Officials: Vaccine rollout to improve
Wisconsin health leaders urge patience during early confusion, frustration
Kim Rudat picked up his phone as soon as he read the news that 70-yearolds like him would soon be eligible for a vaccine against a virus he can’t afford to get.
He called his pharmacist, who told him to go to a website that didn’t have any instructions.
Then he tried his health clinic. No answers there, either. Rudat was told to wait for an email that would come when his health care providers were ready — which wasn’t this week. It likely won’t be next week, either.
Even the state Department of Health Services’ website that he’s scoured for weeks hasn’t been helpful, he said.
“There’s a lot there, but it really wasn’t getting to what I wanted to know, and that is, ‘How do I obtain the vaccine?’” Rudat said. “There seemed to be a lot of smoke and mirrors.”
Five weeks into Wisconsin’s vaccine effort, the rollout lurches forward amid confusion over where to get the vaccine, criticism over who is eligible, and frustration over how to speed up immunizations when supply remains scarce nationwide.
Since Dec. 14, the state has administered roughly 310,000 doses of the coronavirus vaccine — an average of about 8,000 shots per day.
At this rate, it will take more than two years to fully vaccinate 70% of Wisconsin’s adult population, when experts estimate herd immunity will start kicking in.
The possibility of two to three new vaccines coming onto the market soon — as well as a new administration in the White House — could help with ramping up vaccine efforts.
In the meantime, state health officials who’ve spent the last 11 months battling the pandemic are urging the public to be patient in the early stages of the unprecedented rollout. Vaccine supply is limited and states are bearing the brunt of disorganization at the federal level, they say.
The pace of vaccinations in Wisconsin has also been accelerating each week, officials pointed out.
At a news conference Tuesday, DHS Deputy Secretary Julie Willems Van Dijk emphasized that it would take time for all health care providers to “really get rolling” as they prepare to vaccinate Wisconsinites ages 65 and up. “I implore people for their patience,” she said.
“As we get more people through this system and vaccinated, we’ll hit a cadence,” she added. “And we will get everybody vaccinated who wants a vaccine.”
Communication breakdowns have also defined the rollout. State officials want more information from the federal government about when allocations will increase. And local officials want more notice from the state health department about when groups will become eligible for vaccines.
Meanwhile, Wisconsin residents have few resources to turn to in their quest to figure out how or where to get a shot in their arm — or one for their loved ones.
Rudat, who is from Neenah, decided he couldn’t wait. He has diabetes, a condition that makes him more likely to experience complications from COVID-19. Ultimately, he made appointments for himself and his wife at Prevea Health in early February and plans to cancel if his own ThedaCare clinic offers it to him first.
“It’s almost like you’ve got to scramble,” Rudat said. “Every man for himself.”
A nationwide ‘production problem’
Many of Wisconsin’s challenges aren’t unique. Across the U.S., the COVID-19 vaccination campaign has been hurt by underfunding and logistical challenges.
Gov. Tony Evers has repeatedly demanded federal health officials send more vaccine doses to Wisconsin and improve communication with states.
The federal government informs states just days in advance about how many doses they can expect to receive in the upcoming week. Wisconsin health officials then allocate those doses to more than 1,300 hospitals, pharmacies and local health departments that have enrolled as vaccinators.
“Could things have gone better? I suppose by a day or two, if everything worked perfectly,” Evers told reporters Thursday. But “at the end of the day, we’re driven by how many shots we have to put in the people’s arms.”
“If they’re not making enough, that is the problem,” he added. “At the end of the day, if we’re still fighting over needing three times as much as we have now, that’s a production problem.”
Chris Beyrer, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, said the national vaccination campaign has been hurt by lowerthan-expected supplies of vaccine due to difficulties in production. He said that although the U.S. had contracted to receive 20 million doses of the vaccine made by Pfizer and BioNTech, only 13 million doses have arrived.
“This is a period of vaccine scarcity,” Beyrer said. “We are not going to have enough vaccine to immunize all of the Americans who want to be vaccinated until May or June.”
He said the rollout has also been hampered by the extreme temperature requirements, especially the Pfizer vaccine, which must be kept between minus 80 degrees Celsius and minus 60 degrees Celsius.
The good news, however, is that additional vaccines that are easier to use should arrive soon. Beyrer predicted that the AstraZeneca vaccine should receive emergency use authorization before March, followed a little later by a fourth COVID vaccine made by Johnson & Johnson.
In the short term, however, little is expected to change. On Thursday, Willems Van Dijk said the state expects it will continue to get around 70,000 doses per week for the next month.
Wisconsin’s slow start
Data compiled by the U.S. Centers for Disease Control and Prevention suggests that Wisconsin has lagged behind its Midwestern neighbors in the vaccine rollout, leading to criticism from Republican lawmakers.
As of Thursday, Wisconsin ranked 10th among 12 Midwest states in the percentage of the population that had received at least one dose, ahead of Missouri and Illinois.
State health officials have pointed out that the CDC figures are slower to update than the state’s own data. In addition, DHS officials say the disproportionately large number of Wisconsinites in assisted living has prevented them from getting more shots into arms.
That’s because the federal program for long-term care residents requires states to reserve enough doses for every resident before starting immunizations. For Wisconsin, that meant banking 140,000 doses before activating the assisted living part of the program, which begins Monday. Wisconsin will be one of the last states to begin vaccinating assisted living residents.
West Virginia, the only state that declined to participate in the federal program, is also among the states that have been fastest at vaccinating residents.
As of Friday, Wisconsin has administered 310,256 doses of the coronavirus vaccine, including 56,680 second shots.
Republicans who control the state Legislature are hammering Evers and the state health department over their progress.
