The rollout of COVID-19 vaccines across Alabama, at warp speeds, would always be a challenge. But the state effort was delayed by federal miscommunication, misunderstandings and confusing federal leadership during the last snap of the Trump administration.
From the initial implication that states would get more vaccinations than they received, to the announcement of policies and their implementation never to a vanished stock of vaccine and problems getting CARES Act funds in Alabama, the difficult task of the state of getting shots in the arms does not facilitate.
No. 1: the expected doses decrease
Dr. Scott Harris – Alabama’s state health officer and head of the Alabama Department of Public Health, which distributes the vaccine to hundreds of hospitals, pharmacies and clinics in Alabama – has said since the early days of the launch that the biggest obstacle was that Alabama was not enough doses of the vaccine.
The federal government planned early states to deliver a certain amount of doses as quickly as possible. But planning can only go so far if there is no product to expand.
Harris said Alabama initially expects 112,000 doses during the first week of launch in December. But when the bottles were shipped, Alabama found that it received only 41,000 doses.
“We communicated at the federal level that Alabama would have a lot more vaccine, and not Alabama, every state, had the idea that they would get a lot more vaccine than they eventually got,” Harris said Friday. “I assume it’s related to optimistic forecasts and ultimately the inability of the manufacturers to keep up with it, I suppose.”
Harris said the CDC later told the states that the early vaccine numbers were for planning purposes only.
“The response to CDCs, if we ask them, is that we never told you to get 112,000, but only for you to plan as if you were getting 112,000,” he said.
Nr. 2: States do not know how many doses they receive week to week
Planning is much easier if you know what to expect, and ADPH does not know it yet.
Harris said the state does not know from week to week how many doses it will receive in the state, and therefore it is difficult to export it to the more than 800 facilities now registered to give the vaccine.
“We do not know what we are getting until the day before we get it, or at least until the day before it is sent to us,” Harris said. ‘It’s very frustrating for people trying to run clinics, you know.
“It’s hard to make an appointment if you do not know if you are going to get vaccinated.”
When the delivery was announced, Harris said it was creating a state-of-the-art frenzy to determine where the doses should go.
‘If we find out what our total allocation from the state may be, we have people who have to scurry wildly, work all night to find out how the doses are distributed and where they are going, by the time they start shipping, by the next day or so, ”Harris said.
Nr. 3: The non-existent stock
On January 12, eight days before Joe Biden’s inauguration, officials of the outgoing Trump administration announced that they would no longer hold vaccine reserves for second doses.
The then secretary of health and human services, Alex Azar, announced at a comprehensive news conference that the CDC would release doses he kept in reserve for immediate distribution.
“Because we now have a constant rate of production, we can now ship all the doses kept in physical reserve,” Azar said. “We are now making the full reserve doses we have available to order, [and] we are 100% committed to ensuring that a second dose is available to every American who receives the first dose. ”
Government officials believed it meant a new flood of shipments to hospitals and clinics.
That did not happen.
The Washington Post reported on January 15 that in fact no such stock existed. The CDC has been sending everything it has had since December. States would not get additional deliveries after all.
“Our first thought was, ‘Oh, that’s great,'” Harris said. ‘Our grant is likely to double and of course we are hopeful that this 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 no second doses were physically held.”
Nr. 4: CARES Act funds do not come through
Alabama is significantly funded for the introduction of vaccines by federal CARES law, but it is not always easy to access this money.
Harris said most federal money is delivered through refunds. And the process so far has not been smooth, Harris said.
“It was essentially a line of credit, so we had to spend money first and then submit it for compensation, and their rules for compensation were not always clear to us,” Harris said Friday.
‘At the moment I think ADPH has somewhere $ 8 million in expenses that we have not been able to reimburse so far. We’ll see if that changes soon. ”
Nr. 5: Change the rules, or just appear on
At the same press conference in which he announced that the empty stock would be released, Azar also announced that the feds would switch the program, that the CDC, instead of distributing vaccines based on the population, would start giving more vaccines to whatever states have given. it out the fastest.
‘This new system gives states a strong incentive to ensure that all vaccinations are reported immediately, which are not currently the case, and … to ensure that doses work … protect people, rather than putting them on the shelves sitting or freezers, ”said Azar.
But the change seems to have been announced but never implemented. Azar said on January 12, the policy would begin in two weeks, when he and others had only eight days left.
While four lawmakers in Alabama wrote an open letter to ADPH arguing that the change would cost Alabama extra doses, given the slower vaccination rate of the state, Harris said he had never been told by anyone under one of the administrations that the state allocation would not change.
“It’s never been discussed with us,” Harris said. ‘I have never talked to anyone about it at the federal level. No one at the federal level has ever brought this to my attention. ”
Harris said in all his communications with the CDC that states would be vaccinated based on their population, not how many doses they were given.
“We get a per capita award,” Harris said. Alabama is about 1.4% of the United States [population], we get 1.4% of the quantity produced. And the number is steady, and they told us, not going to change anytime soon. ”
The CDC also last week softened its second-dose guidelines, suggesting that it may be acceptable for people to receive their second admission 42 days after the first time, instead of 21 or 28 days, depending on the vaccine the person took. has.
Some experts, including dr. Anthony Fauci, warned that postponing the second dose could reduce the effectiveness of the vaccine, and that people would not be fully protected until one to two weeks after the second dose.
Nr. 6: Pharmacy program did not materialize
Alabama expected significant contributions from chain pharmacies such as CVS and Walgreens through a program run by the federal government that would not come from Alabama’s grant.
The idea was that those pharmacies would offer vaccination appointments at their retail locations throughout the country to provide another way for people in Alabama to get the vaccine.
But the program has not yet materialized.
Now Alabama says it is partnering with Walmart pharmacies to distribute the vaccine at those locations, but it is not part of the federal program. These doses come from Alabama’s grant that would otherwise go to hospitals or smaller medical centers.