Michigan and Minnesota both had ample opportunities to push out vaccines through professional health care settings and into the arms of patients. They have essentially the same numbers of hospitals, rural clinics and doctors per capita.
But in the race to put shots in arms, Michigan lost. Its vaccination rate lagged Minnesota’s, exacerbating a late-pandemic spike in cases that killed 2,500 people. The vaccination gap between Minnesota and Michigan was particularly high for older people.
An analysis of data from both states – the only two to provide detailed and comparable vaccine records in response to records requests from USA TODAY – reveals key reasons Minnesota moved faster.
Minnesota supercharged its health care system, dispersing doses to a wide network of doctor’s offices and hospitals across the state. Michigan, in an effort to equitably distribute vaccines to rich and poor alike, steered doses to public health departments that aimed to entice uninsured residents to mass vaccine events.
Not only did Michigan trail Minnesota’s overall vaccination rate through the end of March, it didn’t do any better at vaccinating Black and Latino residents.
Elizabeth Hertel, director of Michigan’s Department of Health and Human Services, defended the state’s approach when asked about its emphasis on local health departments over hospital systems and clinics.
The choice of who distributes the vaccine “was really a decision based on who is best equipped in certain regions to handle doing that,” she said, adding that in some rural areas of the Michigan “there isn’t a health system.”
“One of the things that we were trying to focus on was the ability to make sure that people had access, and going through the health systems may not have always been the most efficient way to do that,” Hertel said.
Hertel’s agency said separately, in a written statement, that local health departments “are well suited to reach minority and vulnerable populations.”
“We also recognize that these efforts to address equity sometimes do not yield the high numbers” other channels might, the statement said, “but we strongly believe this is an important strategy to address equity.”
To be sure, Minnesota had some advantages unrelated to how it handled the vaccine supply. It historically has had a higher percentage of residents who receive flu vaccines, and the typical Minnesota household earns more than Michigan’s. States pursued myriad vaccine strategies, and none got it perfect when it came to speedy or equitable distribution.
But decisions about where to channel vaccines in Michigan and Minnesota had important impacts, according to data and interviews with experts and health administrators. The states’ divergent experiences in the crucial early months of vaccination offer lessons about what worked and what didn’t.
Few people have studied the differences in state rollout strategies.
Dr. Kirsten Bibbins-Domingo, chair of the department of epidemiology and biostatistics at the University of California, San Francisco, recently examined Minnesota and California. She said Minnesota’s push to vaccinate people easily reached by the established clinical system left people of color behind. But so did Michigan’s approach.
Adriane Casalotti, with the National Association of County and City Health Officials
“Those communities weren’t going to be reached by mass vaccination sites,” Bibbins-Domingo said. “They’re not going to be reached by Walgreens and CVS.”
Inadequate funding for local health departments in Michigan and elsewhere made it hard for them to lead successful immunization campaigns, according to health care executives and public health officials.
Adriane Casalotti, chief of government and public affairs with the National Association of County and City Health Officials, said the enormous strain of the coronavirus on public health continued through the vaccination push this year.
“There was no money,” Casalotti said, “even though the shots were rolling out the door.”
Minnesota began to pull ahead of Michigan early, according to news reports at the time. By the end of February, a month after older adults had become eligible in both states, 39% of Michigan’s seniors had received at least one dose of a COVID-19 vaccine. In Minnesota, more than 50% of them had received at least one dose.
The gap widened by late March. About 79% of Minnesota adults 65 and older had at least one dose versus 65% in Michigan.
Delays in the pace of vaccinations in the early months of the rollout no doubt had an effect on hospitalizations and deaths later on, experts said.
“It does look like Michigan’s slower pace in vaccination in February was really crucial,” said Julie Swann, a professor at North Carolina State University who worked with the Centers for Disease Control and Prevention on the response to the H1N1 pandemic. “At least some of those people would have been protected.”
The fundamental difference in Minnesota’s approach was its reliance on hospitals, doctor’s offices and clinics.
USA TODAY obtained records from each state for every shot given from mid-December through late March, a crucial period of the vaccination effort. The states listed dates, provider organizations, manufacturer names and lot numbers with each record. The news organization’s analysis classified providers into three types: clinics, hospitals and doctor’s offices; pharmacies; and local health departments.
The data showed Minnesota health care facilities delivered 27 doses per 100 residents between December and March. Michigan hospitals and clinics administered just 14 doses per 100. (Records don’t indicate whether the dose was a person’s first or second.)
To hit the higher mark, Minnesota enlisted many more of its hospitals and clinics. The data show twice as many Minnesota health care locations gave at least one shot compared with Michigan — even though Michigan has a much larger health care system.
The numbers don’t surprise Dr. Bryan Jarabek, chief informatics officer at M Health Fairview in Minnesota.
Jarabek led a coalition of 10 health systems that coordinated COVID-19 vaccinations, including M Health Fairview, with 10 hospitals and 60 clinics of its own. At his first strategy meeting with the Minnesota Department of Health and Minnesota Gov. Tim Walz, Jarabek brought a map.
“All the hospitals in the state have clinics surrounding them,” said Jarabek. “The hospitals and clinics are positioned to take care of the whole state. We then showed that to the governor and MDH and said, ‘You can trust us. Give us the vaccines. We will get it to the places that need it.’”