As frustration spreads over the slow pace of vaccination for Covid-19, it is instructive to compare two states. One has the highest median household income of any state in the country—the other, the second lowest. One has the second lowest poverty rate, 8.2%, while the other’s is one of the highest at 17.6%. In one, about 40% of the adult population has a BA degree or more; in the other, about 20%.

Now compare their performance in administering COVID-19 vaccines to their populations. One ranks 2nd in the share of its population that has been inoculated and has turned 83% of the doses received from the federal government into actual inoculations. The other ranks 35th for its inoculation rate and has delivered only 46% of doses received into its people’s arms, well below the national average of 53%.

Here’s the surprise: the wealthy and highly educated state—Maryland—is the one that has done a substandard job of delivering inoculations, while the poor and less educated state—West Virginia—is among the nation’s leaders.

At this early stage, two key factors have emerged as explanations for this implementation gap. First, West Virginia was the only state in the country to opt out of the vaccine distribution partnership between the federal government and two national pharmacy chains—CVS and Walmart—for vaccinating residents at nursing homes and other long-term care facilities. Instead, the state relied on a network of nearly 250 independent pharmacies.

Read the full article about success in distributing COVID-19 vaccinations by William A. Galston at Brookings.