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Texas ranks 47th among U.S. states in vaccine distribution, so why isn't the state getting its fair share?

Healthcare workers receive the Moderna COVID-19 vaccine at a vaccine drive on Jan 14. (Jordan Vonderhaar)

When Operation Warp Speed officials announced back in November that they would allocate COVID-19 vaccines to states based on their adult population, it seemed to bode well for Texas, the second most populous state in the country. More than two months into the rollout, however, Texas finds itself almost dead last in terms of the number of vaccine doses it has received from the federal government on a per capita basis.

As of Monday, the state of Texas had received 4,402,275 doses of the COVID-19 vaccine, according to the Centers for Disease Control and Prevention. This evens out to 15,182 doses per 100,000 people, leaving Texas in 47th place nationally. This marks a slight improvement from a few weeks ago when Texas ranked 48th in the country.

On average, states have received 17,839 doses per capita, according to the CDC data. If Texas had received vaccine doses at this rate, the state would have an additional 647,325 doses to administer—enough to provide initial shots to an additional 14% of the residents in the top two priority groups, according to Ariadne Lab's Vaccine Allocation Planner.

"We're very much aware of it," Texas Department of State Health Services Director of Media Relations Chris Van Deusen told Austonia. The agency has been in touch with federal officials, who said state allocations are based on adult population numbers. "It's something we're still looking into," he added. "We want to make sure that Texas is getting the numbers that it should be."

A closer look

Alaska leads the pack, with 33,969 doses delivered per capita, CDC data shows. This is largely thanks to additional allocations made by the Department of Veterans Affairs and the Indian Health Service. As a result, the state has received enough doses to vaccinate more than twice as many people on a per capita basis as Texas.

Other factors contribute to discrepancies between states, including unpredictable weekly shipments and last-minute adjustments to their allocations, as reported by ProPublica. Texas officials are not the only ones who have taken notice: Nevada's COVID-19 response director recently met with CDC and FEMA officials to discuss the state's allocation, and Utah's health department director suggested his state was being shortchanged because it is the youngest state in the nation.

This chart shows per capita vaccine allocations for 20 states: the 10 that have received the most (Alaska through Rhode Island) and the 10 that received the fewest (Wisconsin through South Carolina).

Former Houston mayoral candidate and blogger Bill King wrote that Texas was getting shortchanged as part of the federal vaccine rollout on his blog last month. "I kind of became a little obsessed with (COVID data)" he told Austonia. When he realized Texas ranked so low in terms of per capita vaccine allocation, he reached out to some of Texas' congressional representatives. "The only person I got to pay attention to it was (U.S. Rep. Dan) Crenshaw's office," he said.

Even if the federal government changes its distribution strategy to rightsize Texas' share, it wouldn't necessarily account for this deficit. "It's not an inconsequential number," King said.

Underserved but overperforming

Although Texas has received fewer doses of the COVID-19 vaccines on per capita than most other states, it is administering those doses fairly quickly. As of Monday, Texas had administered 75% of its allocated doses—more than 30 other states and the national average, according to the CDC data.

Recent changes to the state's rollout plan have addressed some concerns. After Texas House Democrats urged Gov. Greg Abbott to address constituents' "growing confusion and frustration" around how to access vaccines last month, he announced a shift to large-scale hub providers.

With this change, Austin Public Health was designated a hub provider and debuted a pre-registration waitlist. It remains deeply oversubscribed, with more than half a million people signed up, but is open to anyone who is eligible under the state's priority guidelines. Before the creation of such hubs, some smaller providers were only offering appointments to existing patients or did not have a waitlist at all, leaving eligible residents feeling shut out.

These improvements, however, do not address the scarcity of vaccine doses allocated to the state overall. "It's just never going to be enough right now," National Association of County and City Health Officials CEO Lori Tremmel Freeman told Austonia.

New governance

Under the Biden administration, the vaccine distribution process remains largely the same. But there have been some "subtle" shifts, Freeman said, including a 5% increase in the weekly allocation to states thanks to increased production by Pfizer and Moderna, direct shipments to pharmacies and improved communication with state and local health departments.

The president has also promised to give states firmed up weekly allocation numbers three weeks in advance to allow for better on-the-ground planning. APH and other local providers typically learn of their weekly allocations a couple days in advance, a department spokesperson told Austonia.

But challenges remain, including concerns about equity, lag times in second dose shipments and new virus variants.

"The longer view we can have as to vaccine supply, the better the distribution and administration of vaccines will be," Freeman said.


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