Smaller, redder states have been more successful than media coverage would suggest. Look at the rankings for Covid-19 vaccine doses given and you’ll see West Virginia, Alaska, North and South Dakota, and Utah ranking high. These states benefit from having fewer people to vaccinate—and only a few large health systems operate in North and South Dakota, allowing for easier logistics and nimbler vaccination plans— but they aren’t without geographical difficulties. Yet many of their governors have been pilloried in the press. South Dakota governor Kristi Noem, a common target, began planning her state’s vaccine rollout in mid-summer, well before the federal government gave its own guidance. Noem’s team held daily coordination meetings with local partners, who, in turn, led the distribution and shared lessons learned along the way.

The success of heartland states compares favorably with the performance of New York and California. A large hospital system or pharmacy network is by itself no guarantee of success in public health, as NYC Health + Hospitals likely knows. Meantime, California—whose governor, Gavin Newsom, was celebrated as “#PresidentNewsom” on Twitter last April—has consistently lagged the nation in vaccinations, at one point ranking dead last. In early January, Newsom promised 1 million doses in ten days; two weeks later, the governor acknowledged that he had no idea if the state had met its goal. “High-tech California can’t seem to efficiently administer the vaccine at scale,” summarized NPR. The Golden State had prided itself on stringent lockdowns and mask mandates, yet it experienced a winter surge on the way to becoming the first state to surpass 3 million cases. Things got so bad in January that Southern California’s air regulator suspended cremation limits to deal with the backlog of bodies from Covid-19.