Delivering COVID-19 vaccines across Alabama at high speed would always be a challenge. But that statewide effort was slowed down by federal communication failures, misunderstandings and confusing federal guidelines during the Trump administration’s last gasps.
Since initially suggesting that states would get more vaccines than they received, the announcement of policies and never implementing them, the disappearance of vaccine stocks and problems with getting funds from the CARES Act for Alabama, the state’s difficult task of getting vaccines for weapons has not been facilitated.
No. 1: expected drop in doses
Dr. Scott Harris – Alabama State Health Officer and head of the Alabama Department of Public Health, which is distributing the vaccine to hundreds of hospitals, pharmacies and clinics in Alabama – said from the early days of the launch that the largest O obstacle was that Alabama did not have enough doses of the vaccine.
Early on, the federal government told states to make plans to deliver a certain number of doses as soon as possible. But planning can only go so far if there is no product to launch.
Harris said Alabama initially expected 112,000 doses during the first week of launch in December. But then, when it was time for the bottles to be shipped, Alabama found that it was receiving only 41,000 doses.
“We received communication from the federal level that Alabama would have a lot more vaccine, well, not Alabama, all states, thought they were going to get a lot more vaccine than ultimately,” Harris said on Friday. “I suppose this is related to optimistic predictions and, ultimately, to the manufacturers’ inability to follow them, I suppose.”
Harris said the CDC later told states that the first vaccine numbers were for planning purposes only.
“The CDCs’ response when we ask is, well, we never said you were receiving 112,000, we just asked you to plan as if you were receiving 112,000,” he said.
No. 2: states don’t know how many doses they are taking each week
Planning is much easier when you know what to expect, and ADPH doesn’t know it now.
Harris said the state does not know each week how many doses it will receive in the state, so it is difficult to ration for the more than 800 facilities now registered to give the vaccine.
“We don’t know what we will receive until the day before we receive it or at least until the day before it starts shipping to us,” said Harris. “This is very frustrating for people who are trying to run clinics, you know.
“It is difficult to make an appointment when you do not know if you are going to get the vaccine or not.”
Then, once the shipments are announced, Harris said he creates a frenzy at the state level to determine where those doses should go.
“When we find out what our total allowed state quota is, we have people who have to fight frantically, working almost all night, to find out how these doses are divided and where they go, the moment they start to be sent, on the day next or later, ”Harris said.
No. 3: The nonexistent stock
On January 12, eight days before Joe Biden’s inauguration, officials from the Trump Administration who was leaving office announced that they would no longer maintain vaccine reserves for the second doses.
The then Secretary of Health and Human Services, Alex Azar, announced at a broad press conference that the CDC would release the doses it had saved for immediate distribution.
“As we now have a consistent production rate, we can ship all doses that were in the physical reserve,” said Azar. “Now we are making the total reservation of doses that we have 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 believe that this means a new flood of remittances to hospitals and clinics.
This did not happened.
The Washington Post reported on January 15 that, in reality, this type of stock did not exist. The CDC was already shipping everything it had since December. After all, states would not receive additional remittances.
“Our first thought was, ‘Oh, that’s great,'” said Harris. “Our allocation is likely to double and, of course, we hope it means that 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 being physically maintained.”
No. 4: CARES Act funds are not coming
Alabama received significant funding for vaccine implantation through the federal CARES Act, but that money is not always easy to access.
Harris said most of the federal money is being paid out through repayments. And the process has not been smooth so far, Harris said.
“It was essentially a credit line and therefore required us to spend money first and then send it in for reimbursement and its rules for repayment were not always clear to us,” Harris said on Friday.
“At the moment, I think ADPH has something close to $ 8 million in expenses for which we have not been able to be reimbursed so far. We’ll see if that changes soon. “
No. 5: Change the rules or just seem
At the same press conference in which he announced that the empty stock would be released, Azar also announced that the feds were changing the program, that instead of distributing vaccines based on population, the CDC would start giving more vaccines to states that were giving the faster.
“This new system gives states a strong incentive to ensure that all vaccinations are promptly reported, which currently is not, and … to ensure that doses will work … protecting people, rather than sitting on the shelves or in freezers, ”said Azar.
But it seems that this change was announced, but never implemented. Azar said on January 12 that the policy was set to start in two weeks, when he and others had only eight days left on the job.
While four lawmakers in Alabama wrote an open letter to ADPH arguing that the move would cost Alabama extra doses due to the state’s slower vaccination rate, Harris said he was never informed by anyone under any administration that the state’s allocation would change.
“It was never discussed with us,” said Harris. “I never talked to anyone at the federal level about this. It was never brought to my attention by anyone at the federal level. “
Harris said he was informed in all of his communications with the CDC that states will receive the vaccine based on their population, not how many doses they have distributed.
“We have a per capita distribution,” said Harris. “Alabama is about 1.4% of the United States [population], we obtain 1.4% of the manufactured quantity. And that number is stable, and they told us, it will not change anytime soon. “
The CDC also softened its guidance on the second dose last week, suggesting that it may be acceptable for people to receive the second injection 42 days after the first, instead of 21 or 28 days, depending on the vaccine the person has received.
Some experts, including Dr. Anthony Fauci, have warned that postponing the second dose may reduce the vaccine’s effectiveness and that people are not fully protected until one to two weeks after the second dose.
No. 6: the pharmacy program did not materialize
Alabama expected significant contributions from drugstore chains like CVS and Walgreens through a federally administered program and would not come out of Alabama’s budget.
The idea was that these pharmacies would offer vaccination appointments at their retail locations across the state, offering another route for people in Alabama to receive the vaccine.
But that program has not yet materialized.
Now Alabama says it is partnering with Walmart pharmacies to distribute the vaccine in those locations, but that is not part of the federal program. These doses are leaving the Alabama quota that would otherwise be going to smaller hospitals or medical centers.