How Manitoba's southern neighbour is among the leaders in the U.S. COVID-19 vaccine rollout

North Dakota has gone from a hotbed of COVID-19 early in the pandemic to a leader in the campaign to get people vaccinated.

How have they done it — and how can Manitoba learn from its neighbour to the south?

Just a few months ago, coronavirus cases were skyrocketing in North Dakota, which shares the international border with Manitoba. Hospitals were filling up and physicians and nurses were travelling around North Dakota, helping out where needed most.

"I'd never seen anything like it," said Dr. Doug Griffin, the chief medical officer at Sanford Health in Fargo, N.D., one of four large health systems in the state. 

"We got just really very overwhelmed in the state."

A vaccine tracker compiled by the New York Times has North Dakota ranked sixth among U.S. states for the number of people fully vaccinated.

In fact, 20 per cent of North Dakotans had received one dose, while 10 per cent of the population had gotten both doses as of Wednesday.

Across the border, just 2.5 per cent of Manitobans are fully vaccinated against COVID-19.

Top public health officials in the state credit early preparation, collaboration with groups in different parts of the state and broad eligibility for vaccines for their success.

Molly Howell, the state's immunization director, brought all stakeholders together to plan for the rollout in August — months before any vaccines were approved in the U.S.

At that point, the state recognized that a central distribution facility, ultra-cold freezers and couriers were needed to store and distribute the vaccine.

It also partnered with health regions and pharmacies early on to ensure they were equipped to administer doses.

"We wanted to make sure vaccine was available to the public close to where they live, so they weren't having to travel long distances to be vaccinated. We wanted it as convenient as possible," Howell said.

Flexible system

Unlike Manitoba, which is vaccinating its oldest residents first and rolling it back by one-year increments, North Dakota is vaccinating members of the public of a certain age, plus those who have certain co-morbidities and risk factors because of their jobs.

In its current phase, North Dakotans who are 75 or older have first priority, followed by people age 65 to 74 with two or more underlying conditions, then people age 65 to 74 with one or more underlying conditions, then people age 65 to 74 without any underlying conditions.

For the most part, people are vaccinated by priority level, but it isn't always that rigid, Howell said.

"You can't be super strict with priority groups and wait until everyone's vaccinated in that priority group until you move on to the next," she said. 

"You don't want to wait for everyone in that priority group to get vaccinated before you move on, because that could mean vaccine sitting in the refrigerator instead of going into arms." 

North Dakota also has the advantage of being a small state that's dominated by four large health systems, said Dr. Paul Carson, a professor in the department of public health at the state university.

"We didn't have to deal with hundreds of different clinics, hospitals or systems," he said.

Vaccine hesitancy biggest problem

The vaccine rollout hasn't been completely smooth in North Dakota.

Officials realized shortly after they started immunizing older members of the general public that finding information to book an appointment was difficult for less tech-savvy people.

To address the issue, an appointment hotline was set up.

There's also the issue of vaccine hesitancy because of misinformation circulating online. Dr. Griffin hopes that will abate as the vaccine campaign continues.

"I think as you get more and more people vaccinated, it just adds to the information we have about the vaccine, about its safety and efficacy," he said.

"I am optimistic that people that were kind of waiting until there was more information, or more people received it, will become more comfortable receiving it."

Another hurdle is the newly approved Johnson & Johnson vaccine, Howell said.

In a global trial, the Johnson & Johnson vaccine was found to be 66 per cent effective at staving off moderate to severe illness and 85 per cent effective at preventing the most serious outcomes. Some people don't want that vaccine because its results don't seem as good as other vaccines.

Although the efficacy is slightly worse than the Moderna and Pfizer-BioNTech vaccines, it's more effective against variants of concern, Howell said.

"I think it's mostly communicating the efficacy and that you can't compare. There hasn't been a head-to-head trial between the vaccines."

Comparing Manitoba

Manitoba's vaccine campaign has been slower to get off the ground than North Dakota's due to ongoing shipping delays for both the Moderna and Pfizer-BioNTech vaccines, public health officials have said.

Even so, Jason Kindrachuk, an assistant professor and Canada Research Chair in the department of medical microbiology and infectious diseases at the University of Manitoba, thinks lessons can be learned from North Dakota.

For one, the state government is very clear about who's getting vaccinated when, breaking down different front-line groups, including teachers, grocery store workers and even IT workers who can't work at home.

"[Manitoba doesn't] provide a lot of information for high-risk or higher risk groups in the general public, and that's where … North Dakota provides quite a bit of context for people who have maybe been somewhat forgotten," he said.

"People in the public are wondering when they're going to get vaccinated, and beyond the obvious cohorts … what does it look like for the rest of the population?"

The province has faced some challenges in terms of distribution to rural and remote communities, but has done well so far, Kindrachuk said.

He's optimistic the newly approved AstraZeneca-Oxford vaccine, which can be administered by pharmacists and family doctors, will be more accessible to Manitobans and help the province keep pace with our neighbour to the south.