By Rose Hoban and Anne Blythe
Across the state, phones at local health departments are ringing off the hooks, with people on the other end all asking the same question: “When can I get my vaccine?”
“Now we receive more than 15,000 calls per day,” wrote Granville-Vance Health Director Lisa Harrison in an email.
At NC Health News, we’ve received hundreds of emails asking the same thing.
The answer to that question has been upended across the state as health care systems and local health departments realized appointments they had made would have to be postponed and rescheduled because of shifting state allocations.
For example, Cone Health postponed vaccine appointments for 10,400 people because the state did not deliver enough doses for a mass vaccination clinic to be held in the Greensboro Coliseum Special Events Center.
“We are deeply disappointed that we are forced to delay these essential vaccinations,” said Cone Health CEO Terry Akin in a Friday press release. “In order to maintain an aggressive vaccination strategy, we need predictability and regular vaccine shipments from the state as originally promised.
“I am very unhappy that the state appears to keep changing the rules for vaccination allocation.”
Meanwhile, a mass vaccination event went forward at Charlotte Motor Speedway over the weekend, where close to 16,000 people received doses of the COVID vaccine between Friday and Sunday.
People up and down the supply chain are frustrated and confused.
“Due to a change in the number of COVID-19 vaccines Cape Fear Valley Health has been allotted by the State of North Carolina, the health system has had to reconfigure the way in which we run our COVID-19 vaccination clinics,” a spokesperson for the system told the public Monday in a press release.
On Monday afternoon, the state Department of Health and Human Services put out their own press release to address some of the controversy swirling around vaccine supply.
The statement noted that the federal distribution network told North Carolina that only 120,000 first doses will come to the state.
The release noted that as of Sunday evening, 88 percent of the state’s first doses had reportedly been administered. The state also has second doses for all of those people who received their first doses. But state officials are holding those in reserve so that they can complete the vaccine series for all those people who got their first doses.
In some ways, the way the federal government has distributed vaccines to states has created a Catch-22: States like North Carolina that worked to get vaccines to small health departments and into remote counties with few people have been criticized for moving too slowly. But ramping up mass vaccination clinics in population centers and focusing on speed has meant that supply gets shut down to those smaller counties and municipalities.
And there aren’t enough supplies anywhere.
“I know that’s really frustrating and I know that is not something that we are used to,” Betsy Tilson, North Carolina’s State Health Director, said during a telephone town hall meeting with AARP members Monday afternoon. “That is going to be the reality for the next couple of months, is that the demand and the people eligible for the vaccine is going to be far greater than the amount of vaccine that we have.”
Supply and demand
There are about 400,000 health care workers in North Carolina, about half of whom are seeing patients regularly and could be exposed to COVID. That group was the very first cohort of people to receive vaccines based on federal guidance created last fall from both the Centers for Disease Control and Prevention and the National Academies of Science, Engineering and Medicine.
The CDC and NASEM agreed that the second priority group would be older people living in nursing homes and assisted living facilities where the virus has taken a tragic toll. North Carolina had designated “Phase 1b” to also include everyone over the age of 75, who has been at the greatest risk of dying from COVID. According to statistics from the U.S. Census, there are more than half a million North Carolinians in that age group.
Initially, North Carolina planned to focus vaccine distribution on just those two big groups of people, but targeting just those people was proving to be slow.
“The way we did our allocation prioritization was to make sure that we were getting an equal number of doses per county population,” Health and Human Services Secretary Mandy Cohen told lawmakers during an oversight committee meeting on Jan. 12. “And you know, we have a very geographically diverse state, a very rural state, but we felt it was a priority to get vaccine out everywhere.”
But Cohen came under intense criticism from lawmakers for the pace of the rollout.
“Most of us don’t feel that this process has moved as quickly as it could or should have to this point, and we’re wanting to deal with it,” said Sen. Ralph Hise (R-Spruce Pine). “We merely handed it over to basically 100 county health departments and hospitals and said, ‘Have fun.’”
Around the same time Cohen was getting grilled by lawmakers, former federal HHS Sec. Alex Azar changed the federal vaccine distribution strategy.
“Only four weeks into our launch, we have gained confidence in the integrity of our system,” Azar said during a press briefing on the same day. “It’s time to move onto the next phase of our vaccination campaign.”
Laying the blame squarely on states for the slow vaccine rollout, Azar expanded the scope of the people recommended to receive the vaccine to people who were 65 years old and older, even as the other groups were not completely vaccinated yet. Azar also told states to speed things up and threatened to penalize states that were moving more slowly by releasing less vaccine to them.
