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Deploying COVID-19 vaccines across Alabama at lightning speed was always going to be a challenge. But that state effort was hampered by federal communications errors, misunderstandings, and confused federal guidance during the Trump administration’s final gasps.
From initially implying that states would receive more vaccines than they did, announcing policies and never implementing them, to running out of vaccine stock and problems securing funds of the CARES Act in Alabama, the state’s difficult task of receiving gunfire was not made any easier.
N ° 1: Expected dose reduction
Dr. Scott Harris – Alabama state health official and head of the Alabama public health department, which distributes the vaccine to hundreds of hospitals, pharmacies, and clinics in Alabama – a said from the early days of the deployment that the biggest hurdle was that Alabama didn’t have enough vaccine doses.
From the start, the federal government asked states to plan to deliver a certain number of doses as quickly as possible. But planning can’t go that far if there isn’t a product to deploy.
Harris said Alabama initially expected 112,000 doses during the first week of the deployment in December. But then, when it was time for the vials to be shipped, Alabama found out it was only getting 41,000 doses.
“We had a communication from the federal level that Alabama was going to have a lot more vaccines, well not Alabama, every state, had the idea that they were going to get a lot more vaccines than they have. finally received, “Harris said Friday. “I guess it has to do with optimistic forecasting and ultimately the inability of manufacturers to keep up with this I guess.
Harris said the CDC told states later that early vaccine figures were only used for planning purposes.
“The response from the CDC when we ask is, well, we never told you you got 112,000, we just told you to plan like you got 112,000,” he said.
# 2: states don’t know how many doses they’re getting week-to-week
Planning is much easier when you know what to expect, and ADPH doesn’t know it yet.
Harris said the state did not know from week to week how many doses it would receive in the state, so it was difficult to divide it among the more than 800 facilities now registered to administer the vaccine.
“We don’t know what we’re getting either until the day before we receive it, or at least until the day before it’s shipped to us,” Harris said. “It’s very frustrating for people who try to run clinics, you know.
“It’s difficult to make an appointment when you don’t know if you’re going to be vaccinated or not.”
Then, once the shipments were announced, Harris said it created a state-level frenzy to figure out where those doses needed to go.
“When we find out what our total state allocation is, we have people who have to scramble frantically, working most of the night, to figure out how these doses are distributed and where they go, as they start to ship, the next day or so, ”Harris said.
N ° 3: The non-existent stock
On January 12, eight days before Joe Biden’s inauguration, officials in the outgoing Trump administration announced that it would no longer hold vaccine reserves for second doses.
Then-Health and Human Services Secretary Alex Azar announced at a high-profile press conference that the CDC would release the doses it had in store for immediate distribution.
“Because we now have a constant production rate, we can now ship all the doses that had been kept in physical reserve,” Azar said. “We are now fully stocking the doses available to order, [and] We are 100% committed to ensuring that a second dose is available for every American who receives the first dose. “
State officials believed this meant a new wave of shipments to hospitals and clinics.
This does not happen.
The Washington Post reported on Jan. 15 that in reality such a stock did not exist. The CDC had already shipped everything it had since December. States would not get additional deliveries after all.
“Our first thought was, ‘Oh, that’s great,’ Harris said. “Our allocation is likely to double and of course we hope that means there will be a second dose when we need it in three or four weeks.
“But that our understanding was – and everyone in the country – was not correct, because there was no second dose physically.
N ° 4: The funds of the CARES Act do not transit
Alabama has received significant funding for vaccine deployment through the federal CARES Act, but accessing this money is not always easy.
Harris said most of the federal money goes in the form of refunds. And the process hasn’t been smooth so far, Harris said.
“It was basically a line of credit, so it required us to spend money first and then submit it for repayment and their repayment rules weren’t always clear to us,” Harris said on Friday. .
“Right now, I think ADPH has somewhere close to $ 8 million in expenses that we don’t have the capacity to be reimbursed for so far. We’ll see if that changes soon. “
N ° 5: Change the rules, or just appear
At the same press conference where he announced that the empty stock would be released, Azar also announced that the federal government was changing the schedule, that instead of distributing vaccines based on population, the CDC would start. to give more vaccines to the states that gave them. it is the fastest.
“This new system is a strong incentive for states to ensure that all vaccinations are reported promptly, which is not currently the case, and … to ensure that doses work … to protect people, rather than to stay on shelves or freezers, ”Azar said.
But it looks like this change was announced, but never implemented. Azar said on Jan.12 that the policy was due to begin in two weeks, when he and others were only left with eight days of work.
While four Alabama lawmakers wrote an open letter to ADHD claiming the change would cost Alabama extra doses, given the state’s slower vaccination rate, Harris said no one gave him had never said under either administration that the state allowance would change.
“It was never discussed with us,” Harris said. “I have never had a conversation with anyone at the federal level about this. It has never been brought to my attention by anyone at the federal level.
Harris said he had been told in all of his communications with the CDC that states would receive the vaccine based on their population, not the number of doses they administered.
“We get a per capita allowance,” Harris said. “Alabama represents about 1.4% of the United States [population], we get 1.4% of the quantity produced. And that number is constant, and they told us so, won’t change anytime soon.
The CDC also relaxed its guidelines on second doses last week, suggesting that it might be acceptable for people to get their second injection 42 days after the first, instead of 21 or 28 days depending on the vaccine the person took. .
Some experts, including Dr Anthony Fauci, have warned that postponing the second dose may reduce the effectiveness of the vaccine and people are not fully protected for one to two weeks after that second dose.
# 6: the pharmacy program did not materialize
Alabama expected significant contributions from chain pharmacies like CVS and Walgreens through a federally administered program that would not fall out of Alabama’s allotment.
The idea was that these pharmacies would offer vaccination appointments at their retail stores across the state, providing an alternative avenue for Alabama residents to get the vaccine.
But this program has not yet materialized.
Now, Alabama says it is partnering with Walmart pharmacies to distribute the vaccine to those locations, but that’s not part of the federal program. These doses come from Alabama’s allocation that would otherwise go to hospitals or small medical centers.
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