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Supply versus demand: Which states reach their COVID-19 tipping points?



We recently assessed that the US was close to its “COVID-19 tipping point” – that is, the point where the vaccine supply may begin to exceed demand. We also noted that national averages can mask important differences by state. We therefore sought to understand where states fall along this spectrum; such differences are important for understanding how best to target efforts to increase vaccine coverage across the country.

To do this, we looked at the proportion of adults with at least one vaccine dose by condition, daily rates for the first doses administered (using a 7-day rolling average), and how this rate has changed in the last week (see methods). We were particularly interested in identifying conditions that may still have relatively low vaccine coverage (ie, less than 50% of adults 1

8 or older) combined with signs of a decrease in initial dose uptake, as these states may constitute the largest challenges in obtaining adequate vaccine coverage in the United States

From April 29, we find among the 50 states and DC that:

The proportion of adults who had received at least one vaccine dose was 55% overall and varied markedly across the country from a low level of 41% (Alabama) to a high level of 74% (New Hampshire). In addition, there are signs of a decline in the rate of new admissions in most states. The daily rate of administration of the first dose at national level is 451 per 100,000, ranging from 136 per. 100,000 (Mississippi) to 889 (Rhode Island). Most states (31 of 51) vaccinate below the national rate, reflecting the fact that vaccination rates are generally higher in larger states (e.g., California and Pennsylvania). Furthermore, the rate of first dose administration per 100,000 in the last week for the United States in general (-27%) and for almost all states (45 of 51) (see Table 1).

At the higher end of the vaccine coverage spectrum, more than 60% of the adult population has received at least one dose in 12 states. These states are primarily in the northeast (8 of 12). Seven have vaccination coverage of at least 65%, and all but 2 (New Hampshire and New Mexico) administer the first doses well above the US rate. Eight of the 12 states have seen declines in the first dose administration rate over the past week, suggesting that these states may be approaching or have reached demand saturation, albeit at relatively high vaccination coverage levels and administration rates.

At the lower end of the vaccine coverage spectrum, less than 50% of the adult population has received at least one dose in 13 states, including 6, which are below 45%. Nine of these states are in the south, and in total the daily rate of first vaccination is per. 100,000 below the national rate. In addition, most experience a decrease in the rate of the first doses administered. This suggests that these states may not only be approaching or reaching their tipping points, they may have done so at relatively low levels of vaccine coverage.

The rest of the states that fall between these two extremes are primarily in the Midwest and to a lesser extent South and West.. In about half of these conditions, between 55% and 60% of adults have received at least one dose. All except one experienced a decrease in the rate of the first doses administered in the last week.

States demonstrating a combination of low overall vaccination coverage along with slow and declining vaccine uptake raise major concerns. There are the 13 states with less than 50% coverage with at least one dose, all of which vaccinate their adult populations below the national rate. Twelve of these states also saw a decline in the rate at which they vaccinated adults over the past week. These include 3 states (Alabama, Louisiana and Mississippi) with vaccination coverage at or below 42%, the lowest in the country, each vaccinating with approx. half the total speed of the United States. These are the states that are potentially the greatest distance away from reaching adequate levels of vaccine coverage and may be at risk of future outbreaks if the level does not increase significantly.

Discussion

As with the United States in general, it appears that most states are at or near their COVID-19 tipping points – the point where their supply exceeds demand. While this may not be such a major concern for states that have already vaccinated large proportions (> 60%) of their adult populations with at least one dose, approx. one in four states has not yet reached 50%, which is far below coverage levels likely to be needed to reduce the risk of outbreaks going forward. In addition, the vaccination rate in these states is below the national rate. The fact that most of these states are also seeing declines in the rate of first dose administration suggests that they will be important targets for targeted efforts to generate increasing vaccine demand.

Methods
Vaccination data were obtained from the Johns Hopkins University Centers for Civic Impact, which collects state-level vaccination data from both the Centers for Disease Control and Prevention (CDC) and state COVID-19 dashboards. Adult population data (18 years and older) were obtained from the state population in 2019 according to characteristics from the US Census Bureau. We calculated both the 7-day rolling average of the first doses administered and the proportion of the adult population who received at least one dose for each state and the United States in general (excluding territories and doses administered through federal facilities to the total US calculations). We used these rolling averages to calculate the rate at which states and the United States administer the first doses per day. 100,000 adults. Weekly changes in the rates of the first doses were calculated using the percentage change from the current rate (April 29, 2021) to the rate from 7 days before. Finally, we categorized states by region using the U.S. Census Bureau Region and Division 2010 classifications.


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