Despite reports of technological problems, changes in distribution of supplies, and other logistical obstacles, some states have emerged as clear leaders in effective efforts to vaccinate Covid-19.

More than 31 million doses of Covid 19 vaccine have been distributed to U.S. states and other jurisdictions, but only 12.2 million – 39% – have actually been administered, according to the most recent data from the U.S. Centers for Disease Control and Prevention.

However, nine states managed to capture more than half of the doses received: North Dakota, West Virginia, South Dakota, Connecticut, Texas, Louisiana, Kentucky, Colorado and Montana, and Washington.

North Dakota and West Virginia lead the country with more than 65% of the scattered doses.

For comparison: Alabama and Georgia took only 23% of their doses, and five other states took no more than 30%.

When it comes to effective vaccination against Covid 19, there is no magic formula, said Claire Hannan, executive director of the Association of Immunization Managers.

In rapidly evolving states, strategic planning and communication, strong local partnerships, and national ownership of the process are important.

In South Dakota, conversations about the vaccination schedule began in August and have continued daily, Daniel Bucheli, director of communications for the state Department of Health, told CNN.

Panic-free preparation is the key, he said. Daily communication, with the opportunity for partners to provide feedback on what works and what doesn’t. The open lines of communication will continue to exist.

In Colorado, they also began work over the summer to create a unified system, bringing together hospital systems, emergency management systems, technology leaders and more for a statewide approach, Scott Bookman, incident commander for Covid-19 at the state health department, told CNN.

According to Bookman, all government vaccine suppliers must administer the doses received within 72 hours. Otherwise, the state will intervene and house the unused cans elsewhere.

He said you hear 72 hours in Colorado all the time. We moved the vaccine from one place to another. And we are now at a point where suppliers understand what we expect and how seriously we take it.

The key, he says, is to set expectations from the beginning and often with all stakeholders.

We have made it a top priority. We hope to succeed, save lives and get Colorado back on track.

In Colorado, virtually all long-term care facilities, including nursing homes and assisted living facilities, have participated in a federal program in partnership with CVS and Walgreens to provide vaccine doses to the highest priority population.

But across the country, the federal program has received mixed reviews, with some nursing home directors and other caregivers blaming the slow implementation of the program on poor logistics and bureaucracy.

Bookman said that while the program has not progressed as quickly as planned or hoped, Walgreens and CVS have been excellent partners in Colorado’s long-term care facilities, and the state has stepped in where needed to provide additional staff and technical assistance.

In the meantime, West Virginia has assumed full responsibility for administering the vaccine. Hannan of the Association of Immunization Managers attributes some of the success in West Virginia to the decision to drop the federal long-term care program.

The biggest thing we’ve done is go back to the standard (federal) program, West Virginia Governor Jim Justice told CNN.

More than 40 percent of West Virginia pharmacies are not connected, and the state wants to make existing relationships a priority, the governor said during a press briefing on the 16th. December.

Instead, we work with every pharmacy in West Virginia. We felt that if we had opted for the federal program, from the government’s standpoint it would have limited our ability to quickly distribute and administer the vaccine to people in need, he said.

West Virginia began vaccinating long-term care facilities a week earlier than the other states.

The state has also deviated from federal guidelines for which groups should get the vaccine first, emphasizing timeliness over specificity.

There’s a real sleeping giant that’s a problem, and that’s one thing: We, along with other states, are going to hide the inventory in such a way that it becomes unrecognizable because everyone is trying to develop a program for managing vaccines, Justice told CNN.

Tuesday, federal regulators urged states to put people 65 and older and those at higher health risk on the front lines. But West Virginia has already announced a vaccination program for the elderly – Operation S.O.W.: Save Our Wisdom – about a week before.

It should be noted that many of the states where vaccines are most effectively distributed are among the most rural states in the country.

Some argue that a smaller number of health systems serving a larger proportion of the population may play a role in success.

Hannan noted that in North Dakota, the state works closely with vendors to distribute needed supplies and reallocate them as needed. The same is true in South Dakota, where several large health systems cover a large portion of the population.

They have strong ties to service providers that cannot be duplicated in large states, she said.

Pending approval for the use of the Covid-19 vaccine in emergencies, Monument Health in South Dakota has begun creating databases of individuals under its care who can be treated proactively, said Dr. Shankar Kurra, vice president of medical affairs at CNN.

As one of the three largest healthcare providers in the state, Monument Health covers nearly half of the population, as evidenced by its charts and educational materials.

There are many reasons for this success, Curra said. The Ministry of Health and the way it communicated the date of availability of vaccines, the three state health systems greatly facilitate logistics, and the third factor is essential : Even with only three systems available, we have made it our mission to introduce doses within a week of receipt.

CNN’s Nadia Kunang contributed to this report.

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