Federal, State Bottlenecks Behind Missouri's Slow Coronavirus Vaccine Rollout
Andy Stites has spent the past year afraid to go out in public. Born with a rare disorder that has left him with one lung and heart problems, if he catches the coronavirus, he could die.
So when Stites, 36, became eligible to receive the coronavirus vaccine last month, he signed up for appointment updates everywhere he could —hospitals, health departments. But hope soon turned into a headache.
“News of the vaccine came, and it was really exciting, because OK, great, we're going to have something to at least prevent infection in some way, shape or form,” said Stites, an Anheuser-Busch employee who lives in Soulard. “But then, as we've all seen, the rollout in the state has been atrocious.”
Stites and thousands of other patients in the region are still scrambling to get the coveted coronavirus vaccine. Missouri has one of the lowest coronavirus vaccination rollouts in the country. As of this week, 6% of the state’s 6 million residents have received their first dose of the vaccine, according to the Centers for Disease Control and Prevention.
The federal government has given little guidance on how to distribute the vaccine, and clinics, hospitals and health departments are competing against each other for meager and irregular shipments. Systems for registering and making appointments are disjointed and favor those with time and who are tech-savvy. At the end of the line, patients like Andy Stites are left confused and frustrated.
On a tip from a friend, he finally got an appointment at a BJC vaccination site. But soon after, the hospital notified him that his appointment had been canceled.
“To get that cancellation was really, really dejecting,” Stites said. “We thought that we were going to get some little protection from this thing.”
Missouri isn’t an outlier. Only about 8% of people across the nation have received their first dose of the two-shot vaccine.
One problem: There hasn’t been a centralized effort to distribute and administer the vaccines. Instead, state and local health departments, health systems and clinics have had to make their own plans, said William Galston, a governance studies fellow at the Brookings Institution.
“This is what happens when complex problems are dealt with by complex systems,” he said.
While the federal government helped companies develop the vaccines, it hasn't focused as much effort on distributing them.
“The states, in turn, were left mostly on their own to take it from there,” Galston said. “This is a situation that requires quasi-wartime-level mobilization in order to deal with it quickly and fairly.”
Each state devised its own vaccine distribution plan, with chronically underfunded health departments leading the way.
It's sometimes a slapdash effort, with states deciding weekly shipments for hospitals, mass vaccination events and local health departments. They haven’t been getting regular amounts, and that can lead vaccinators to cancel appointments.
In Missouri, there are hundreds of vaccinators applying to receive doses every week, according to the state’s Department of Health and Senior Services. The state can only fill around a third of those orders.
“I heard it called yesterday the Hunger Games of Health Departments,” said Kelley Vollmar, the director of the Jefferson County Health Department, last week. She’s put in orders for months but has not received any shipments from the state.
"I've seen counties that have been approved for orders, and their orders have not shown up,” Vollmar said. “But a neighboring county has suddenly received an order of about the same amount, with no explanation.”
The federal government has been giving states little notice about how much vaccine it's allotting to each state weekly. Federal officials have notified states of shipments just days in advance, requiring state health officials to make quick decisions about where those vaccines will go.
Once clinics, local governments and health departments know how much to expect, they have to scramble to create appointments to give people the shots, which makes it difficult to plan in advance, Vollmar said.
“People are getting pulled in a lot of directions,” she said. “And unfortunately, that's slowing the process down,” she said of the fragmented rollout.
In Missouri, different sites or counties have different eligibility requirements. Someone who's eligible in one county may not be eligible in another. Doctors have encouraged people to register at many sites, which can lead to confusion and no-shows once the vaccine appointments are available.
“The vaccinators have been somewhat independent of each other, and so there hasn't been this coordinated rollout,” Vollmar said.
A more centralized system for appointments, sign-ups and dosage sharing would help, Vollmar said.
That’s worked in other states. West Virginia, which has relied on a network of independent pharmacies with centralized leadership from its governor's office to vaccinate residents, has among the nation's highest vaccination rates, with 11% of residents receiving at least one dose.
The three vaccination sites in Jefferson County have banded together in an ad-hoc network to share resources, Vollmar said.
Public health experts say the health departments put in charge of the effort are ill-equipped to vaccinate tens of millions of people.
“We are unfortunately having to build more disparate systems that do not communicate with each other,” said Dr. Ruth Carrico, an infectious diseases professor and nurse practitioner at the University of Louisville.
State and local health departments have been progressively more cash-strapped and understaffed, she said.
“Typically, states have not invested in public health, they haven't seen the importance,” she said. Now, those decisions are coming home to roost. We did not support public health, we did not support public health planning. And now we expect public health to fix this problem.”
That’s compounded by the practical challenges of giving the coronavirus vaccines.
“It’s not like just giving a flu shot. It is a lot more complicated,” she said. “The paperwork, the assessment, you know, all of the documentation that is done, the handling, the monitoring of individuals post vaccination …. we just don't have that workforce readily available.”
And the vaccines are finicky. They don't come in prefilled syringes, they need to be kept cold, and they take a long time to thaw out. Once the vials are opened, they need to be used quickly.
State officials have stood by the vaccination effort in Missouri. Gov. Mike Parson last week accused critics of cherry-picking data and claiming the CDC’s data is incomplete and inaccurate due to reporting lags.
In response, the state has launched its own website to track vaccinations, which shows the state has given the first dose to just over 7% of residents, which is still lower than the 8% who have received it nationally.
State officials in Missouri and several other states have blamed part of the lag on a federal partnership that used CVS and Walgreens pharmacies to vaccinate people in long-term care facilities. That effort is taking longer than expected, Parson said last week.
Federal vaccine shipments are becoming more regular, state health officials said in a briefing for vaccinators last week. The state can expect to receive 75,000 doses a week throughout February, which will make it easier to plan how and where they will be distributed. Parson also called on the National Guard to help the state during mass vaccination events.
Randall Williams, the state’s health director, repeatedly has said the biggest hurdle to getting shots to people is that drug companies aren't yet producing enough doses. While the Biden administration aims to ramp up production to manufacture more vaccines, states likely won’t see those effects until the spring.
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