Why? A common problem seems to be a focus on process rather than on getting shots into arms. Some progressive leaders are effectively sacrificing efficiency for what they consider to be equity.

The European Union has taken a ponderous, risk-averse approach that tries to avoid upsetting its member countries, Kauffmann points out. Similarly, many U.S. states have delegated decisions to local health officials and have suffered from “confusion and competition among localities,” William Galston of the Brookings Institution has written. State leaders in Alaska and West Virginia have taken a more top-down approach, Elaine Povich of Stateline has reported.

Some blue states have also created intricate rules about who qualifies for a vaccine and then made a big effort to keep anybody else from getting a shot. These complicated rules have slowed vaccination in both California and New York.

“Across New York State,” my colleague Dana Rubinstein has written, medical providers have had “to throw out precious vaccine doses because of difficulties finding patients who matched precisely with the state’s strict vaccination guidelines — and the steep penalties they would face had they made a mistake.”