IN THE VACCINE RACE, ‘SIMPLICITY IS A VIRTUE’
Access to a COVID-19 vaccine depends largely on where you live
Through the icy hollows of West Virginia, members of the Army National Guard are driving precious doses of COVID-19 vaccines to the state’s independent pharmacies. So far 6 of every 100 residents have received the vaccine, making this poor and rural state the nation’s leader at getting shots in arms.
Halfway across the country, South Dakota has taken a very different yet equally effective approach: Divvying up its 66 vast and windswept counties among its major health care plans, it tasked each plan with vaccinating every resident in its assigned counties, using well- established courier services.
In contrast, the tech-savvy, populous and economic powerhouse of California has given only 2 doses per 100 residents, even though it has received roughly the same amount of vaccine, per capita, as
those other states. The Golden State is relying on an ambitious but complex tiered priority system. Residents complain of poor messaging and confusion about who is eligible, saying they don’t know when, how and where to go for vaccination.
Even as the federal government Tuesday called for loosening eligibility for vaccines to accelerate lagging distribution,
access to a lifesaving COVID-19 shot depends largely on where in the nation you live. In some states access is more simple and straightforward, and vaccination rates are higher.
“It’s become a very complex web across the country, with differences not just across states but even within states,” said Jennifer Kates of the Kaiser
Family Foundation, where she studies state vaccination policies.
“Local flexibility is important, to some extent. Different states have different needs,” she added. “But with … lots of differing rules and plans, it’s very hard for people to figure out what is happening and know what to do.”
On Tuesday, in an effort to expand access, the federal Depar tment of Health and Human Services urged states to provide the vaccine to anyone 65 or older, as well as to adults who have a preexisting condition that puts them at greater risk for severe illness. The change will sharply increase the number of people eligible for the shots, but also put further pressure on states with struggling distribution networks. It could also sow confusion, because
states are already in the process of vaccinating different groups, based on their own criteria.
The federal government also promised to make more doses of the vaccine available immediately, rather than hold them back for second doses, and it urged states to do the same.
Experts say that part of the challenge with speeding up vaccination programs in California, New York, Florida and other hard-hit states may be that responsibility has percolated down to the local people and places that are overwhelmed by the pandemic. Those local health officials may lack funding and resources to carry out efficient vaccination campaigns. They may be saddled with demanding protocols and paperwork.
To make matters worse, vaccine deliveries are often sporadic and not finalized until the last minute — making it difficult for local health departments to plan when and where to administer
the doses.
“T he federal government has delegated to the states and the states have delegated to hospitals and health systems,” said health care consultant Dav id Johnson of 4sight Health.
Some of the most successful rollouts “see simplicity is a virtue,” he said. In the nation’s smaller and less populated regions, it’s much easier to keep track of vaccines and get them where they’re needed.
Blaire Bryant of the National Association of Counties said that while some regions across the country are able to get the funding and supplies they need, “other states and counties just don’t have the resources.”
Rural regions face geographic challenges but they also may have less demand, she said. Whereas in urban regions, such as densely populated counties in California with high COVID-19 caseloads, “vaccines are in high demand,” she said.
Across the nation, the
rollout has been a study in contrasts.
On the day F lor ida opened its phone lottery lines, seniors looking for a vaccine got a busy signal instead. Broward Health, a major hospital system, announced that all appointments are booked through February. There were long lines, disappointment and confusion.
“You had a better chance of picking the five winning numbers on Powerball,” wrote Norm Kent, publisher of the South Florida Gay News. “South Floridians are discovering ‘ Operation Warp Speed’ might have been better named ‘Operation Lost Turtle.’ ”
In northern Kentucky’s Owen County, a historic place of rolling hills, hardwood forests and a population the size of Capitola, septuagenarian Tona Johnston Barkley placed a call to her health department, asking where she was in line. They’d have to look it up and get back to her, they said.
“She called back in just a few minutes, and said ‘ We had some cancellations, so y’all come in,’ said Barkley, an artist and grandmother. “So we got in the car and went up there.”
West Virginia, locked in a long, sputtering economic decline after decades of coal mine and steel mill closures, resisted the federal offer to distribute vaccines to nursing facilities through CVS and Walgreens.
Instead, it turned to its 50 independent pharmacies, which already have existing relationships with the nursing homes. Using an efficient hub-and-spoke model, it enlisted the National Guard to deliver the vaccine from five geographic “hubs” to pharmacies — and within hours, they were delivered directly to facilities. It’s now finished with this group, and is vaccinating teachers and staff.
“We ended up having more pharmacies that wanted to help than we
actually had ( long- term care) facilities,” said Marty Wright of the West Virginia Health Care Association.
South Dakota is now vaccinating 50,000 EMS and front- line public health workers, law enforcement and correctional officers. T here’s been a unique amount of cooperation among its three big three health systems, Avera , Monument and Sanford.
“We sat down with the other health care systems and the state of South Dakota and mapped out — county by county — which system is vaccinating which county,” said Dr. Mike Wilde, vice president medical officer for Sanford Health in Sioux Falls, South Dakota.
“We’re certainly competitive in other areas, but when it comes to the greater good of getting the folks taken care of, we are going to cooperate,” he said.