Why some of the most COVID-19 infected North Carolina counties aren't on the top of the list to get the vaccine

Health officials across North Carolina are preparing to receive doses of the first COVID-19 vaccine next week.

On Thursday, the North Carolina Department of Health and Human Services (NCDHHS) announced 53 hospitals are set to receive a portion of the first Pfizer shipment.

The federal government based each state's doses based on population. North Carolina is expected to receive 85,500 doses of the Pfizer vaccine next week. North Carolina's initial doses will deliver the first shot to healthcare workers most at risk, however the first shipment will not be enough for every health care worker or every hospital.

How rising COVID-19 numbers are impacting central North Carolina hospital capacity, emergency rooms

"Independent state and federal public advisory groups have determined the best way to fight COVID-19 is to start vaccinations first for those most at risk and then reach additional people as the vaccine supply increases," NCDHHS Secretary Mandy Cohen said during a press conference on Thursday.

NCDHHS said it prioritized hospitals with higher number of healthcare workers. The state also took into account county population and hospital bed capacity when choosing where to distribute the initial doses.

"As more of the vaccines become available it will be distributed to more of our hospitals and then our health departments to focus on vaccinating those high-risk healthcare workers," Cohen said on Thursday.

The ABC11 I-Team uncovered more than half of the counties currently ranked top for COVID-19 infection will not receive doses next week.

Avery, Warren and Yancey County each reported around 1,200 COVID-19 cases per 100,000 residents, the highest in the state. None of the three counties are on the list to receive a vaccine next week.

One of the main reason for this is COVID-19 is spreading faster in rural areas of the state that already have less access to healthcare resources.

Three of the top counties for COVID-19 infection rate (Warren, Yancey, Yadkin) have no hospital.

A fourth of the other top counties have a hospital but are not scheduled to receive doses in the first week.

"There's a lot of talk on how to address some of the logistical challenges and how to make sure we are able to cover those rural areas or more at-risk areas if there's not really easy access in those areas," said Michelle Ries, the interim director of the North Carolina Institute of Medicine.

Ries also works on the state's vaccine advisory committee and said getting doses to rural areas in a concern for health officials.

"We do have a lot of areas in our state that are still far from even those smaller urban areas in the state so it will be a logistical challenge and I will say both our advisory committee and some other committees that DHHS has working on this are really thinking hard about how to solve those problems," Ries said.

Hospitals who receive the vaccine also need to have the capability to keep the vaccine cold for up to 30 days.

NCDHHS does not know how many doses it will receive in the second week. Officials said they do expect to receive both the Moderna and Pfizer vaccine in the second week, which will hopefully allow them to reach every county.

"The Moderna vaccine will be distributed in minimum ship amounts of 100 units, allowing us to further distribute to additional hospitals and local health departments. Our goal has been to ensure vaccine is administered rapidly to those at risk of contracting COVID-19 or at risk of severe illness from COVID-19 and minimize the risk of excess supply at any particular provider," a NCDHHS spokesperson wrote in an email.