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They all started in the same place, with no one immunized, no stockpiles of vaccine and no choice but to dive in immediately with perhaps the most high-stakes public health campaign in American history. Seven weeks later, the nation’s states are all racing to deliver a potentially lifesaving defense against the novel coronavirus to millions of arms. But some states are having far more success than others. In the states moving fastest, up to 1 in 7 people had received at least their first injection as of Wednesday, according to data compiled by The Washington Post. At the other end of the rankings, it was 1 in 17.

Beginning in August, a half-dozen researchers at a Pfizer lab in Massachusetts sat down with vials of experimental coronavirus vaccine to learn how to transform the “overfill” in every vial — an extra amount of liquid that is standard for injectable pharmaceuticals — into a precious sixth dose. Over the next few months, they tested dozens of different combinations of syringes and needles, drawing out vaccine and squirting it into a beaker resting on a digital scale, repeating the experiments 5 to 10 times for each. By Jan. 6, the work paid off. Pfizer won approval from the Food and Drug Administration to say its vials contained six doses, instead of the five the agency had approved less than a month earlier with its Dec. 11 emergency authorization of the vaccine.

The COVID-19 vaccine rollout has been a nightmare for many Americans as they struggle through multi-step registration and appointment systems. The federal government had envisioned states using one national vaccine scheduling system, and it offered a contractor US$44 million to develop it. But that system turned out to be so poorly designed that all but nine states opted out before even trying to adopt it, even though it was being offered by the government for free. The few states that do use the Vaccine Administration Management System, or VAMS, have reported random appointment cancellations and unreliable registrations. Some vaccinators have had to resort to creating records on paper because of system glitches, slowing down the pace of getting shots into people’s arms.

Regularly testing for Covid-19 in K-12 schools can help identify cases and provide an extra layer of protection for staff and families, according to two reports commissioned by the Rockefeller Foundation released on Thursday. Implementing testing, however, is an enormous, logistically complex undertaking, and most schools need significant resources to make it feasible, the reports also found. One of the reports, conducted by research firm Mathematica, assessed programs in six pilot locations that either already have started or are planning to implement rapid antigen testing with the support of the Rockefeller Foundation, a philanthropic foundation that has focused on Covid-19 testing for much of the pandemic. Tests were provided by the Department of Health and Human Services.

Operation Warp Speed invested billions of taxpayer dollars to develop safe and effective vaccines to protect people against the worst outcomes from COVID-19. Under the Emergency Use Authorization (EUA), the pharmaceutical industry has delivered — in record time — two vaccines with the Food and Drug Administration (FDA) approval. Johnson & Johnson and Novavax have released promising efficacy data from their phase three clinical trials. Immunizing health care workers and those living in long-term care facilities was slower than expected, largely due to the logistics of getting people vaccinated. The vaccine supply chain is now beginning to show some structure, with the expectation that there will be ample supply and capacity to immunize everyone who wants to be immunized by the summer.