Small and independent medical providers in northeast Minnesota get one chance each week to appeal for their share of next week's COVID-19 vaccine supply — an online meeting titled "rants, raves, recommendations."

Alternating between competition and cooperation, the providers decide who is in the best position to get vaccine to Minnesota's priority groups, including health care workers and senior citizens. The plan is finished Wednesday and vaccine orders go out Thursday for delivery the next week.

"Those Tuesday meetings serve as a back alley to discuss who got vaccine the week before, which communities are served by which streams of vaccine ... and how we together can ensure that each community is served the following week," said Adam Shadiow, a leader of Minnesota's Northeast Healthcare Preparedness Coalition, which spans from Aitkin to Grand Portage.

Minnesota's little-known network of eight health care regions has become a key cog in vaccine distribution — filling in geographic or population gaps that are otherwise missed by the state's strategy.

Providers in regional meetings make their weekly pitches, knowing that they have a buildup of anxious patients awaiting vaccination against a COVID-19 pandemic that has caused 6,378 deaths and 474,169 known infections in the state.

That includes two deaths and 611 infections newly reported on Monday.

"Right now, we are not talking about large amounts of vaccine coming into our region," said Shawn Stoen, whose eight-county West Central region has a population of 200,000 but distributed 600 doses this week.

Minnesota expected 87,925 more first doses this week — with 19,400 going to local public health agencies for vaccination of teachers and seniors, and 9,700 going to state-run vaccine sites in Minneapolis, Duluth and Rochester. Among 39,625 doses designated for health care providers, most went directly to the state's 10 largest hospital systems. About 10,000 doses went to the coalitions to distribute to smaller hospitals, pharmacies and other providers.

The Metro Health and Medical Preparedness Coalition steered its doses this week to providers who could vaccinate about 8,400 remaining health care workers — mostly independent practitioners such as physical therapists and optometrists who have been waiting their turn for weeks.

The value of the coalition is that it knows which workers are waiting, so it can distribute vaccine to nearby providers, said Jonathan Bundt, a coordinator of the coalition. "We know where we need vaccination to happen."

Minnesota's eight regional coalitions were formed after 9/11 and the 2001 anthrax scares to ensure adequate disaster response. Initially, they were only going to be used to ration doses for vaccination of health care workers, but state leaders decided they could make smarter decisions about where doses for the public should go compared with a random lottery.

All local providers have a voice at the regional meetings, which ensures they don't get overlooked and reduces the chance of favoritism or bias in vaccine distribution, coalition leaders said.

"Coalitions can add great value to an equitable sharing of vaccine as we don't make decisions in a vacuum," said Deb Teske, deputy manager of the State Healthcare Coordination Center, which oversees the eight regions.

The state on Monday reported that 675,329 people have received at least first doses of two-dose COVID-19 vaccines, and 238,104 of them completed the series.

Minnesota ranks 22nd for its rate of vaccine administration per 100,000 people, according to the U.S. Centers for Disease Control and Prevention. The state used a series of pop-up vaccine sites for senior citizens and other methods to boost its pace, having previously ranked as low as 45th.

State Health Commissioner Jan Malcolm said Minnesota needs to maintain that pace, especially given the emergence of more infectious variants of the coronavirus that could produce another wave of COVID-19 infections.

"We are in a race against time," Malcolm said.

Minnesota's approach has received criticism, both from senior citizens who have struggled to access vaccine and from other states with faster administration rates.

South Dakota leaders said they tried to avoid the "red tape" of government decisionmakers by assigning five major medical providers the roles of distributing vaccine in designated counties. The border state is among the 10 fastest in vaccine administration.

Minnesota state Sen. Michelle Benson, R-Ham Lake, this month asked West Virginia leaders to testify before her Health and Human Services Committee regarding that state's rapid rollout, arguing that Minnesota "faced a myriad of problems with our vaccine rollout leading to confusion and frustration among many Minnesotans." Testimony was postponed Monday due to a prolonged Senate floor debate.

Linda Reichert, 70, of Maplewood said she is tired of Minnesota's fragmented approach that leaves seniors like her scrambling across multiple medical, pharmacy and state websites looking for rare appointments.

The state created a waiting list for its vaccine sites, but closed it after 220,000 senior citizens signed up.

"Getting through to a site to actually make an appointment is an all-consuming effort — every day, odd hours," she said. "Truthfully, I am exhausted."

Reichert lives in a senior independent living facility — but these facilities have received inconsistent access to vaccine compared with nursing homes and assisted-living facilities.

Shadiow said an advantage of the regional coalitions is that they can identify these kinds of underserved demographic groups or cities each week and steer more vaccine to them. He commended providers for working together rather than fighting over scarce doses.

"We see providers, that are under a ton of pressure, concede vaccine knowing that their community is already being served," Shadiow said. "This, we believe, is why it has been working. The providers ... are willing to put the people that live in the community they serve above their desire to be the one serving them."