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Vaccine Rollout Plagued by Confusion, Lack of Direction by Feds

The first phase of COVID-19 vaccine distribution has been slow in some states and has resulted in confusion on the part of residents, causing concern among officials about the rest of the process.

Closeup of gloved hands preparing a vaccination.
State and local governments are grappling with the initial rollout of the COVID-19 vaccinations without much guidance from the federal government and, predictably, the results are mixed at best.

Reports of confusion about where to get the vaccination and who is going first among those eligible are plaguing the efforts, as is the pace of vaccinations becoming available. Local jurisdictions are, for the most part, dependent on state coordination and guidance in developing their strategies.

Reports from Michigan’s initial rollout suggest confusion from some seniors who are eligible for the vaccine but confused by a lack of information on whether there is a vaccine available and how to schedule appointments.

Similar issues are coming from Georgia and Alabama, and reports of seniors on walkers and in wheelchairs lined up for blocks outside in the cold waiting to be vaccinated are causing concern and frustration. “There has to be a better way,” one resident said. In California, the rollout has been too slow, according the state’s governor.

A big concern going forward is reaching vulnerable populations, such as the homeless and unemployed or those of different cultures who may not trust government.

“I’m a little concerned,” said Anthony Beverina, co-founder and chief strategy officer of Socially Determined, a social risk analytics company committed to addressing social determinants of health. “The issues I see are that at each state level and at each local level you have myriad logistical challenges.”

Those include finding and notifying vulnerable populations and getting the vaccine to them. “You are talking about multiple populations that are living in elderly care facilities, people with underlying health problems,” he said. “These people are so spread out all over the place, you have to identify who they are and figure out where they are.”

The Centers for Disease Control and Prevention (CDC) has given “very broad” guidelines on reaching those populations, leaving it to the states to figure it out. “I worry about there being 50 different ways of figuring it out and 50 different concepts of how to do this,” Beverina said.

The federal government also hasn’t provided much in the way of resources for the states, and the rate of the vaccines coming to the states has been slow.

“You know you’re going to get a fixed number of doses and you have to figure out not only who should get it, which is a matter of policy, and the how you’re going to get it into place,” Beverina said. 

In Wyandotte County, Kan., Bob Bennett, the COVID-19 vaccine operations director, has just begun the rollout. He was initially given about 800 doses of the vaccine and then received about 900 more doses for local health-care organizations to administer to the organizations’ staff. So far, the county has vaccinated about 1,700 people and is expecting another round of doses to arrive next week.

The county is using an empty K-Mart building to store and administer the vaccines. The huge building (about 110,000 square feet) allows plenty of space for social distancing, and up to 10 lines for people to wait and be vaccinated and still adhere to social distancing. Bennett said he can vaccinate up to about 1,800 people per day.

He said the process so far has gone very well.

“We’re rocking through our priority-one health-care workforce so far,” Bennett said. “We’re getting another vaccine drop next week and I anticipate we’ll get going with some of our older population folks, 75 and older, who are not part of long-term care facilities, and who are not supported by Walgreens and CVS.”

The county has been working to reach out to its citizens through social media, town halls with community groups and, Bennett said, a special focus on groups that have historically been bypassed, such as the unemployed or homeless. “Obviously it is a continuous process of communications,” Bennett said. “It is a requirement for us to use every tool at our disposal.”

The unemployed or homeless don’t have a bulletin board at work or a union to inform them when and where to get vaccinated, and it takes work for the county to reach those people. “That’s where those social safety nets come into play,” Bennett said. “Entities like churches and shelters and engaging those leaders allows us to get that population.”

There are a multitude of cultures in Wyandotte County, with some seven different languages being spoken in various communities. Some of those cultures have a distrust of government, but Bennett said the health-care apparatus already knows these populations, and there has been a level of trust built up over the years.

“Government in general right now has less of a batting average of acceptability than it used to for a lot of folks, but health departments, by and large, because we provide services that people need, give people flu shots and take care of them when they’re sick, there is a greater level of trust in that community,” Bennett said.

He said most of the long-term care facilities have existing contracts with either Walgreens or CVS and will get their vaccinations through those entities. Those that don’t will be taken care of through the county. In fact, the county today is auditing one of those facilities to get information on how many vaccinations will need to be given.

“We’re verifying with those facilities in our community that they are in fact getting the vaccine with their existing vaccine support structure,” Bennett said.

Bennett talks with state officials three times per week, and part of the discussion involves the state taking questions. If they don’t know the answers to the questions, they find out within 48 hours, he said.

“I think from their perspective, they are just trying to get the vaccine out and hope that we do our part,” Bennett said. “I’m pleased to be a part of the team that has done its part aggressively. But I have a lot of friends in other places where that’s not the case.”