Which states are doing the best job of vaccinating their people? That’s the most important question that should be on the minds of the Biden administration.

Job One for Joe Biden is dealing with the Covid pandemic that is still widespread in our nation. If he fails to get the pandemic under control, the rest of his agenda will be meaningless. Therefore, making sure vaccine is getting into the arms of most Americans must be his first priority.

Distribution has been following the federalism model, which allows states to make their own decisions after the federal government makes recommendations. The CDC initially recommended healthcare workers and nursing home residents receive the vaccine first. There was not much argument over that, but the next priority group began the bickering.

According to The Wall Street Journal, after six weeks since the first distribution of vaccines were shipped, the U.S. has administered some 53% of the distributed vaccines. The gap continues to grow between states that are getting shots into arms, and those arguing over who gets what and when.

North Dakota has administered some 84% of its supply as of January 23, and West Virginia about 83%. Compare that to states like California (45%) or Alabama (47%) and you see that federalism is showing what works and what doesn’t work. WSJ says President Biden is fortunate to inherit Operation Warp Speed. Biden says he’ll trigger the Defense Production Act to expand vaccine production, but doesn’t say how he’d build on the existing plan.

The most successful state rollouts have been those that departed from overly prescriptive federal rules. North Dakota stuck with the initial recommendations to vaccinate healthcare workers and nursing home residents, but then opened the program to anyone age 65 and up, as well as adults with underlying health risks. Florida did the same. This makes perfect sense since we should be vaccinating those at greatest risk first and age is the number one determinant of risk.

South Dakota added law enforcement and corrections staff to its initial tiers, and then moved quickly to inoculate 65 and older adults and school workers. The states with the highest per capita vaccination rates are all rule-breakers: (as of January 23)

• Alaska – 12,885 per 100,000
• West Virginia – 11,321 per 100,000
• North Dakota – 9,602 per 100,000

Compare those numbers with the states with the lowest vaccination rates:

• California – 5,568 per 100,000
• New York – 5,816 per 100,000

The best performing states also showed creativity about how best to distribute and administer the vaccines, even if that meant departing from federal advice. North Dakota began planning its vaccine rollout last summer and chose to distribute vaccine supplies to healthcare providers statewide – not only to hospitals or public health systems. West Virginia opted out of a federal program putting CVS and Walgreens in charge of vaccinating most nursing homes, which has proved especially slow. Instead, the state used a network of 250 local pharmacies, most of which had existing relationships with patients, which sped up scheduling and paperwork. It also used the National Guard to help deliver vaccines to the state’s long-term care facilities.

Federalism benefits most when using the “laboratories of democracy” in each state to learn valuable lessons about what works and what doesn’t. Those states with the poorest vaccination rates should pay attention to those most successful if they want to vaccinate their people faster and more efficiently.

In 1987, Joe Biden ran for president. As a 44-year-old Senator, he was considered an up and coming star of the Democratic party and one of seven hopefuls for president that year. As chairman of the Senate Judiciary Committee, he would preside over the confirmation hearings of Judge Robert Bork, a controversial conservative nominated to the Supreme Court. This would give him great visibility in the coming presidential election campaign and the political stars seemed to be aligning in his favor.

But a few days before those confirmation hearings began, a scandal erupted. Biden had made a speech in his presidential campaign at the Iowa State Fair. Investigative journalists pieced together footage of U. K. Labour Party leader Neil Kinnock giving a speech that Biden had clearly used for his Iowa speech without giving attribution to Kinnock. Other examples of Biden’s plagiarism were soon found and he had to drop out of the presidential campaign only three months after he began.

In the 2020 presidential election campaign, Biden came out with his plan to curb the spread of the Covid pandemic. It was so similar to President Trump’s plan, the Wall Street Journal editorial board stated, “The Democratic nominee is also promising a better virus strategy, which would be wonderful if he had one. But the virus plan he’s pushing is little different on the substance than what the Trump Administration is already doing.” (see Biden’s Covid Plan is Trump’s Plan)

Now that he is president, Joe Biden has just announced his plans to deal with the Covid pandemic. He has promised 100 million vaccinations in the next 100 days. According to The Wall Street Journal, the new strategy is focused partly on ramping up vaccinations and curbing the spread of the virus through mask wearing, testing data and treatments, and includes new executive orders and directives. One order directs agencies to use their authority, including the Defense Production Act, to meet shortfalls in supplies such as masks, while another establishes a pandemic testing board to expand testing supply and access. Another order requires masks in airports and in certain transportation such as many trains, ships, intercity buses and airplanes.

