‘LUMPY AND BUMPY’: Without guidance, rollout is going aswell as you’d feared
Texans are beginning the new year the same way we spent much of the last one: straggling through a devastating pandemic with a patchy public health infrastructure, a confusing mishmash of rules and procedures, and an ominous absence of effective statewide leadership.
We have a COVID-19 vaccine now: that’s the good news. Two of them, actually, one by Pfizer and the other by Moderna, both developed as part of the federal Operation Warp Speed and approved by the Federal Drug Administration for emergency use last month.
We knew that distributing hundreds of millions of vaccines would be a challenge. Each requires two doses and careful handling — including ultra-cold storage for the Pfizer vaccine. Each is being distributed to a population that includes potential recipients skeptical of vaccines in general, and the COVID vaccine in particular.
But we had several months to figure this out. And it’s quickly become painfully clear that we didn’t.
In Phase 1A of the plan put forward by the Texas Department of State Health Services, the first doses of the vaccine were distributed to front-line health care workers and residents of long-term care facilities, beginning last month. On Tuesday, the state announced that vaccine providers could begin immunizing Texans in group 1B —those over age 65 and those with pre-existing conditions.
The experiences of Texans in that group gives you the impression that we’ve responded to an ongoing crisis with a maddening, high-stakes scavenger hunt. In Harris County, for example, there are dozens of providers that have partnered with the state to distribute vaccines, but making an appointment at any of them seems to require persistence, endless phone calls, and a hefty dose of luck.
Overall, the distribution process has been inefficient and confusing. As of Dec. 31, according to DSHS, some 283,000 people across Texas — roughly 45,000 in Harris County — had received the first dose of the vaccine. That’s of the 773,000 doses the state had shipped to various providers, up to that point.
And it’s a worrisomely low figure, according to public health professionals, given that we’ll need to vaccinate up to 80 percent of the population to achieve the herd immunity that will allow normal life to resume. Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, has pointed to the straightforward back-ofthe-envelope math: with roughly 30 million people in Texas, we should be aiming for a million immunizations a week to achieve herd immunity by mid-year.
Last week, as these difficulties began coming to light, Gov. Greg Abbott pointed the finger at the state’s hospitals and other vaccine providers.
“A significant portion of vaccines distributed across Texas might be sitting on hospital shelves as opposed to being given to vulnerable Texans,” Abbott said on Twitter.
“The state urges vaccine providers to quickly provide all shots,” he continued. “We get plenty more each week.”
In the Houston area, at least, providers say they’re doing just that. And Texans are having unpleasant memories of the early days of the pandemic, when state leaders such as Abbott took a largely hands-off approach to the public health response — intervening only when local leaders in cities such as Houston and Austin crossed what he deemed to be a red line.
“Here we are, once again, hoping that private companies will figure out a decent vaccine distribution system since the State of Texas sure hasn’t,” said state Rep. Erin Zwiener, a Democrat, on Twitter. “But that means it will be disparate and confusing and hard for our constituents to navigate.”
These issues aren’t unique to Texas. Even states with relatively robust public health systems have seen what Massachusetts Gov. Charlie Baker described this week as a “lumpy and bumpy” rollout.
An exasperated U.S. Sen. Mitt Romney of Utah vented in a statement on New Year’s Day.
“That comprehensive vaccination plans have not been developed at the federal level and sent to the states as models is as incomprehensible as it is inexcusable,” Romney said.
“It was unrealistic to assume that the health care workers already overburdened with COVID care could take on a massive vaccination program,” he continued. “So, too, is the claim that CVS and Walgreens will save the day: they don’t have excess personnel available to inoculate millions of Americans. Nor are they equipped to deal with the rare but serious reactions which may occur.”
The distribution of COVID vaccines is, without question, a matter of urgency. We begin the new year with more than 12,000 Texans hospitalized due to the virus, and public health experts fretting about the impact of holiday gatherings and travel on those statistics — as well as reports that cases of a more transmissible variant of the virus have been confirmed in the United States.
The state’s plan to rely on public/private partnerships to distribute the vaccine may be sensible, given Texas’s extant public health infrastructure. But, at the minimum, we need better communication from state leaders about how Texans who are eligible for the vaccine can access it — not finger-pointing and politics.