A national leader in vaccine rollout, North Dakota looks to tackle 'vaccine hesitancy' in upcoming phases

"100%, the biggest hurdle is going to be vaccine hesitancy," the director of North Dakota's immunization program said on Wednesday.

OhioHealth Director of Infectious Diseases Joseph Gastaldo gives Dr. Simrit Bhullar, a pulmonary and critical care physician, a COVID-19 vaccination at OhioHealth Riverside Methodist Hospital in Columbus on Wednesday, Dec. 16, 2020. Adam Cairns / Columbus Dispatch / TNS
We are part of The Trust Project.

BISMARCK — With a third COVID-19 vaccine newly authorized for emergency use, the director of North Dakota's rollout said skepticism and uncertainty about the safety of the vaccines will present the biggest challenge to the state as it moves closer to immunizing the general public.

"One hundred percent, the biggest hurdle is going to be vaccine hesitancy," said Immunization Program Director Molly Howell at a press conference on Wednesday, March 3. "I think it's just going to take a bit of time for some people to make that decision to get vaccinated, but we just have a lot of work correcting misinformation that's out there."

North Dakota has been among the top states in the country in the distribution of its vaccines so far, with more than 10% of the state fully vaccinated. The addition of Johnson & Johnson's new single dose vaccine is expected to boost the immunization effort already underway with Pfizer and Moderna's products.

Howell said the state will have to find ways to address the possibility for slower uptake as the vaccination process opens up to broader swaths of the population. She cited one Centers for Disease Control and Prevention study which found fewer than 50% of the unvaccinated adults in North Dakota said they plan to get vaccinated. This week, Howell noted, the health department is mailing out informational letters to 62,000 North Dakota residents over the age of 65 who haven't received a dose of the vaccine yet.

An initial allocation of 6,300 doses of the Johnson & Johnson vaccine is set to arrive in North Dakota on Friday, according to the Department of Health, with the bulk of the new vaccine being spread to pharmacies in every county to ensure wide availability of the single-dose vaccine.


The Johnson & Johnson product comes with a few differences from the Pfizer and Moderna vaccines already being administered. The new vaccine is single-dose, meaning it doesn't require a booster shot several weeks after the initial shot. Its vials can also last up to three months in refrigerated storage, making it logistically easier to distribute than the previously approved vaccines that spoil without ultra-cold or freezer storage.

In clinical trials, the new vaccine showed an 85% efficacy at preventing severe outbreaks of COVID-19 and 100% effectiveness at preventing death. Its success at preventing milder cases of the virus is somewhat lower, at 65%. Howell said Wednesday that the health department considers the Johnson & Johnson vaccine equal to the Pfizer and Moderna products and stressed that residents should get whichever vaccine they can.

"I just want to stress that the best vaccine you can get is the first vaccine available to you," she said.

Most of North Dakota's vaccine providers have moved to the second phase of the immunization process, known as Phase 1B, with some providers advancing to Phase 1C this week, according to a health department update on Tuesday. This third stage targets essential workers and anyone older than 16 with a high risk of severe health effects from COVID-19.

Howell said the differing rates of administration between providers around the state may be partially due to a difference in urban and rural demand. Vaccine hesitancy may be higher in rural areas, she noted, but she also said that the disparity could be driven by rural residents getting vaccinated at health care hubs in cities.

As different parts of the state progress at different paces, Howell said, the health department will adjust the amount of vaccine it sends to providers accordingly.

With the addition of the Johnson & Johnson product, President Joe Biden announced Tuesday that the country is on track to have enough vaccine for all adults who want it by the end of May. Should the federal government ramp up its vaccine supply, Howell said, North Dakota still has room to scale up its rollout.

A health department survey of vaccine providers found North Dakota can currently administer up to 60,000 doses a week, and Howell said the state could activate the National Guard or request FEMA assistance if it needs more support.


Readers can reach Forum reporter Adam Willis, a Report for America corps member, at

What to read next
A North Dakota Department of Transportation employee was seriously hurt last week when he was hit by a car while repairing a cable median barrier.
Review by North Dakota's assistant Attorney General found no wrongdoing
Christopher Thompson is accused of driving under the influence when he crashed into a tree last month. The crash killed Red River Valley Sugarbeet Growers Association Treasurer Jason Schatzke.
There were 131 drug overdose deaths statewide last year. The number has risen considerably from the 76 overdose deaths in North Dakota in 2019.