By Anne Blythe
Not long after North Carolina’s vaccine distribution plan was updated last week, the questions flooded in.
“Where can I sign up to get my COVID-19 vaccine shot? I am 85 years old.”
“I am 91, my wife is 83. Where and when do we get our COVID-19 vaccine shots?
“How do I learn where and when to go?”
In a state with 100 counties, there could be 100 different answers to such questions. Or at least 85, the number of county health directors there are in North Carolina.
As part of a multi-phased vaccine distribution plan, health care workers in intensive care units, in COVID-19 wards and emergency rooms, as well as those inoculating people against the extremely contagious virus, are the first to have access to the two-dose Moderna or Pfizer shots. Residents and staff in long-term care facilities and nursing homes also fall into that group, which the state calls Phase 1a.
This week, some counties in North Carolina entered the next tier of the first phase of the vaccine distribution plan in which people who are 75 and older are now eligible for inoculations.
The problem is many North Carolinians are uncertain about how to find out where and when they can get a vaccine in their county.
“There are a lot of people in that group who want to get vaccinated really badly to the point where they’ve called in hundreds of times or sat out for hours waiting for a vaccine,” Mark McClellan, a Duke University health care policy professor and former director of the Centers for Medicare and Medicaid Services, told reporters during a webinar Wednesday. “I hope we can get to better mechanisms to make it easy for people to find out exactly when they can get a vaccine in their county or locally, and how they can make an appointment to do so.”
The way the system has worked so far is that county health departments could be the source of that information.
Directors of the local health departments throughout North Carolina receive an email each week from the state Department of Health and Human Services, typically over the weekend, letting them know how much vaccine they will receive for the coming week.
Then county health directors and their teams schedule vaccination clinics, register recipients and make it available to those eligible under the state’s multiphase plan.
Sheila Davies, director of the Dare County Department of Health and Human Services, said this week that her team had completed inoculations of health care workers in Phase 1a in that county. She said they’ve scheduled clinics on Jan. 6, 11 and 19 to begin vaccinating people in “Phase 1b,” those who are 75 and older, no matter their health status.
“We are seeing great enthusiasm and eagerness,” Davies said in an email response to questions about how such information can be obtained. “In a day and a half, we have scheduled over nearly 600 individuals age 75 and over for appointments. We are very anxious to know our next week’s allotment so we can continue to schedule appointments.”
National Guard deploying help
On Tuesday, Gov. Roy Cooper announced that he would activate the National Guard to help with vaccine distribution across North Carolina without providing details for how their help would be used.
Many states across the country have experienced slower rollout of vaccines than anticipated. North Carolina, according to a Centers for Disease Control and Prevention data tracker updated on Wednesday, has administered vaccines at a rate of 1,308 per 100,000 people, a lower rate than Tennessee and Virginia, two bordering states, but slightly higher than South Carolina and Georgia.
There are many reasons in North Carolina and elsewhere, McClellan said, that inoculations are not moving as swiftly as distribution plans anticipated.
There’s been an unprecedented surge in COVID-19 cases since Thanksgiving, then distribution began shortly before Christmas and New Year’s Eve, holidays which are expected to result in even more cases. All this has put a burden on health care systems and their workforces who are exhausted from months of intense work battling the virus, just at a time when many of them were looking forward to a well-deserved break.
Additionally, skepticism and vaccine hesitancy has meant many who have been eligible for vaccines were not ready yet to roll up their sleeves for a jab.
Furthermore, because the Pfizer and Moderna vaccines require two doses, and new technology was developed to keep track of who gets which shot when, there has been a learning curve that could be slowing the distribution down.
The National Guard can play an instrumental role in trying to increase the number of inoculations, McClellan said.
“One of the big constraints right now is just bandwidth,” McClellan said. “Our hospitals do not have a lot of staff that they can devote to expansive vaccination programs. They’re very stretched. So the more we can augment them, the better.”
All hands on deck
CVS and Walgreens, two big-box pharmacies, are playing a role in getting vaccines to nursing homes and long-term care facilities through a federal program. Residents have been more willing than many of the staff to be immunized.
“My preference would be to see the National Guard focus on some of the high-risk groups that are otherwise hard to reach,” McClellan said. “We’re otherwise going to be able to reach some of these groups. There are a lot of people who want to get the vaccine now who will stand on a line, who will call repeatedly until they can get through in some of these high-risk groups.”
Frontline workers, such as those in grocery stores, construction crews, agricultural sites and food processing plants, who may not have time to make numerous phone calls or queue up for long waits could be reluctant to go get vaccines. The National Guard could stage events that result in more buy-in from those vaccine recipients.
“Bring the vaccines to them through special events, reaching neighborhoods and communities where we’re worried the vaccine uptake is going to be low at the same time that the burden from COVID has continued to be high,” McClellan said. “So lower-income neighborhoods, neighborhoods with high rates of minority or immigrant populations, those are where I think the National Guard extra help could really come in handy.”
County health departments could use more help, too, according to directors across the state.
“The super good news is that we have a vaccine,” Lisa Harrison, director of the Granville Vance District Health Department, said in an email response to questions.
“The hard news is that it arrived (with zero dollars) at our local health department the Wednesday before Christmas to a worn-out bunch of workforce who have been case investigating, contact tracing, managing data, managing outbreaks and clusters, communicating to the public and partners, with immediate expectation for delivery into peoples’ arms effectively and quickly,” she said.
“It’s time to stop (well, pause and streamline) that 12- to 14- hour / 7- day-a-week work focused on COVID-response and turn now full-force into vaccination — just at the same time we are all learning the nuance about the vaccine, its cold chain, its effectiveness, its safety, its reconstitution, its ability to travel, and then manage a new computer system that wasn’t in our toolbox before December 20th.”
In a briefing with reporters on Wednesday, the governor, Mandy Cohen, secretary of the state Department of Health and Human Services, and Todd Hunt, major general of the North Carolina National Guard, spoke about how they planned to assist local health departments and others with vaccine distribution.
Fifty guardsmen and women will be sent out in teams of six to places in need, with two of the members able to help with inoculations and the other four there to help with data entry, help with scheduling or even answering phones.
“We want to make sure to get these vaccines out as effectively and quickly as possible,” Cooper said.
Can pharmacies lend a hand?
Pharmacists are trying to get in the mix, too.
Penny Shelton, executive director of the North Carolina Association of Pharmacists, said on Tuesday that she and Andy Ellen, president and general counsel for the North Carolina Retail Merchants Association, have been discussing how pharmacists, especially those not yet with national contracts, can become places where vaccines are administered, too.
While supplies are so limited, Shelton said she expected that pharmacists won’t be included in Phase 1 of North Carolina’s plan, but thought pharmacies could help speed up the overall vaccination process at some point.
Many people in North Carolina do not have a routine physician and often get flu shots at their local pharmacy.
In some parts of the state, such as northern Stokes County, residents in smaller towns and crossroad communities would have to travel a great distance to get to a CVS or Walgreen store, when there is an independent pharmacy much closer.
Corey Fulk, owner of Stokes Pharmacy in Danbury, said this week that his facility has been fielding many calls from residents who are anxious to get the vaccine.
A couple of weeks ago, many of the Stokes County residents he encountered were very much “on the hesitancy side” about the vaccines.
Now, there is more enthusiasm. As a pharmacist and immunizer, he hopes to start getting COVID vaccines perhaps as early as next month.
“Some are knocking on the door, saying when,” Fulk said. “Others are saying, ‘We know we have to wait for our time.’ We have a list started to reach out to when we have more information.”
Rose Hoban contributed reporting to this story.