voted to extend an 8 p.m. curfew for another week along famed South Beach, with the possibility of extending it well into April if needed.
They stressed that this isn't the typical spring break crowd. They said it's not college students, but adults looking to let loose in one of the few states fully open during the pandemic.
Law enforcement officers from at least four other agencies, along with SWAT teams, were added to help contain the raucous crowds, but it wasn't enough. After days of partying, including several confrontations with police, Miami Beach officials enacted a curfew Saturday from 8 p.m. until 6 a.m., forcing restaurants to stop outdoor seating entirely during the three-day emergency period, and encouraging local businesses to voluntarily shut down.
Since Feb. 3, the police department said, about 1,000 arrests have been made, including 350 on felony charges. About 51% of the arrests involved non-Floridians. Officers also seized 80 firearms.
"It's a lot of pent-up demand from the pandemic and people wanting to get out," Commissioner David Richardson said. "And our state has been publicly advertised as being open, so that's contributed to the issue."
The city has been mostly calm during the day but volatile and unpredictable in some areas at night, according to authorities.
One restaurant was "turned upside down" in a melee, as "chairs were used as weapons," and broken glass covered the floor, Miami Beach Police Chief Richard Clements said.
Next door, the iconic bar the Clevelander South Beach announced it was temporarily suspending all food and beverage operations until at least Wednesday after crowds crammed Ocean Drive, breaking out into street fights.
After gunshots were fired, a young woman cut her leg so badly in a stampede that she was transported to the hospital, where they initially thought she had been shot, police said.
"How long can you go before something bad happens and you realize that you didn't say something?" Clements said.
With its miles of beaches and famed party scene, Miami Beach has long been a spring break destination. City officials have for years attempted to crack down, citing raucous crowds and occasional fights.
Such actions have drawn criticism from the National Association for the Advancement of Colored People, with leaders noting that many of those who visit over spring break are Black. Some Black leaders expressed concern over the city's latest crackdown attempts, including the use of pepper balls to help clear Ocean Drive on Saturday night.
"I was very disappointed," Stephen Hunter Johnson, chairman of Miami-Dade's Black Affairs Advisory Committee, told the Miami Herald. "I think when they're young Black people [on South Beach], the response is, 'Oh my God, we have to do something.'"
The mayor and other city officials insisted they were targeting conduct rather than specific groups of people. Clements said officers used pepper balls Saturday night in response to some in the crowd rushing toward them.
This year has seen more visitors and more disruptions than previous years, officials said, with interim City Manager Raul Aguila describing it as "a spring break like no other."
Miami Beach leaders attributed the surge in visitors to coronavirus-related closures in other areas, coupled with cheap flights and demand for travel. Florida reopened before many other states and has fewer restrictions. The city's tourism arm also spent $5 million on its biggest national advertising campaign in 20 years.
At the same time, local officials banned alcohol from the beach, along with all alcohol sales after 10 p.m. in an effort to curb partying. The city even sent cellphone text messages to tourists warning, "Vacation Responsibly or Be Arrested."
"I just feel like it's really not fair," tourist Heather Price told NBC 6. "People paid a lot of money to come all the way out here, just to not be able to do the activities they wanted to."
Information for this article was contributed by Carla K. Johnson, Nicky Forster, Heather Hollingsworth and Kelli Kennedy of The Associated Press; and by Brittany Shammas of The Washington Post.