Assembly Health Committee Chairman Joe Sanfelippo, R-New Berlin, said earlier this month it was “unacceptable” to wait until early summer to begin vaccinating the general public, as state health officials have estimated. He proposed a bill to make vaccine available to the general public by mid-March.
Patrick Remington, a former CDC epidemiologist who runs the preventive medicine residency program at UWMadison, said the patchwork vaccine rollout is a product of a decentralized and underfunded public health system
at the federal, state and local levels.
That’s why many states, including Wisconsin, are relying on private hospital systems and health insurers to assist with tasks that are government duties in other countries, he said.
Many Americans oppose a more centralized government, Remington said. “But the price we pay is the inefficiency during a crisis. When we want systems to be uniform and coordinated and consistent, we find we don’t have them.”
Opening the gates leads to confusion
Wisconsin began its vaccine rollout with a more conservative approach, limiting eligibility to health care workers and long-term care residents while other states opened the gates to essential workers or the elderly.
But that changed Tuesday when state health officials announced that more than 1 million Wisconsinites ages 65 and older would be eligible starting Monday, following shifting federal guidelines.
The state’s announcement came as a surprise to some local health officials, who said they were soon overwhelmed with calls.
At a media briefing Tuesday, DHS officials acknowledged there would be “a little bit of messiness in the beginning” and told people to reach out to their local health departments, doctor or pharmacy for appointments.
But many people reported that their doctors or local health departments had little information to offer. One doctor said she didn’t know how to get doses for the people calling to schedule appointments. Some health systems explicitly asked patients not to contact them and said they would reach out when ready.
In Sheboygan, several patients with Ascension’s Marsho Clinic called a Green Bay Press-Gazette reporter seeking information about how to get the vaccine.
According to the patients, the clinic had no information about how to get immunized, and instead sent them the reporter’s article about a Prevea Health vaccine clinic and the reporter’s contact information.
In a statement, DHS spokeswoman Elizabeth Goodsitt said all health care providers who are registered as vaccinators with the department received an alert about the announcement. Those that have not yet enrolled to be vaccinators can still do so, she said.
Goodsitt added that DHS holds forums with local health departments multiple times a week.
On Thursday, Willems Van Dijk said the number of shots requested by providers had doubled since the announcement and encouraged people who hadn’t gotten an appointment to try again in a few weeks.
Doctors and pharmacies are “getting ready,” she said. “I’d say to that person, give a call in another week or two and I think you’ll get another answer.”
State health officials said creating a statewide lottery system for vaccines would be difficult because of Wisconsin’s locally controlled public health system. However, DHS is working with Microsoft to create a centralized registration site that will be ready by mid-February to connect Wisconsinites with vaccinators, Willems Van Dijk said.
Doug Fisher, a Marquette University emeritus professor of business who specializes in supply chain issues, criticized the state’s lack of communication and confusing distribution channels.
He said he attempted to sign up for vaccine appointments on three different websites — Froedtert, the grocery chain Meijer and the City of Milwaukee.
“This is a state-by-state execution issue which right now doesn’t look all that promising,” Fisher said.
“Right now, I’m just trying to see who answers first.”
Who’s next in line?
The next round of vaccines will likely include educators, grocery workers, prisoners, public transportation workers and adults with disabilities, in addition to people 65 and up and first responders.
DHS is expected to make a final decision on this second phase, known as Phase 1B, early next week.
The department’s 17-member vaccine committee, responsible for recommending which groups of people to prioritize, originally hoped to keep the phase relatively small so the rollout would be more organized.
But in the interest of speed and keeping up with changing CDC recommendations, DHS jumped ahead of its own committee twice by letting police and fire personnel start vaccinations, then people 65 and up.
The proposed Phase 1B has since swelled to an estimated 1.6 million people, a third of Wisconsin’s adult population.
Many other vulnerable people, including other types of essential workers and those with high-risk medical conditions, are likely to be included in the third round, Phase 1C.
Public health experts warned that the rush to get shots into arms as quickly as possible is likely to highlight socioeconomic disparities.
In Milwaukee County, local leaders have raised concerns that the majority of vaccines have so far been administered to younger, white residents, even though COVID-19 tends to disproportionately affect Black, Hispanic and Native communities.
Remington noted that most of the vaccines in Wisconsin are currently flowing to hospital systems, with health officials directing people to talk to their doctors to get an appointment.
That means the vaccine is likely to go first to people who “have a primary care provider. They have a MyChart (phone app). They have the Internet connection,” said Remington. “Those are the people who are going to be served first.”
Biden promises changes, but hurdles are ahead
Medical professionals are hoping that the change in administration will mark a new approach to the pandemic, including the vaccine campaign, for which President Joe Biden has set an ambitious goal.
“The 100 million doses in 100 days would more than double what we’re currently doing,” said Ajay Sethi, an epidemiologist and associate professor of population health at the University of Wisconsin-Madison.
“The details need to be supplied, but the goal signals that the administration is taking on the challenge.”
Sethi said that the federal government must coordinate money and guidance for vaccinations and come up with a general plan that can be adapted to work in different local communities.
Biden plans to use the Defense Production Act to increase vaccine supply and work with states to create vaccine centers in large facilities, like stadiums.
At the local level, Sethi said vaccination centers should have an alternate “go-to” list of vaccine recipients that will allow them to ensure that any doses left at the end of the day are used, not wasted. Like other health experts, Sethi stressed the importance of allowing scientists and medical experts to play a central role in decision-making about the pandemic.
“The administration has elevated the director of the Office of Science and Technology Policy into a cabinet-level position,” he said. “Having somebody speaking on science and technology and speaking at the cabinet level is a good sign.”
Benita Mathew of the Green Bay Press-Gazette and Molly Beck and Patrick Marley of the Milwaukee Journal Sentinel contributed to this report.