Wednesday, January 20, 2021
Jan. 20, 2021

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Patchwork of rules sows confusion in state-by-state vaccine rollout

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An accelerating rush to give coronavirus vaccines to Americans is leading to confusion over who can get a shot when, and creating disparities that could complicate the push toward widespread immunity.

As COVID rips through the population and states struggle to vaccinate residents with limited supplies and a paucity of federal assistance, some governors are opting for radical solutions. Rather than giving initial vaccines only to the elderly and front-line health workers, they’re offering shots to a wide swath of people to quickly reach the maximum possible.

Any resident of Georgia, Florida, Texas, Delaware or Ohio who is 65 or older can now sign up for a shot. California has opened mass clinics in places like Dodger Stadium in Los Angeles and Petco Park in San Diego. New York City is offering vaccines in schools and post offices, among other sites, and will have 24-hour centers in each of its five boroughs.

That has led to a dizzying patchwork of rules — strict hierarchies based on risk or need in some states, and more freewheeling approaches in others — that create variations in access to the potentially life-saving shots. In some cases, the frenzy to get doses into arms has rewarded people merely for being in the right place at the right time, while high-risk individuals are left exposed.

On Tuesday, Trump administration officials plan to encourage states to expand access to vaccines to anyone over age 65, regardless of any underlying medical conditions, as well as anyone over 16 who has a pre-existing condition. U.S. officials have been frustrated that the immunization effort hasn’t been able to get shots into arms more quickly; President-elect Joe Biden had vowed to accelerate the immunization push when he assumes office next week.

There is pressure to use doses before they are wasted. Once a pharmacist prepares a syringe, it can’t be put away unused. Additionally, coronavirus cases are surging and deaths are soaring, topping 375,000 in the U.S. as of Monday, according to Johns Hopkins University data compiled by Bloomberg. Those figures argue for immunizing people as quickly and widely as possible, some medical experts say.

“There is a trade-off between efficiency and the ideal categorization of who gets the vaccine when, and making sure there isn’t line-cutting,” said Ashish Jha, dean of the Brown University School of Public Health. “All of that is important, but has the potential to slow things down. What we need is to start getting people vaccinated. It’s a mistake to try to get it perfectly right.”

The urgency to get moving and not waste precious doses is resulting in unpredictable scenarios. Mark Sussman, a 36-year-old stay-at-home father, heard that the pharmacy inside a Safeway market in Washington was offering doses unclaimed by health-care workers to shoppers who came in near closing time. He signed up himself and his wife, Laurie, a 37-year-old attorney, on a waiting list. Within 48 hours, both were immunized. Meanwhile, Sussman’s 65-year-old disabled father in Charlotte, North Carolina, who has numerous underlying medical conditions, is still waiting.

Similar scenes are playing out across the country. In Florida, healthy 65-year-olds are able to get immunized even as their older siblings who didn’t move south from New York and New Jersey wait out the winter with little hope of getting a vaccine for weeks or months.

Yet opening up the floodgates is a huge risk, said David Rhew, the global chief medical officer at Microsoft Corp., an infectious disease doctor who has been working with the U.S. Centers for Disease Control and Prevention, states and hospitals on coronavirus control.

“Current systems are not designed to deliver large-scale vaccinations in a prioritized manner,” he said. “We have seen that simply opening up clinics to deliver vaccines on a first-come, first-served basis can lead to long lines, crowded waiting rooms, people being turned away and very frustrated consumers and staff. It also poses health risks to the most vulnerable, as we are now at surge levels of virus everywhere.”

The idea is to make sure no doses go unused. Thousands of doses have been left sitting in freezers where states haven’t been able to line up willing takers. In some disastrous cases, thawed doses have been thrown out after recipients didn’t materialize.

A big part of the problem in these states is the high level of resistance from health-care workers, a category that includes not only doctors and nurses, but hospital food-service and janitorial staff. Nationwide, about a third of the 21 million health-care workers who have gotten the green light so far have declined shots because they are worried about side effects.

The hope is that such reluctance will fade as the vaccine’s safety becomes established. Georgia Governor Brian Kemp’s decision to offer the shot to everyone 65 and older may spur those who skipped it initially to reconsider: As millions queue up for access, more safety information becomes available and competition for the vaccine grows.

Phoebe Putney Health System, covering southwest Georgia, hadn’t used all 5,000 doses from its initial December shipment before another 3,900 arrived Friday, said communications director Ben Roberts. It set up a hotline for people to make appointments starting Monday and was inundated with 1,600 calls on the first day. It added more operators and the first few days of appointments are booked.

For Aftab Khan, an internist and attending physician at AdventHealth Hospital in Davenport, Florida, the problem is administering the shots, not a dearth of the vaccines themselves.

“We have supply,” he said. “We don’t have trained staff. We did not have any planning to vaccinate all these people. It’s just mind-boggling that we didn’t anticipate and plan for any hiccups eight months ago.”

As state and local health officials muddle through, they are up against a formidable foe. The pandemic is rampaging, and vaccination delays could be catastrophic as health-care facilities are overwhelmed.

“If you had asked an infectious disease physician to design a worst-case scenario, that’s what we are doing,” said Gregory Poland, director of the vaccine research group at the Mayo Clinic.

“I either throw a Hail Mary pass, or I do the routine and conservative thing that is almost certain to lose the game,” he said. “That’s why I say, out of a sense of desperation, I’m sympathetic with the idea that our hand may be forced into a Hail Mary-type of position.”

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