“Some states’ heavy-handed micromanagement of this process has stood in the way of vaccines reaching a broader swath of the vulnerable population more quickly,” he said.
At the same time, he opened up eligibility to people 65 years old and older, and those people under the age of 65 with a preexisting condition with some form of medical documentation of their condition.
Azar’s move meant expanding the number of eligible people in North Carolina by more than a million people and unleashing a wave of demand. Now, between health care workers and people over 65, North Carolina has as many as 2 million people who are eligible for receiving the vaccine, with each person requiring two doses of either the Pfizer or Moderna vaccines.
But, to date, North Carolina has received 960,000 doses, according to CDC data. And what’s been hard for many people to absorb is that eligibility does not mean availability.
“What we get in the state is about 125,000 doses a week,” Tilson told the AARP town hall. “So less than 10 percent of the doses for the population.
“It is going to be in short supply for the foreseeable future and it’s gonna be hard for people to find appointments,” she said. “The demand is greatly gonna outstrip the supply.”
No win situation
“I think we … could have done a better job at setting expectations, managing those expectations, communicating to the public, and how we are measuring state performance,” said Julie Swann, a faculty member at NC State University who studies pandemics and supply chains.
She said that the federal government told states to do one thing and then evaluated states by a different metric.
“The advisory bodies told states ‘prioritize these populations in these orders,’ and then we’re measuring them, how fast are you administering doses,” she said.
Swann pointed out that the advice from the CDC and NASEM were geared toward reducing deaths, not getting lots of people vaccinated at once.
“The goal of the vaccination was never ‘stop the pandemic immediately.’ There’s no way but it can’t do that, you’ve got to have 400 million doses before you get to that level,” she explained. “You’re not going to stop the pandemic in a short number of weeks with a limited supply, what you can really do is prevent some deaths and prevent some hospitalizations.
“The real question we need to ask is, what is the best way to prevent deaths, prevent hospitalizations, and ensure that our society continues to function,” she said.
And the current focus on speed and getting all those older adults vaccinated now doesn’t accomplish some societal goals of getting people back to work.
“What about the teachers and the firefighters and the food workers and the grocery store workers who are exposed potentially every day and need protection against that risk?” she said. “We’ve now set aside what states were told for months to focus on.”
Swann also said that the numbers people are dealing with here are so big, they’re hard for people to wrap their heads around. Right now, the federal government has distributed about 40 million doses to states, enough to vaccinate about 20 million people, which sounds like a tremendous number.
But that’s only enough to vaccinate about six percent of the total population.
She also said that the folks in local health departments who are tasked with doing vaccinations now are the same people who have been working overtime since last March to manage the pandemic.
“Let’s start with the fact that state and local health departments had been asking for funding and resources for last-mile distribution for months, and finally got allocated something December 27, December 27!” she said. “We did not have a national focus on last-mile distribution until somebody was unhappy.”
Speaking of equity and diversity
At issue is whether the state can effectively get its weekly vaccine allotments into arms quickly while also equitably getting doses to communities of color and historically marginalized populations.
DHHS has committed to equitable distribution to the historically underserved and under-represented communities, while also struggling to meet the demands of lawmakers and vaccine enthusiasts in the 65 and older groups.
The Association of Mexicans in North Carolina, or AMEXCAN, an advocacy organization for Latinx residents, held an NC Latino COVID-19 Task Force meeting on Zoom meeting Monday morning in which part of the discussion was about vaccines.
The DHHS dashboard showed on Monday afternoon that Hispanics had received only 3 percent of the first doses given over that past month and only 4 percent of the second doses.
“Our numbers don’t look good in our Latino community,” Juvencio Rocha-Peralta, executive director of the community resource organization, told meeting participants.
Public health officials have been rolling out campaigns to overcome the expected vaccine hesitancy in communities of color. Latinx residents have voiced concerns about having personal information they provide to health care workers being turned over to immigration officials. State health officials have tried to counter those fears, saying there are no plans to do that.
In McDowell and Rutherford counties in the western part of the state, Centro Unido Latino-Americano, a non-profit organization working to promote social justice, health equity and inclusive education services for the Latinx community, has been working with the county health departments to educate residents about the vaccine.
Margarita Ramirez, executive director of CULA, told participants on the Zoom call that her organization has been contacting people who tested positive for COVID-19 or were tested for the virus and giving them information and answering questions for those who are hesitant.
Over the weekend, they gave out flyers to families who came to the food pantry. Afterward, CULA received calls from two families asking to be put on the vaccine waiting list.
“They said, ‘We trust you,’” Ramirez said. “We’ll do this.”