ST. CLOUD – More than 1 million Minnesotans — 19.3% — have received at least one dose of the COVID-19 vaccine.

That percentage nose-dives in Sherburne County, which has the state's lowest percentage of residents who have received their first dose — 11.6%, which is more than a full percentage point below the next lowest county, Benton, at 12.8%. Sherburne also has the second lowest percentage of residents who have completed the series: 6.3%, ahead of only Isanti County.

Why? It's likely a combination of the county's lack of a major health care system, accessibility and central Minnesota's "independent mind-set," said Dr. George Morris, CentraCare's COVID-19 incident response commander.

It's important to recognize nothing about the pandemic or response has been uniform statewide, Morris said.

"Even when COVID was hitting all of us, it didn't hit equally," he said. "There were regional, geographic and economic differences for how COVID swept through the state."

The state's vaccination distribution plan relies on coordination between places receiving direct federal shipments, state hubs, big health care systems and emergency preparedness networks that distribute vaccines to smaller public health systems or pharmacies.

"I think it's terribly inefficient," Morris said. "That does pose problems."

Cook County has the state's highest vaccination rate: 44.2% of residents who have received their first dose, according to Minnesota Department of Health data as of Saturday.

Nearly 91% of Cook County residents age 65 and older have received at least one vaccine dose — much higher than Sherburne County's rate of 52.5%.

According to census data, Cook County is one of the state's oldest counties, with a median age of about 50, whereas Sherburne County is one of the state's youngest counties, with a median age of 33. Morris said he didn't think that plays a big role in the discrepancy because vaccine rates for Minnesotans 65 and older vary widely by county — from about 47% in Anoka County to 91% in Mahnomen County.

Instead, counties with large medical campuses or many long-term care facilities took an early lead with vaccinations because of the state's focus on vaccinating health care workers and the most vulnerable.

"It was designed that way," Morris said. "So there's a lot of playing catch-up for these areas that either have smaller hospitals or only clinics."

Benton County, for example, does not have a hospital — and it ranks 86th of 87 Minnesota counties for residents receiving the first dose, at 12.8%. Similarly, Sherburne County has no major health care hub, although it has multiple clinics.

Rural communities also might not have the same accessibility to vaccines as larger communities, which might have large vaccination hubs or more pharmacies with doses.

"You have to be willing and able to drive distances," Morris said. "The smaller clinics and small-town local pharmacies — they've gotten some vaccine but it's just harder to bring it right close to home because we're still short."

In addition to vaccine prioritization and access differences, there are also differences in ideology.

"I don't want to call it red and blue, Democrat [and] Republican," he said. "It's a little bit of: I don't want people to tell me what to do."

Health leaders are trying to respond by asking people to think about the greater good.

"I get it. It's your individual right to say yes or no," he said. "But it's also our individual responsibility and individual accountability to help our community."

As a medical provider, Morris said it's painful to see patients hospitalized due to COVID-19 who said they wanted to get the vaccine but couldn't.

"Had we had more vaccine available, we could have given it to them a month ago, which might have prevented their hospitalization," he said.

Morris said he'd like to see a more standardized distribution approach.

"We will get to the end line — everybody vaccinated," he said. "Not that we can't, it's just a struggle to get there."