Northwest Arkansas Democrat-Gazette
States face pressure on access to vaccine
Just weeks into the U.S.’ coronavirus vaccination effort, states have begun broadening access to the shots faster than planned, amid tremendous public demand and intense criticism about the pace of the rollout.
Some public health officials worry that doing so could create chaos in the complex operation and increase the likelihood that some of the highest-risk Americans will be skipped over. But the debate over how soon to expand eligibility is intensifying as deaths from the virus continue
surging, as hospitals are overwhelmed with critically ill patients, and as millions of vaccine doses delivered last month remain in freezers.
Governors are under pressure from their constituents to get their states’ doses into arms swiftly. President-elect Joe Biden’s decision, announced Friday, to release nearly all available doses to the states when he takes office Jan. 20, rather than holding half to guarantee each recipient gets a booster shot a few weeks after the first, is likely to add to that pressure.
Some states, including Florida, Louisiana and Texas, have already expanded who is eligible to get vaccinated now, even though many people in the first priority group recommended by the Centers for Disease Control and Prevention — the nation’s 21 million health care workers and 3 million residents of nursing homes and other long-term care facilities — have not yet received shots.
On Friday, New York became the latest state to do so, announcing it would allow people 75 and older and certain essential workers to start receiving a vaccine Monday.
But reaching a wider swath of the population requires much more money than states have received for the task, many health officials say, and more time to finetune systems for moving surplus vaccine around quickly, to increase the number of vaccination sites and people who give the shots, and to establish reliable appointment systems to prevent endless lines and waits.
Some states’ expansions have led to frantic and often futile efforts by older people to get vaccinated. After Florida opened up vaccinations to anyone 65 and older late last month, the demand was so great that new online registration portals quickly overloaded and crashed, people spent hours on the phone trying to secure appointments, and others waited overnight at scattered pop-up sites offering shots on a first-come, first-served basis.
Similar scenes have played out in parts of Texas, Tennessee and a handful of other states.
Still, with CDC data suggesting that only about onethird of the doses distributed so far have been used, Alex Azar, the health and human services secretary, told reporters last week that “It would be much better to move quickly and end up vaccinating some lower-priority people than to let vaccines sit around while states try to micromanage this process. Faster administration would save lives right now, which means we cannot let the perfect be the enemy of the good.”
CDC GUIDELINES
The CDC guidelines were drawn up by an independent committee of medical and public health experts that advises the agency on immunization practices; it deliberated for months about who should get vaccinated initially, while supplies are still very limited. The committee weighed scientific evidence about who is most at risk of getting very sick or dying from covid-19, as well as ethical questions, such as how best to ensure equal access among different races and socioeconomic groups.
Although the committee’s recommendations are nonbinding, states usually follow them; in this case, the committee suggests that states might consider expanding to additional priority groups “when demand in the current phase appears to have been met,” “when supply of authorized vaccine increases substantially,” or “when vaccine supply within a certain location is in danger of going unused.”
Dr. Kevin Ault, an obstetrician at the University of Kansas Medical Center who serves on the advisory committee that came up with the CDC guidelines, said it was reasonable for states to start vaccinating new groups before finishing others but that they should be careful about exacerbating inequities and biting off more than they can chew.
After the first vaccinations were given in mid-December, a dichotomy emerged between governors who were adhering precisely to the guidelines and others who moved quickly to populations beyond health care workers and nursing home residents.
Until Friday, Gov. Andrew Cuomo of New York, a Democrat, had threatened to penalize hospitals that provided shots to people who are not health care workers. By contrast, Gov. Ron DeSantis of Florida, a Republican, traveled to retirement communities around his state to emphasize the importance of getting people 65 and older, who number more than 5 million there, immunized quickly.
“In Florida, we’ve got to put our parents and grandparents first,” DeSantis said at The Villages, the nation’s largest retirement community, just before Christmas.
Decisions on how soon to expand eligibility for the shots have not fallen neatly along partisan lines.
Gov. Larry Hogan of Maryland, a Republican, announced Tuesday that he would immediately switch to what he called the “Southwest Airlines model” for vaccine allocation, referring to the airline’s open seating policy. “We’re no longer going to be waiting for all the members of a particular priority group to be completed,” he said, “before we move on to begin the next group in line.”
Gov. Mike DeWine of Ohio, a Republican, urged patience in a news briefing Tuesday as he declined to estimate when the state would start vaccinating people beyond the first priority group.
“We’re asking every health department, ‘Don’t go outside 1A [the first priority group]; stay within your lane,’” he said, adding about the vaccines, “This is a scarce commodity.”
By Thursday, DeWine had set a date for people 80 and older to start getting the vaccine — Jan. 19 — and said he would phase in everyone 65 and older, as well as teachers, by Feb. 8.
SLOW START
The reasons so many doses received by states have not yet been administered to the first priority group are manifold. The fact that vaccination began around Christmas, when many hospital employees were taking vacation, slowed things. More health care workers are refusing to get the vaccine than many of their employers expected, and some hospitals and clinics received more doses than they needed but felt constrained by state rules from giving them to people outside the first priority groups. Some initially worried they could not even offer leftover doses in open vials to people in lower-priority groups, so they let them go to waste.
And federal funding for vaccination efforts has been slow to reach states and localities. They got only $350 million through the end of last year, a little more than $1 per resident of the country. The economic rescue package that Congress passed in December included $8 billion for vaccine distribution that state health officials had long sought, but the first tranche of it, about $3 billion, is only now starting to be sent out.
“There was great funding in the development of these products, great funding in the infrastructure to ship them and get them out,” said Dr. Steven Stack, commissioner of the Kentucky Department for Public Health. “But then there was no funding provided of meaning for administering the vaccine, which is the last mile of this journey.”
