Demand far outweighs supply right now. The U.S. Food and Drug Administration has authorized only Pfizer/ BioNTech and Moderna to make vaccines that prevent COVID-19. National experts say supply chain issues and a lack of federal coordination has slowed down distribution efforts across the country. States decide how to use their respective weekly allocation from the federal government. The rollout in Texas has been faster than most other states, but has also been marred by weeks of confusion amid miscommunication and technical issues.
There are just too many people trying to get in at the same time.
Most providers who are offering the vaccine are fully staffed with people to take calls when the word goes out that appointments are available, but because there's so many people who are eligible and want to get the vaccine — and there simply aren't enough doses to go around — that the lines are constantly flooded with calls.
Within its first three weeks, a whopping 8 million calls came in for appointments at WellMed's vaccine sites at the Elvira Cisneros Senior Community Activity Center, 517 SW Military Drive, and the Alicia Trevino Lopez Senior One-Stop Center, 8353 Culebra Road.
Those sites are meant to provide vaccinations for residents living on the South and West sides of San Antonio who don't have access to the internet or transportation. Appointments are available only by telephone; there's no online option.
The city did not get enough of the vaccine to give out during the week of Jan. 25, but started accepting reservations for 9,000 doses from 8 a.m. to 8 p.m. Saturday to register people for appointments that start on Feb. 1. The hotline is 833-968-1745.
Previously, 9,000 time slots were taken up within six minutes when the city opened its phone lines.
How many people are eligible right now?
At this time, people in both groups 1A and 1B are eligible. That includes health care workers, first responders, anyone 65 or older and those who are 16 and older with chronic health conditions, including diabetes and obesity. In Bexar County, that's more than 1 million people.
Why did Texas open up eligibility for 1B people if there wasn't enough vaccine?
That's not clear. Initially, the COVID-19 vaccines were reserved for people who work in health care settings and those who live in long-term care facilities but on Dec. 24, state officials announced that vaccines weren't going out fast enough. So the state health agency decided to open up eligibility to anyone age 65 and older, and those 16 and older with chronic health conditions, which goes against what the Centers for Disease Control and Prevention recommends.
The CDC instead recommends a more phased approach that would make the vaccine available to frontline essential workers and those 75 years and older because they are at higher risk of hospitalization, illness and death from infection.
Why isn't there a wait list?
Metro Health says a wait list would not be feasible, in part because providers are only told week to week how many doses they're getting.
University Health started a waiting list last week with spaces for 24,240 people in the coming weeks despite not knowing exactly how many doses are coming. All the slots were booked in less than 4 hours.
How much vaccine has been allocated for San Antonio residents?
Since Dec. 14, Bexar County has been allocated 235,400 doses or only enough to fully vaccinate 12 percent of its residents currently eligible for the vaccine — health care workers, long-term care patients, anyone 65 and older, and anyone 16 and older with a chronic medical condition.
Why can't more vaccine be sent?
Both the Moderna and Pfizer vaccines use a novel genetic technology known as mRNA, which gives the body instructions on how to create a protein that fights SARS-CoV-2. These kind of vaccines take time for manufacturers to produce and require a cold chain distribution process to ensure its quality.
Where does the supply come from?
The Pfizer vaccines come from a manufacturing plant in Kalamazoo, Michigan, while the Moderna vaccines are produced in Massachusetts facilities. Both companies have distribution centers and send the vaccine doses directly via air and ground to health care providers approved by their respective states to receive the vaccine.
How does the supply come in?
Pfizer developed special temperature-controlled shippers that utilize dry ice to keep the vials frozen. Roughly the size of a carry-on suitcase, these shippers can also serve as temporary storage for up to 30 days.
Moderna doesn't have the same kind of cold chain hurdles because it doesn't need to be kept as cold as Pfizer's vaccine, although it still must be in a freezer. It goes to distribution centers managed by McKesson, a company based in Irving, a suburb of Dallas.
Both vaccine-makers use FedEx and UPS to deliver the vaccine to administration sites.
Who decides who gets doses, how many and when?
On Tuesdays, the U.S. Department of Health & Human Services notifies the Texas Department of State Health Services how many doses the state will get for that following week. The federal government allocates vaccines and the supplies necessary to administer them to jurisdictions based on adult population.
How does the state decide who gets doses?
In Texas, an Expert Vaccine Allocation Panel comprised of state lawmakers, public health and academic leaders prioritize where the doses should go. DSHS allocates vaccine to a mix of designated hubs and smaller providers based on the priorities set by the allocation panel. The agency's commissioner, Dr. John Hellerstedt, approves the allocations based on the panel's recommendations and on Wednesdays the amount allocated to each provider is loaded into the vaccine inventory and ordering system where providers can see it. That's when all vaccine providers are notified of their allocations for the following week. Providers then have the opportunity to accept, reject or reduce the amount of vaccine allocated to them for the following week.
Because of limited supply, state officials say it's not possible to send vaccine to smaller providers each week. The bulk of the vaccines go to hubs so that doses can be administered to large numbers of eligible people quickly.
Who puts in the vaccine orders?
The state's health department orders the vaccines and then Pfizer or Moderna ships the doses to the providers.
How often does it come?
Shipments arrive within one to two days on a weekly basis. In San Antonio, it's usually on Monday or Tuesday.
Why isn't there more?
Moderna and Pfizer officials say they're cranking out as many doses as possible — likely enough to vaccinate the majority of U.S. adults by the summer. Many more COVID-19 vaccines are being developed right now, including one by Johnson & Johnson that could get emergency-use authorization in early March. This vaccine doesn't need to be kept in a freezer and could provide protection with one shot, instead of two.
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