How Puerto Rico became the most vaccinated place in America

Taiwan responded to COVID-19 quickly, which helped keep cases low and avoid widespread shutdowns. The country had closely tracked its PPE stockpiles since the 2003 SARS outbreak, has a national health command center to coordinate responses, and uses a well-defined set of procedures to track and manage people under infectious risk or quarantine. Masks are required and provided to every citizen, inbound travelers were quickly regulated, and contact tracing and testing is widely used to prevent outbreaks. Citizens generally listen to authorities, though fines and other sanctions also encourage compliance.

Taiwan was among the first countries to respond to COVID-19 with decisive actions that contained the virus’ impact on the population. Its 2003 experience with the SARS virus provided an established infrastructure to focus on eliminating the virus rather than its mitigating spread. In-bound travel was quickly regulated, a centralized office coordinated responses across sectors, and clear communication campaigns limited disinformation. Officials temporarily authorized “intrusive data collection measures” to track, trace, and isolate infections and masks were required and made widely available.

Although Nebraska’s governor never ordered a statewide shutdown, shuns mandates, and the state’s vaccination rate is not high, the state has had an efficient and effective response to the COVID-19 pandemic. Nebraska has fared among the best in the country when it comes to health, economic, social, and educational factors. The success is due to a combination of solid pre-existing medical infrastructure, particularly in infectious disease, and efficient state government that allowed the state to function logistically without relying on the federal government.

The key to United Airlines successful vaccine mandate, even in areas that have low vaccination rates, was gradually phasing in the mandate after a year-long effort laying the groundwork. The airline worked with the union to set up vaccine clinics at its major hubs and offered incentives to employees who got vaccinated. Incentives, like extra pay or vacation days that declined over time until they expired, led the majority of employees to get vaccinated, and the mandate proved to be the final push that was needed.

Wayanad is the first district in Kerala to have vaccinated the entire adult population with at least one COVID-19 vaccine. Rather than waiting for people to make appointments, officials went door-to-door providing all adults with appointment times. The district’s efforts started early, setting up vaccine infrastructure and assigning people appointment dates by where they live. Rapid Response Teams conducted outreach and education efforts, particularly among tribal populations, and made sure people showed up at their appointment. Getting vaccinated with their neighbors also decreased vaccine hesitancy.

Dare County, a relatively isolated and rural coastal county in North Carolina, has the highest vaccination rate in the southern U.S. The successful vaccination campaign is due in part to an existing communication infrastructure that local governments and healthcare systems use to coordinate during hurricane emergencies. Existing communication channels and relationships made it easier to publicize mass vaccination sites and get people to register online. Officials also went to great lengths to get more vaccines, petitioning the state for extra doses and even driving to other counties to pick up surpluses.

When a smallpox outbreak was deemed to be a likelihood in New York City in 1947, the city’s health commissioner rapidly launched a vaccination campaign that leveraged internal collaboration, consistent and transparent communication, and contact tracing. The effort culminated in more than six million people receiving vaccination in under a month, and only 12 infections and two deaths total. While this "public health triumph" hold lessons for the current COVID-19 pandemic, experts caution, “It’s almost inconceivable that we’re going to be able to do something similar as rapidly and as effectively.”

Many countries in Africa have been able to contain the spread of COVID-19 due to lessons learned from fighting the Ebola epidemic. Although not all African countries have implemented successful strategies, those that have seen success credit strong government leadership, community compliance, and a physically healthy population.

As the United States looks toward reopening, some states are preparing by directing resources toward contact tracing strategies, which is not a new protocol for controlling communicable disease and has shown success in other countries during the coronavirus pandemic. Although the practice does not come without limitations, in Montana, the public health departments have still hired and retrained staff dedicated to this practice to be better prepared in case of a resurgence.

In Taiwan, a combination of "early intervention and a well-oiled command structure" have helped to mitigate the spread of the coronavirus. Measures such a public health hotline, temperature check points, enhanced hygiene protocols, integrated databases, and a diversion of funds and military personnel towards making protective masks, all worked together to slow the spread and offer lessons to the countries still fighting an increasing caseload.