Can county hospitals fix vaccine problems?
Vaccinations ground to a halt in Shelby County last week as winter weather unseen in the Mid-south for decades brought sub-freezing temperatures, snow, ice and sleet. The health department started to cancel appointments Feb. 11 and most vaccination sites remained closed through Saturday. On Friday, the health department announced more than 1,300 vaccine doses expired and were discarded amid the severe weather.
But the vaccination process was bumpy even before the storms, stymied by an error-plagued scheduling system resulting in alternating days of long lines and unfilled appointments at some sites, confusion about how to sign up and difficulty procuring second-dose appointments. And the health department last week announced it would follow the state in proceeding to phase 1b, vaccinating teachers and those 65 and older, despite ongoing struggles to vaccinate every person in phase 1a who wants a shot.
Management experts say drivethru vaccination sites are one of the best ways to administer mass vaccinations, provided supply is adequate and staffing is sufficient to rotate the nurses giving the shots multiple times a day.
Shelby County Health Department has largely been in charge of distributing vaccine doses locally. But the state has been asking hospital systems to start vaccinating more people outside their walls to quicken the pace of immunizations. The request has added
significance in Shelby County as medical experts warn the more contagious UK COVID-19 strain could soon be the dominant virus strain locally.
As of Sunday, 104,364 total vaccine doses had been distributed in Shelby County and 3% of the population had received two shots, according to the health department.
In letters sent to hospital systems last month, Tennessee Department of Health Director Dr. Lisa Piercey encouraged hospital systems to vaccinate community members.
“We believe that these decisions to vaccinate the most vulnerable will result in more rapid impact in rising death rates in the state as well as the strain on hospital capacity that you know too well,” she wrote in a Jan. 4 letter.
In a Jan. 27 letter, Piercey said the state was “focused on implementing the most efficient and convenient delivery methods to serve the population currently in phase.”
She acknowledged limited supply was a complicating factor for everyone, but said if hospitals wanted to receive supply beyond 1a, the facilities have to make vaccines available to people who are not employees and existing patients — including those without insurance. Hospitals also have to use all their allocation within a week and provide second shots to people even if they did not get their first shot at the hospital.
Shelby County Health Department Director Alisa Haushalter has said she eventually wants to see hospitals and pharmacies, rather than the health department, become the primary vaccine distributors locally.
State health department spokesperson Bill Christian said the state was working “more directly” with Memphis and Shelby County to expand access to COVID-19 vaccines at hospitals, pharmacies and clinics.
“(The Tennessee Department of Health) is able to allocate vaccines across qualified providers at its discretion, but not providing health departments with vaccines has not been considered,” he said. “Public health provides the vast majority of vaccine administration across the state.”
Limited community vaccinations
Memphis-area hospitals have periodically shared raw numbers of vaccine doses given, but have declined to say what proportion of employees have been vaccinated. However, hospitals have moved beyond vaccinating those with direct patient contact.
Morgan Jones, an inpatient critical care pharmacist with Methodist Le Bonheur Healthcare, said in early February vaccines were available to any employee who wanted them and employee vaccinations were ongoing. As of Feb. 3, the system had administered about 17,000 doses.
“As doses have become available, we have vaccinated a very limited number of community members who are at least 75 years old. But I do want to be clear: our focus right now is vaccinating employees,” he said in early February.
Regional One Health and Saint Francis did not respond to requests for comments about internal vaccination processes. Baptist spokesperson Ayoka Pond said no one in the hospital system was available to speak about the hospital system’s internal process for COVID-19 vaccinations and other regular vaccine distribution efforts.
However, at the beginning of February, Baptist Memorial Hospital-memphis had vaccinated about 1,000 patients and community members, she said. That was in addition to the more than 15,000 total doses distributed across the system to more than 9,000 employees. More than 4,000 of those employees vaccinated were in Shelby County. Those figures have increased since.
At least one person vaccinated at Baptist-memphis this month, who has a doctor affiliated with the system, said the process was efficient and easy to schedule. Many people who have been vaccinated at health department sites, or tried to sign up to be vaccinated at health department sites, have reported different experiences.
