U.S. States Rewrite Vaccine Rules to Get Covid Shots Moving

(Bloomberg) -- U.S. states are improvising new delivery systems and rewriting priorities as Covid-19 vaccinations are off to a tortoise-paced start.

Colorado on Wednesday said it would vaccinate people 70 and older, joining Texas and Florida in trying to quickly immunize older residents -- even though federal guidelines favor health-care workers. Other cities and states are just now registering recipients, weeks after the Trump administration made clear it considered its job done once vaccines were delivered to hospitals and agencies.

Some senior public-health officials expect the pace will pick up as soon as next week. Nursing homes and other long-term care facilities are likely to get more shots done as the new year dawns and the holidays recede, said Nancy Messonnier of the U.S. Centers for Disease Control and Prevention. The agency also expects to begin publishing new data that will give a more precise picture of the mass immunization effort.

The task of delivering shots that could end a pandemic that has killed 340,000 U.S. residents so far is taxing a largely private medical system designed to maximize profit rather than deliver public health. Governments and institutions are struggling with complex logistics to keep the shots cold, organizing cohorts of people to receive them and persuading those made skeptical by a flood of online disinformation.

West Virginia finished giving the first of two required shots to residents and employees of long-term care facilities, the first state to do so, Governor Jim Justice said during a briefing Wednesday. The state is now vaccinating prison guards and emergency workers, and then will target teachers and residents 80 and older, Justice said.

“Take the vaccine, for crying out loud,” Justice said. “People say you are going to grow a third arm, you’re going to grow antlers. I mean, give me a break.”

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U.S. officials have shipped more than 14 million Covid-19 shots, Army General Gustave Perna, who oversees distribution, said Wednesday. So far, only 2.6 million have made it into arms, according to the CDC.

Fewer shots have been administered than the Trump administration had hoped, Moncef Slaoui, scientific adviser to the government’s Operation Warp Speed vaccine program, told reporters Wednesday. The total is well below the administration’s goal of 20 million vaccinations by year-end, a number already scaled back.

President-elect Joe Biden has said the administration is failing to protect Americans and has promised 100 million inoculations in his first 100 days if Congress provides funding.

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Some of the apparent slowness is due to a lag in data, which can take three to four days to see, Slaoui and Perna said. Perna also blamed snowstorms and providers learning how to handle the vaccines.

Christy Gray, director of the immunization division for the Virginia Department of Health, said far more people have received the dose than state data suggest, and that providers administering vaccinations have been slow about reporting it.

Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, attributed the slow rollout to public health departments being strained by the pandemic, launching a massive inoculation campaign amid the holiday season and the Covid-19 vaccines’ special handling and storage requirements.

The formula created by Pfizer Inc. and BioNTech SE needs to be stored at 94 degrees below zero Fahrenheit. That makes the logistics more complicated than a simple flu shot, said Kris Ehresmann, infectious-disease director of the Minnesota Department of Health.

“This is a new vaccine with new processes that have to be put in place, and that adds some time,” Ehresmann said Wednesday in a press conference.

At least three shipments of Moderna Inc.’s vaccine were held back in Texas last week because they displayed signs of falling out of their required temperature range.

The federal officials said they will assess what’s working and what needs to be adjusted.

“Here’s what I have confidence in: Every day, everybody gets better and I believe that uptake will increase significantly as we go forward,” Perna said.

State Struggles

Much of the responsibility falls to local leaders, as President Donald Trump made clear in a Wednesday morning tweet that told states: “Get moving!”

Each receives a set number of shots from the federal government weekly and decide where they should go and who should get them. Health-care workers and long-term care residents are generally first in line.

New Jersey’s allocations have been lower than what the state anticipated and the numbers have changed, making it difficult to plan, Governor Phil Murphy said during a briefing Wednesday.

“This is not just at the level we’re promised -- it’s also relatively volatile,” Murphy said.

New York Governor Andrew Cuomo during a news conference Wednesday said the massive undertaking has been “grossly underestimated.”

Ohio Governor Mike DeWine chastised providers for moving slowly. Only 17% of the doses distributed have been administered in the state, which is home to some of the largest health-care systems in the country such as the Cleveland Clinic, DeWine said during a news conference Wednesday.

“I’m not satisfied with where we are in Ohio,” he said. “We’re not moving fast enough, but we’re going to get there.”

Logistical issues are slowing vaccinations in hospitals, DeWine said. In long-term care facilities, few workers want the shots. About 60% of those who have been offered a vaccine have refused it, DeWine said.

Ground-level logistics can be opaque across the U.S. Many residents are uncertain whether they will get a shot from their doctor, at a government clinic or at a pharmacy. It’s unclear how government officials will verify eligibility. Some states and cities have launched websites where residents can sign up to be vaccinated.

Sorry, No

Health-care workers are the only people who can register in the District of Columbia. New Mexico created an online portal that allows people to register for vaccination after entering basic information including any chronic medical conditions they may have. The state promises to contact registrants when the shot is available.

Essex County, New Jersey, has a system that in two clicks turns away people who aren’t in health care or otherwise qualified: “Based on your response you are currently not eligible for vaccination at this time. Please be sure to check back as CDC releases new phases and guidelines.”

Some states are already starting to offer the vaccine more widely than the federal government recommends. In Colorado, the vaccine will be available to everyone 70 and up, Governor Jared Polis said Wednesday. Some areas may focus on health-care workers while others may start providing it to senior citizens.

Texas this week opened up vaccination to seniors 65 and older and people over 16 with an increased risk for severe illness. Governor Greg Abbott in a tweet Tuesday urged vaccine providers to quickly use shots, because a “significant portion” may be going unused.

In Florida, some senior citizens are desperate. Photos and videos showed elderly people in Lee County camping out in hopes of receiving one of the coveted vaccines.

The county’s three clinics were first come, first served, according to the health department. All three reached capacity by 6:30 a.m. Wednesday.

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