'Not a one-size-fits-all approach': Washington ranks 17th for share of people vaccinated

Nurse Jaime Navetta gives the Pfizer Covid-19 vaccine to Tianji Yu during opening day of the Community Vaccination Site, a collaboration between the City of Seattle, First & Goal Inc., and Swedish Health Services at the Lumen Field Event Center in Seattle, Washington on March 13, 2021.
JASON REDMOND/AFP via Getty Images

When it comes to getting at least one COVID-19 vaccine dose, Washington is outpacing most of the country -- but it's still trailing behind 16 other states.

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According to data from the Centers for Disease Control and Prevention, the state took the 17th spot out of all the states across the country and Washington, D.C. based on the percentage of people who have received at least one dose of the COVID-19 vaccine.

The most recent data shows about 49.1% of the total population in Washington has had at least one vaccine dose. Among people 18 years and older, 61.9% have had at least one vaccine dose. That means a slight majority of people in total in the state have not yet received a dose of the vaccine, meaning the virus still has opportunities to spread.

Vermont ranked at the top of the list, with about 60% of its population having received at least one vaccine dose. It was followed by Massachusetts, Hawaii and New Hampshire, which all reported between 57% and 60% of people in the state had received at least one vaccine dose.

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On the bottom of the list was Mississippi, with less than one-third of people in the state having received at least one vaccine dose. Louisiana, Alabama and Wyoming all also landed spots in the bottom five.

So, why is Washington toward the middle of the pack instead of the front -- and what comes next?

Officials from the Department of Health said they have been working for months to get the vaccine out to people who need it and to make it as easy as possible for everyone to get vaccinated. But they did not expand on why Washington might be behind so many other states.

"While we can’t speak for any other states, Washington is working hard daily to get vaccine to all our communities across the state," a spokesperson for the department said in an email.

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As of April 28, the most recent date the state has complete data for, the state has administered an average of about 64,500 doses per day. In the days before, the state has reached upwards of 80,000 doses in one day. Of the eligible population 16 and older, more than 55% have received at least one dose and about 40.5% are fully vaccinated.

"We are now reaching groups that take a bit more time to get vaccinated, and this could be for a variety of reasons because we know this is not a one-size-fits-all approach," DOH said. "We are working to get vaccine to places where people typically are, such as walk-in appointments at pharmacies, or at people’s regular healthcare provider offices. We are also working to expand community pop-up clinics, including at events where mobile teams can offer vaccine."

Officials for months have been encouraging everyone to get the vaccine as soon as they could. But during that time, the state has struggled with a limited vaccine supply, meaning people have had to vie for the few open appointments and, at times, wait days or weeks to find a slot that worked for them.

According to data from the CDC, Washington has received about 104,302 vaccine doses per 100,000 people. That puts it in the 15th spot among all states across the country and D.C. in terms of the number of vaccine doses delivered per 100,000 -- similar to its ranking for the percent of people who have received at least one dose. It ranked a bit lower -- the 21st spot -- for the number of doses administered per 100,000 people though. According to the data, the state has administered about 82,000 doses per 100,000 people in Washington.

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But, according to the Department of Health, supply no longer appears to be the challenge it was.

"While supply was a roadblock in the past, this week vaccine supply officially caught up with demand for the first time," a spokesperson for DOH said.

Washington also opened up eligibility to all adults 16 and older later than many other states. Some states, such as Texas, Idaho and Connecticut, allowed anyone to get the vaccine at the end of March or earlier in April. In Washington, every adult became eligible on April 15.

The state, instead, prioritized those who were most vulnerable to getting the virus, including adults 65 and older -- a reflection of what state officials said was an equitable approach to the vaccine rollout. According to the CDC data, Washington ranked 10th based on the percentage of people 65 and older who have been fully vaccinated, with about 78.5% of older adults fully protected.

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Concerns about softening demand

Even as providers in Washington continue to work to vaccinate as many people as possible, state health officials said last week week they had some concerns over waning demand for the vaccine.

"We're so close, but we need everybody's help and we are concerned about what looks like some slowdown in vaccination rates and numbers," said Michele Roberts, who leads the COVID-19 vaccine planning and distribution team at the Department of Health. "So if you haven't been vaccinated yet, what are you waiting for?"

In recent days, there have been thousands of open appointments at Seattle and King County vaccine clinics. Officials have moved to allow people to go to several sites and get the shots without an appointment to make it even easier for people looking for slots. Safeway and Albertsons pharmacies, along with CVS stores, are also now accepting walk-ins to get the vaccine in Washington. Different services are providing transportation and the Department of Health has been working to get out accurate and timely information about the safety and efficacy of vaccines.