Some have expressed frustration with an inability to schedule using the vaccine hotline. Appointments available online often fill up within minutes of becoming available. Hours-long lines have been reported multiple days.
‘Grateful to have the vaccine’
Some with appointments, like Stephan Mclaughlin, have been turned away.
His first appointment went smoothly and Mclaughlin was scheduled to receive his second shot between 9:30 and 10 a.m. on Feb. 5 at the Pipkin Building. But when he got close to the front of the line, vaccine site workers told him they were out of the Moderna vaccine and he would have to reschedule.
“I’m not that frustrated. I’m scared... that’s the biggest thing,” he said after he was turned away. “The last thing I want to do is get COVID because I missed the vaccine.”
Mclaughlin said there is room for improvement in the vaccine rollout, but he added it was a massive undertaking and he hadn’t been expecting perfection. He urged other people waiting for the vaccine to be patient and said everyone had a part to play.
“I almost look at it like wartime, you know. So whether it’s wearing a mask or waiting in line, figuring out how to get the vaccine, we are so lucky that this thing is not worse and we are not literally dying in bigger numbers while we’re waiting to get the help,” he said. “I’m just grateful to have the vaccine out there already.”
He was able to get a vaccine the next day when he looked online to try to schedule the appointment for the next week. None were available, but he did see two unfilled appointments within the next hour and was able to get to the Pipkin Building in time.
Some changes to the local vaccination process meant to remedy situations like Mclaughlin’s are in the works.
The city of Memphis, which has been successfully running the Appling Road site, is taking over the Pipkin Building. Vaccine appointment registration will also soon transition to the state’s scheduling system, which is intended to be easier to use.
“As it stands right now, we’re administering between 10,000 to 15,000 doses per week,” said Memphis Mayor Jim Strickland in a recent weekly update. “The ultimate goal is to be able to accommodate the number of vaccines as the weekly allocation continues to grow to 30,000 or 50,000 a week, and we feel confident we have the right model to do it.”
Sunderesh Heragu, a professor in the school of industrial engineering and management at Oklahoma State University, said if the supply is adequate, a well-run drive-thru site could vaccinate up to 10,000 people a day.
He recently published a paper examining large vaccination efforts, including in Louisville during the H1N1 pandemic in 2009. At one site, 19,000 people were vaccinated in about a day and a half. About 12,000 of them were vaccinated at a drive-thru and 6,000 at a walk-up clinic.
Heragu found people preferred the drive-thru both because of convenience and because of a perception that being in their car was safer than being inside a clinic with other people.
“The big takeaway is that we can do mass vaccinations via a drive-thru clinic in pretty large numbers,” he said.
What could make one drive-thru more efficient than another in large part depends on staffing, Heragu said. The most important thing for running an efficient drive-thru vaccination site is having enough qualified nurses, which can include nursing students, to rotate shifts every about four hours, to prevent them from getting too tired.
“Size doesn’t matter as long as you have enough nurses,” he said.
Supply chain increases
Of course, the amount of vaccine distributed depends largely on the amount of vaccine received from the federal government. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said last week it would be “open season” for all Americans who want the vaccine by April.
President Joe Biden said recently the federal government had signed an additional contract to secure 100 million more vaccine doses from each Pfizer and Moderna by July. As both are twoshot regimens, that’s enough to vaccinate 100 million people.
Johnson & Johnson has promised to deliver 100 million doses by July. However, the company only has a few million doses on hand currently, said White House COVID-19 response coordinator Jeffrey Zients on a press call Wednesday. The company requested emergency use authorization earlier this month and the U.S. Food and Drug Administration is set to review the application for the one-dose vaccine on Feb. 26.
Dr. Bruce Randolph, health officer for the Shelby County Health Department, has said opening more sites before vaccine supply increases would not make the process more efficient. Once more vaccine supply is available, more vaccine sites will open in Memphis and he said he expects some of the kinks in the local vaccine rollout will work themselves out.
As supply increases, the health department plans to set up mobile vaccination sites to increase access for people who have transportation limitations and more doses are expected to flow to pharmacies like Walgreens and CVS.
But when pharmacies and healthcare providers become the primary vaccinating agencies, rather than the health department, remains to be seen.