Where are the shots?
Reporting lags, complex logistics complicating Pa.’s vaccine rollout
For frustrated Pennsylvanians eager for COVID-19 vaccinations, the gap between two key numbers — the doses distributed across the commonwealth and those actually injected in arms — is fueling a widespread question: What’s the holdup? By Saturday, inoculation providers statewide had reported administering just more than 1 million doses of vaccines, or about 52% of the nearly 1.98 million doses known to be distributed to Pennsylvania, according to reports from the federal
Centers for Disease Control and Prevention. That trailed the national injection rate by about 7 percentage points.
While Gov. Tom Wolf said last week the state was working to understand and improve Pennsylvania’s middling rank in the rollout, health officials and providers emphasized they aren’t stockpiling vaccine. Rather, they said, several natural factors likely are contributing to the apparent gulf between distributed and administered doses.
Those factors include the supply set aside for vaccination appointments scheduled over the next few weeks — including visits for second doses of vaccine — along with lags in reporting completed injections to government authorities, health experts said.
Further, they said, unpredictable allocations of vaccine from the federal government in recent weeks made it difficult for many health care providers to plan very far. Pennsylvania has taken a decentralized approach to vaccine administration, engaging local pharmacies and other providers to schedule and administer the inoculations independently.
“We’re not necessarily
holding anything back. We’re making sure we can account for every appointment we can book based on the current allocation,” said Dr. Brian M. Parker, chief quality and learning officer at Allegheny Health Network.
The Pittsburgh-based system, which includes Allegheny General and West Penn hospitals, has been allocated anywhere from 4,000 to 6,000 first doses of vaccine — and amounts in the same range for seconddose vaccine — each week, Dr. Parker said. Both the Pfizer and Moderna vaccines now in use require two shots to complete the vaccination process.
Dr. Parker said the vaccines’ complexity slows the logistics in administering the shots once they arrive at a vaccination site. Both formulas are highly sensitive to temperature and need to be injected within a specific window, introducing issues “at the end of the supply chain that are different from just manufacturing it, boxing it and sending it,” he said.
Further, providers need to adjust staffing to set up vaccine clinics, often without much logistical support from the state, Dr. Parker said.
“There are always logistics that have to be worked out in order to deliver the vaccine safely,” Dr. Carol Fox, chief medical officer at Greensburg-based Excela Health, said in a statement. “We have to maintain social distancing at the vaccine distribution site itself, and, of course, we have to ensure that those patients being vaccinated remain distanced from other patients receiving services.”
Then, there’s the matter of those second doses.
“I think a lot of [providers] are being very conservative to make sure they have a second dose rather than treat every vaccine as ‘Let’s get it out there and get it into somebody’s arm — and hope we can get an allocation that covers us’ ” for second doses in a few weeks, Dr. Parker said.
As for reporting, it can take as many as three days for completed shots to be reported to the state and added to public vaccination counts, according to the state health department, which shares data with the CDC. Providers have 24 to 72 hours to report the inoculations, depending on their particular role in the vaccination effort, acting state health Secretary Alison Beam said.
Health leaders including Dr. Debra Bogen, the Allegheny County health director, have cited lags in reported data reaching public tallies.
“The most important thing for Pennsylvanians to remember is that vaccine providers are working as quickly as possible to vaccinate you,” Ms. Beam said in a news briefing last week. “The demand for vaccine far outweighs the supply, but we will catch up. We must be patient.”
Pennsylvania has a team exploring other states’ approaches to vaccination and remains open to employing different strategies, she said. Likewise, Mr. Wolf said the state is “more than willing to consider” a more centralized method if evidence emerges to support it.
But the biggest challenge remains vaccine supply, the governor said. Vaccinating all Pennsylvanians in the Phase 1A category — which includes health care workers and everyone age 65 and older — would require roughly 8 million doses of the Pfizer and Moderna inoculations.
The state was on track to have received 1.8 million total doses by Saturday, state health spokeswoman April Hutcheson said Friday. Pennsylvania expects to receive 163,000 first doses of vaccine this week, up from 143,275 last week, according to the health department. (State-level numbers generally do not include vaccines received in Philadelphia, which has its own allocation, or federal installations in the state.)
Ms. Hutcheson said that reflects the increase that President Joe Biden’s administration has discussed. Last week, the administration said states will see a 16% increase in vaccine supply for each of the next three weeks — for a minimum of 10 million doses a week.
The improvement should give states “visibility they had lacked to know how many vaccines are coming in,” said Andy Slavitt, a senior adviser to the White House COVID-19 Response Team. Federal officials also are working to “tighten up [reporting] timelines” for vaccinations and understand when they’re completed, Dr. Rochelle Walensky, the CDC director, said in a briefing.
The Biden administration has committed to increasing vaccine supplies, including through the president’s use of the Defense Production Act to accelerate availability.
“States are getting better. The federal government is ramping up its support,” said Jeff Zients, the White House’s COVID-19 response coordinator. “We’ve got a long way to go.”