Vaccine experts say eligibility rules will become an ‘obstacle’
Priority groups were a necessity for starting the vaccine rollout efficiently in Pennsylvania, especially given the fact there aren’t enough doses to go around. But as the rollout progresses, some experts say the guidelines are slowing distribution when strictly followed.
“The question is: Is it becoming an obstacle to getting vaccines into people’s arms? And I think, in some situations, it has,” said Dr. Amesh Adalja, a Pittsburgh infectious disease expert. “You can’t really have a mass vaccination program when you have everyone adjudicating, ‘Is this person eligible? Is this person not eligible?’ ”
About 11.3% of Pennsylvanians have gotten one dose, with less than 4% of the roughly 12.8 million residents in the state having received two doses of a vaccine. State officials last week announced a number of new requirements for providers meant to speed up the distribution, then days later announced a mix-up would cause 55,000 second doses of the Moderna shots to be delayed.
Vaccine providers are already dealing with a “sea of problems” in the rollout, including a lack of predictability in how many doses they’ll receive — and when. The transparency problem leads to errors in how providers plan for clinics, avoid duplicating each others’ efforts and administer doses quickly, Adalja said.
Pharmacists and hospitals sometimes find themselves with extra doses at the end of a clinic day, and they don’t have any person in the priority groups to give it to. Flexibility in the guidelines is crucial now more than ever, Adalja said, given new requirements that providers use 80% of each allocation within seven days of receiving it, and with winter storms keeping people from making their appointments.
There’s also the added challenge of coordinating with different groups — the elderly, those with health conditions, first responders, teachers, other frontline workers — which creates a balancing act for providers just trying to get the vaccine out as quickly as possible.
“It is important, in general, to vaccinate people who are most likely to have severe consequences of the disease first. But there are other considerations,” Adalja said. “Everybody wants this scarce resource.”
Waiting their turn
As of Wednesday, just one of the 40 workers at Naser Foods, a supermarket in Westmoreland County, had been vaccinated, according to manager Diane Espey. She said the worker, who qualified for Phase 1A because of her age, was able to get her shot at a local pharmacy.
Otherwise, “Nobody can get them,” Espey said.
She said the staff can only “follow all the rules the best we can” while vaccines largely remain beyond reach.
“We’re wearing masks and asking our customers to wear masks,” Espey said. “The cashier cleans the register after so many customers and we try to keep 6 feet apart.”
She noted staff who were exposed to the virus outside of work were required to quarantine for 10 days.
Though educators are in Phase 1B, a number of school districts across Westmoreland County have started vaccinating teachers and other staff through local pharmacies. Those include Greater Latrobe, Greensburg Salem, Ligonier Valley, Mt. Pleasant Area and others.
About 81% of Greater Latrobe’s 420 employees have received an initial dose of the Moderna vaccine, according to Assistant Superintendent Mike Porembka. The shots were provided by The Medicine Shoppe, after the Latrobe pharmacy administered shots to many first responders from throughout the county as part of Phase 1A.
Greater Latrobe recipients also included 23 school bus drivers and 21 staff members at the Eastern Westmoreland Career and Technology Center. The district has planned two dates this month for the recipients to receive second doses.
“We offered this regardless of age, years of seniority or medical conditions,” Porembka said of the clinic. “We got a wide variety of participants.”
While some district staffers weren’t able to take advantage of the clinic, Porembka estimated an additional 4% were able to obtain shots on their own.
At the Greensburg KinderCare preschool and day care, just one staff member has been vaccinated by meeting Phase 1A eligibility. Director Bonnie Corey said the remaining 14 staffers all want to follow suit as soon as shots are available under the next phase.
“I cannot wait to get the vaccine,” she said. “I’ve reached out to my pharmacist.”
Just guidelines
Though state and local health officials have promised equity in the distribution, planning to target especially at-risk groups first, many providers are using their own discretion in the guidelines. Some, including Allegheny Health Network and the Allegheny County Health Department, are still limiting appointments to the elderly while supply remains an issue. Teachers and first responders in some parts of the region, including Westmoreland County, have gotten inoculated through community pharmacies, despite the state still being in phase 1A.
Equity is the goal, but Adalja said it can’t be used as a crutch that slows the effort as a whole.
“The end result is the same, you want everybody vaccinated,” he said. “We can’t allow those types of process considerations be something that actually hampers the ability to actually end this pandemic.”
Dr. Mark Roberts, professor of health policy and management and director of the Public Health Dynamics Laboratory at the University of Pittsburgh Graduate School of Public Health, said the prioritization guidelines could never be perfect — they’re a complex balance between fairness and risk.
“It doesn’t bother me that ICU nurses get vaccinated even though, if you actually look at the risk of an ICU nurse picking up COVID, it’s really low because they work really carefully,” he said. “It’s not risk, as much as it is this notion of fairness: that people who are putting their lives out there every day, taking care of COVID patients, we have a responsibility to protect them.”
Much of the difficulties caused in the distribution as it’s going now were caused by the supply issue — more people are eligible for the vaccine than there are doses available, and there’s no way around that. But Roberts noted, there seems to have been very little planning on the state and federal level early on in the vaccine rollout. There was a lack of attention to detail and logistics in the prior presidential administration, and now, he said it’s hard to “put that cat back in the bag.”
“In the United States, we have a very disaggregated health care system, and I think one of the things that happened in the United States — which was a problem in containing the outbreak for lots of reasons, and from doing diagnostic testing and vaccination — we’ve sort of let that responsibility go down to individual health care systems, individual states, individual counties.”
Without clear federal, centralized controls, it’s difficult to have a system that treats everyone the same. That’s why in some parts of the country, it’s still difficult to even get a COVID test unless you’re symptomatic, Roberts said.
“Those kinds of differences just don’t make sense,” he said.
Adalja said the solution is to treat the guidelines just as their name suggests: guidelines. More flexibility is needed to speed the vaccine rollout — which almost all groups agree is moving to slow in Pennsylvania.
“That lack of flexibility,” Adalja said, “is not the right way to go about it.”