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People can even get a vaccine at a Mariners or Sounders home game, no appointment needed.

People who have questions about getting vaccinated can contact their healthcare providers or the Department of Health website. For people looking for where they can get their vaccines, they can text GETVAX with their zip code to see vaccine clinics. People can also call 833-VAX-HELP.

What has changed since demand was far outweighing supply?

Up until now, people who were enthusiastic about seeking out the vaccine were the ones vying for the limited number of appointments. But now, the state appears to have moved forward.

Dr. Leo Morales, professor and chief diversity officer at the University of Washington School of Medicine, described it as a spectrum, saying it might not just be an issue of vaccine hesitancy, but also of convenience. On one side of the spectrum are those people who were really excited about getting the vaccine, willing to drive far distances to get the shot as soon as they could. On the other side are those who have decided against getting the vaccine and little will change their minds.

In the middle though, are those who aren't necessarily as enthusiastic, but are willing to get the vaccine if they find easy access. Then, the spectrum moves to people who are more indifferent, who have some concerns and might need some more persuasion, to people who are more reluctant and have some more deep-seeded concerns.

"I think what we've done is move from vaccinating the enthusiastic to these other groups," Morales said. "The approach to each of these groups is going to be a little different. I think what we're at now is really needing to make vaccines very convenient."

That means working within communities, through churches, community-based organizations and other services to reach people where they are, including those who may not know how to make appointments or be willing to travel, along with people who face language or transportation barriers.

"We can't just expect people to come to our institutions," Morales said.

As demand slows, though, that makes it that much harder for the state to reach a higher threshold of people vaccinated that will in turn help stop the spread of the virus and keep the entire community safe.

"The closer we get to that goal the harder it's going to be," Morales said. "I think we have a ways to go in making that vaccine more accessible."

Officials have been using a number of methods to reach out to the community, but spreading accurate information is essential. Morales said it's important to continue to give people accurate information about the safety and efficacy of vaccines, the rationale behind taking the vaccine and how vaccinations will help the state to open up and allow people to return to a more normal life.

Even younger people who might not be worried about getting seriously ill from the virus could experience long-haul symptoms, which include fatigue, trouble breathing and anxiety. And people who get vaccinated can help protect their relatives and friends, along with themselves.

"The more people we vaccinate, the better," he said. "The more people we vaccinate, the more we suppress the virus and it becomes safer for everyone."

Issues of equity remain

In south King County, a smaller percentage of people 16 and older have received at least one vaccine dose when compared to communities in north King County and east King County.

The most recent data shows in Auburn, Kent and Federal Way, 54.7% of people 16 and older have received at least one vaccine dose. In Bellevue, Issaquah and Mercer Island, about 75% of eligible residents have gotten at least one shot. In East King County and north Seattle and Shoreline, more than 71% have received at least one dose. about On Vashon Island, nearly 80% have had a vaccine dose.

Health officials have since the start said they were working to eliminate those issues of equity that were present throughout the pandemic. South King County saw higher rates of COVID-19 infections and hospitalizations than did other areas of the county over the past year. Officials set up mass vaccination sites in Kent and Auburn and have been doing popup clinics and sending out mobile teams to reach harder to reach communities.

The equity gap has been closing among older adults, but it's still present -- and more clear among all eligible adults 16 and older.

It could be due to a number of reasons, including essential workers not being able to take time away from work and the spread of misinformation.

"Until we suppress the virus in south King County, we're all going to be vulnerable," Morales said. "We just need to really saturate south King County with resources and opportunities for vaccines."

How will things change moving forward?

Going forward, the White House also said it would be making a change in the way it allocates vaccine doses to states, which could allow states with higher demand to get more vaccine.

The Washington State Department of Health also said it would be moving to a need-based approach to allocate the doses it receives. Previously, the department used an approach based on the population in a county.

Lacy Fehrenbach, deputy secretary of the COVID-19 response, said in a statement last week the pro-rata model worked for the beginning of the state's rollout, but the state needed to change its approach "in support of our goals to vaccinate more Washingtonians as equitably, quickly, and efficiently as possible."

"Vaccine continues to be the most critical tool we have to end the pandemic," Roberts said. "The allocation change will help ensure vaccine continues to reach all communities across the state, while also focusing on areas where it has been more difficult for people to find open appointments."