In the immortal words of Yogi Berra, “It’s deja vu, all over again!” This is just a repackaging of the Trump plan. His promise to produce 100 million vaccinations in the next 100 days is not much of a challenge. According to outgoing CDC Director Dr. Robert Redfield, the Trump administration has nearly reached a million vaccinations a day already. A Bloomberg compilation of state vaccination data confirms the rate of inoculations – which has been gradually accelerating since late December – averaged 912,497 per day during the final week of the Trump administration.

The real reason for the slower than predicted vaccination process is blue state governors who have refused to accept Trump administration recommendations. The rollout has been particularly slow in those states while state and local officials argue over vaccination priorities. Mask mandates may sound like a good idea, but it is doubtful they will make any significant difference since masks seem to be already required in all public spaces. The lower-than-usual flu infections this season have been attributed to the widespread use of masks around the world.

All the focus on lockdowns, masks, social distancing, hand washing, and other measures designed to ameliorate the spread of the virus will have much less impact than the vaccination of the population. The important thing to do now is get vaccinated; the sooner the better. Joe Biden wants to take credit for “stopping the pandemic”, but the real credit goes to those who made the vaccines available in record-breaking time.

The rollout of the Covid vaccines has failed to live up to expectations for a number of reasons. Disputes between state and federal officials, varying opinions on priorities, and insufficient supplies of vaccines are just a few of the excuses we’ve heard.

Politics, unfortunately, has only added to the confusion and the difficulties of getting vaccines in the arms of vulnerable Americans. Federalism gives states the freedom to make their own decisions about distribution of the vaccines and some states have clearly done a better job than others.

I am blessed to live in the state of Florida. We have a governor, Ron DeSantis, who has done a wonderful job of keeping our people safe while reopening our economy with safety guidelines. This has kept our virus infection numbers reasonable while maintaining our economy and our schools. He has also shown good judgment in the distribution of the vaccines.

The CDC recommended “Phase A” provide vaccine to healthcare workers and nursing home residents as the top priority. There was not much disagreement on this initial prioritization. Certainly, you should be sure your healthcare workers get vaccinated first, since they not only are at high risk but must provide the treatment others will need. Nursing homes have been the sites of over 40% of all Covid deaths, so they also must be a high priority.

The real trouble comes after that. Many states want to place “essential workers” ahead of the elderly who are not living in nursing homes and others who are at high risk. Teachers unions want teachers to get higher priority, restaurant associations want restaurant workers to get higher priority, police associations want police to get higher priority, and on and on. A system of simplification is needed, based on risk.

There is no question that risk is associated with age for this virus, all other factors considered. The older you are, the greater your risk. Paul E. Peterson, writing in The Wall Street Journal, says age must be the determining factor in prioritizing vaccinations.

Florida Governor DeSantis says more than 80% of Covid deaths in Florida are in persons over age 65. In Massachusetts the average age of death from the virus during roughly the first two weeks of December was 80. Over that short period, 420 octogenarians and older in the state died – a death rate of 143 per 100,000. The death rate for those between 70 and 80 was 33 per 100,000. For those between 60 and 70, the rate was less than 10 per 100,000. Rates for those in their prime working years – 30 to 50 – are only about 1 in 100,000.

Therefore, it is clear that age should be the number one determinant of vaccine eligibility. Not only does this prioritize by risk, but it also simplifies the eligibility documentation. By simply producing a driver’s license, people can be certified for vaccination. This is working well in Florida and should be adopted in all states.

This is not to suggest that others are not vulnerable. Many younger Americans are still at high risk due to immunocompromised conditions including cancer, obesity, diabetes, and chronic lung and heart conditions. They should also receive the vaccine as soon as possible.

Peterson says, “The need for simplicity and speed is similarly important. Shortening the pandemic by one month would save thousands of lives. This isn’t the right moment for deliberate selection among multiple claimants for protection. Keep it simple. Tempus fugit: Vaccinate the population before autumn leaves begin to fall.”