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'We crushed it': How did West Virginia become a national leader in Covid vaccination?

West Virginia, a small, rural state with an older population, was expected to struggle with Covid and any vaccine rollout. Things turned out differently.
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BUNKER HILL, W.Va. — Since December, Ken Reed and his wife Tally, the owners of a small chain of pharmacies in the eastern part of this state, have been waking at dawn to travel to rural counties to vaccinate as many long-term care residents as possible.

The Reeds say their familiarity with the people in counties like Jefferson, Berkeley, Morgan, and Pendleton makes all the difference in gaining their trust.

“These are your neighbors, your friends, your friend's parents, and you just treat them like you'd want to be treated,” Ken Reed said.

West Virginia, a small and mostly rural state with a large elderly population, was tagged early on as a place likely to struggle with Covid-19 and any vaccine rollout.

But the state is now being hailed as a vaccination success story, with 85 percent of its delivered doses already used, according to data from the Centers for Disease Control and Prevention, putting it second in the country behind North Dakota as of last week.

A key part of the strategy, health officials say, was the decision not to activate a federal partnership with the CVS and Walgreens pharmacy chains and instead rely on independent drugstores like those owned by the Reeds.

Image: Ken and Tally Reed
Ken and Tally Reed go through paperwork and vaccine data at their kitchen table.NBC News

“We are a scrappy state that's resilient,” said Dr. Clay Marsh, West Virginia's coronavirus czar and vice president and executive dean of health services at West Virginia University.

“But we absolutely rely on the creativity and the innovation of all of our people. Because we don't want to rely on external resource requirements for us to be able to do what we need to do.”

West Virginia's early success is all the more striking given that a study published by the Kaiser Family Foundation in April 2020 ranked it as the state with the greatest share of adults at risk of serious illness if infected with Covid.

In an Appalachian state known for country roads, mountains and a dying coal industry, the population has long suffered from high rates of co-morbidities, including smoking and chronic conditions that drive its low overall health ranking.

But the state's unique characteristics have in many ways aided its Covid-19 response.

The relatively small and homogenous population has contributed to its success, said Dr. Gabor Kelen, director of the Department of Emergency Medicine at Johns Hopkins University in Baltimore. And the state actually outperforms the nation in some aspects of health care, including access to primary care physicians and percentage of insured patients. Only 6 percent are uninsured, compared to 9 percent nationally, according to U.S. Census Bureau statistics.

“Access to primary care physicians for the population at least allows people to have trust … in the public health system,” said Kelen.

Much of that population lives more than a 45-minute drive from any outlet of the pharmacy chains that dominate most other states. Health officials say that leaves local independent pharmacists, like the Reeds, best situated to provide operational and medical expertise.

Ken Reed said there was no red tape involved in joining the state's vaccination effort when he got a call from a health official.

“Because we're the boss,” he said, as he and wife Tally laughed. “There is no middle management. … She asked if we could do it, and there was no decision-making chain. She hit the top of the decision-making chain.”

West Virginia was actually ahead of much of the nation in its Covid-19 response from the start of the pandemic, due to careful planning and its closeknit, small-town culture. A serendipitous encounter at a football game gave the state an edge in Covid-19 testing last spring, they said.

Two months before the White House required testing of all nursing home residents in mid-May, West Virginia was already negotiating with an executive of Labcorp, a national chain of blood and medical test sites.

Dr. Marsh, the state Covid-19 czar, had met the executive, a West Virginia University graduate, at a college football game in Morgantown. Marsh got in touch and the two men were soon hatching a plan for state-wide testing, which they rolled out on March 5. Their public-private partnership tested all 28,000 of West Virginia's nursing home residents in just two weeks.

The state also created a “team of teams," leveraging the National Guard early on to come up with and run an operations command center that focused on inter-agency communications and work with the Department of Health and Human Resources, the governor's office, and the state's health officers.

Image: WVU pharmacy student Ashton Prusia and Richard Thomas on Jan. 27, 2021.
WVU pharmacy student Ashton Prusia, left, talks with Richard Thomas as she prepares to administer his second vaccine, on Jan. 27, 2021.Jennifer Shephard / WVU

The National Guard has been involved with the state's response since November, running distribution from the state's five hubs. That includes logistical support for the receipt and transport of vaccines, helping to repackage vials and appropriate refrigerated containers to sites where stability can be maintained.

Through a partnership with another company, Everbridge, the consortium has now created a pre-registry system so that each person can be assigned a place in line and notified when and where they can be vaccinated. In the first four days after launching the system, Marsh says over 100,000 people signed up.

After initially experimenting with first come, first served clinics unsuccessfully, he says it was trial and error that led his team to the registry platform. Without the ability to predict the precise dose allotments it will receive each week, it was a challenge to meet demand, something the pre-registry system is now intended to address.

According to the CDC, as of Saturday West Virginia had given out more second doses per capita than any other state, with more than 3 percent of the population fully vaccinated.

Or, as Ken Reed puts it, “We crushed it.”

The Reeds spend their nights and early mornings plowing through the paperwork on their kitchen table and inputting data so the state can track the doses it has administered. Ken says he's also taken to dispelling misinformation about the vaccine — what he calls “garbage" — on social media.

Image: Ken and Tally Reed
Ken and Tally Reed.Courtesy Ken and Tally Reed

In line with the state's progress, the Reeds finished administering their share of second doses at long-term care centers last week and are set to take up work at schools.

“There's nothing like being able to help your neighbor,” said Tally.

As case rates have started to decline across the country, and are down about 35 percent in West Virginia as of last week, according to CDC data, Marsh points to the vaccine rollout.

“We've seen a great diminution of the rate of transmission, hospitalizations, ICU hospitalizations, ventilator use … I'm ascribing that to the vaccine," Marsh said, adding that it's too early to take a victory lap.

Supply remains the critical issue. Marsh's team says it's currently positioned to vaccinate as many as 23,600 people each week and has the ability to scale up to 100,000, but not the necessary supply of vaccines.

“We need more,” he said. While allotment is currently based on population, conversations with the federal government have led to the promise of additional doses of the Moderna vaccine. “We are very optimistic. But right now the supply chain doesn't seem to be able to fulfill the opportunity.”

West Virginia's remotest rural communities also remain a challenge. About 40 percent of residents don't have access to broadband internet, in part because of topography that makes connectivity a challenge.

To address that, Marsh's team is creating mobile vaccination vans and engaging with local health departments and faith-based organizations with a special focus on vulnerable groups and communities of color.

“When it comes to an opportunity to come together, to help each other, to lift each other, that's what West Virginia does best,” Marsh said. “And we're seeing that now.”

For a native West Virginian like Marsh, success in the face of so much adversity has also meant burnishing the image of his state.

“Right now we're changing the narrative externally,” he said. “And we're not doing it to do that. But that's a really, really great side effect.”

Lisa Cavazuti reported from New York.