Pfizer and Moderna have pledged to deliver enough vaccine doses for 100 million people to each get the two necessary shots by the end of March, and many more in the second quarter. Several other vaccine candidates are far along in the pipeline and, if approved for emergency use in the U.S., could help ramp up distribution more quickly.
CALIFORNIA SURGE
A sustained surge of infections has locked Southern California in crisis, overwhelming intensive care wards, ambulance services, funeral homes and local officials.
Dozens of overcrowded hospitals have had to shut their emergency room doors to ambulances for hours at a time. Medical wards are running dangerously low on oxygen and the portable canisters to supply it to patients. Los Angeles County has a coronavirus-related death every eight minutes.
“We’re having our New York moment,” said Dr. Robert Kim-Farley, an infectious disease expert at the UCLA Fielding School of Public Health, referring to the weeks in March and April when New York City was the epicenter of the virus.
It took nearly 10 months for Los Angeles County to hit 400,000 cases, but little more than a month to add another 400,000, from Nov. 30 to Jan. 2. In the coming days, the county, the nation’s largest, is expected to reach a level where 1 in 10 residents has tested positive for the virus.
Los Angeles County averaged 187 deaths a day in the seven-day period ending Friday, the most of any American county and double the nation’s per capita rate.
Hospital leaders urged Gov. Gavin Newsom to temporarily suspend some regulatory requirements so that doctors and nurses “can focus on patient care and not on paperwork.”
“It is challenging when we are in the circumstance that we are in, especially in Southern California, in the San Joaquin Valley, where we have zero ICU capacity left,” said Carmela Coyle, president and chief executive officer of the California Hospital Association, in a teleconference with news reporters Friday.
“We are creating surge capacity within those hospitals, taking care of those who are most acutely ill, and yet we are still having to deal with day-to-day regulations that we might deal with under normal circumstances.”
U.K. DECISION
Faced with soaring hospitalizations and deaths, Britain is launching a campaign to combat a ferociously infectious variant of the coronavirus by spacing the first and second doses of approved vaccines out over months instead of weeks.
The full plan will be published by the government Monday, but the decision to alter the recommended vaccination schedules will apply to the entire population, including the elderly and health care workers.
Without enough doses immediately available, public health officials are betting that crucial second injections of two approved vaccines can be pushed back from their recommended waiting intervals — 21 days for Pfizer and 28 days for AstraZeneca — to 84 days for both.
The government’s science advisers say there is little choice, given the explosion in cases, even as they acknowledge that delaying the second dose involves risk. Clinical trials did not test the efficacy of the vaccines when administered on such an elongated schedule.
When Britain first proposed a three-month wait between doses, scientists in the United States, Europe and at the World Health Organization expressed skepticism.
The Food and Drug Administration last week said it would be “premature” and “not rooted solidly in the available evidence” to change the way the two authorized vaccines are administered.
Then Biden weighed in Friday with his promise to release nearly all available doses — though his spokesman did not say the plan, to be spelled out in detail this week, would entail delays in people getting their second doses.
Limited data suggests a single shot of the Pfizer or AstraZeneca vaccine affords some protection against disease. For example, the first shot of the Pfizer vaccine was 52% effective in the three-week interval before people received the booster shot. Similar results were described for the Moderna vaccine, which British regulators approved for emergency use Friday.
But it is not known how long the protection lasts.
To ensure vaccines get to the right place at the right time — along with the syringes, alcohol swabs and protective equipment needed to administer them — the British government has called in the army.
Brig. Phil Prosser is leading the response. He is commander of the 101 Logistics Brigade, which normally delivers supplies to British forces in war zones.
“My team are used to complexity and building supply chains at speed in the most arduous and challenging conditions,” Prosser said at a briefing Thursday. “In this case, the mission is to support the NHS [National Health Service] in delivering the maximum amount of vaccine to minimize the number of infections and deaths as quickly and as safely as possible.”
The stakes are high for Prime Minister Boris Johnson’s government as it battles the virus variant that has swept across Britain, forcing it into a third national lockdown.
MEASURES IN ASIA
In China, authorities have asked residents in two cities south of Beijing to stay home for seven days as they try to stamp out an outbreak in which more than 300 people have tested positive in the past week. The cities of Shijiazhuang and Xingtai in Hebei province are restricting people to their communities and villages and have banned gatherings.
Vaccine shots will be free in China, where more than 9 million doses have been given to date, health officials in Beijing said Saturday. “Ordinary people will not need to spend a penny,” Zheng Zhongwei, a National Health Commission official, said at a news conference. The announcement cleared up confusion created nine days ago when Zheng said shots would be affordable.
In India, the world’s second-most-populous country, a vaccination drive will kick off Saturday. The Health Ministry said priority will be given to health care and frontline workers, whose numbers are estimated to be around 30 million.
In Japan, several regional governments — Osaka, Kyoto and Hyogo prefectures in central Japan — have asked for a state of emergency declaration like the one issued by the prime minister for the Tokyo area. A government panel of medical experts is to study the situation.
In Sri Lanka, prison authorities have decided to free more than 100 prisoners serving jail terms because of their inability to pay fines, in an attempt to contain the spread of the virus in the crowded facilities. Authorities have been releasing prisoners on various grounds since December. So far, 10,227 prisoners have been released.
Information for this article was contributed by Abby Goodnough, Manny Fernandez, Thomas Fuller and Mitch Smith of The New York Times; by William Booth, Carolyn Y. Johnson and Siobhan O’Grady of The Washington Post; by Danica Kirka and staff members of The Associated Press; and by Cathie Anderson of The Sacramento Bee (TNS).