“The more rules we create, the more penalties we put in place, the less vaccines will be delivered,” former FDA commissioner Scott Gottlieb said on Monday on CNBC. “This is the end result.”
In New York, Governor Andrew Cuomo has spent weeks insisting that only health professionals can get vaccines, although many have refused, and has only begun to ease restrictions in recent days. In California, Governor Gavin Newsom has set up extensive expert committees to weigh complicated distribution rules, confusing the effort in bureaucratic confusion.
The feds sent 1.2 million doses to New York, but less than half a million people received an injection, according to the CDC vaccine tracker. California dispatched nearly 2.5 million doses to local health departments and health systems, but just over 783,400 vaccinations have been administered. President-elect Joe Biden has set a formidable goal of injecting 100 million doses during his first 100 days in office.
“Pharmacists are trying to do the right thing and know the importance of not allowing vaccines to be wasted,” said Mitchel Rothholz, head of the immunization policy at the American Pharmacists Association. “But on the other hand, when we have discussions going on in California and New York, they need to know that their backs are protected if they make a judgment.”
The slow and uncomfortable response from the states comes after the federal government has offered little support to governors, both in terms of political guidance and effective reinforcements. State leaders were left to make important distribution decisions on their own, while facing increasing problems, such as labor shortages and financing problems that will persist until the nearly $ 9 billion passed by Congress to help with distribution vaccines are distributed.
Other states have loosened their rules or tried different strategies to protect themselves against wasted shots. New Jersey and the District of Columbia, for example, explicitly allow pharmacies and other providers to give the public all unused vaccines on a first-come, first-served basis.
And in West Virginia, where authorities have ruled out the federal distribution structure to vaccinate residents and nursing home and assisted living workers in favor of their own chain of independent pharmacies, everyone over 80 has had their first chance – and residents of nursing homes are starting in the second. The state has also started to immunize schools and colleges. Although it is a sparsely populated rural state – defying direct comparisons with larger, more urban states – West Virginia managed almost 90,000 of the 126,000 shots it received.
While New York and California officials have drawn more criticism for their limiting rules, few states have escaped criticism for their complicated implementations.
Virginia, for example, is struggling to keep up with the distribution, in part because the providers don’t know how to check if someone is eligible, reported the Richmond Times-Dispatch. Observers of Maryland’s slow implementation – where two counties have barely used any of their distributed doses and even the city of Baltimore is still sitting in most of their photos – have also theorized that over-prioritizing is part of the problem.
But at the opposite end of the spectrum from New York and California, Florida relaxed its rules for giving the vaccine to anyone over 65 – and is now facing a flood of older adults who, prevented from getting the vaccine in their home states, are migrating to the vacation destination. The MMA that followed generated long lines and a lot of confusion, while highlighting the barriers for the elderly in the rest of the country to be immunized.
Regional contrasts are only increasing the pressure on underperforming campaign leaders to increase their efforts.
“We must follow the CDC protocols and, if the state has doses that will expire, give them to anyone who can before they become useless,” said California State Representative Jordan Cunningham of his own state’s strategy . “Very simple.”
Cuomo, a Democrat, began to respond to the growing pressure.
On Monday, New York’s first respondents, teachers and adults over 75 started receiving their first doses of Covid-19 vaccines, days after Cuomo reversed its policy of reserving doses for healthcare professionals. The governor also announced a new Public Health Corps to accelerate the delivery of vaccines in New York as part of his state’s state priorities for 2021.
“We prefer that people apply and wait for the vaccine than that the vaccine is waiting for people,” said Cuomo during Monday’s speech, delivered virtually from the state capitol.
Despite receiving high praise for his early treatment of the Covid-19 pandemic, Cuomo faced increasing pressure from state legislators and local leaders over his control over vaccine distribution. New York City Mayor Bill de Blasio, who has repeatedly urged Cuomo to expand vaccinations beyond the initial priority group, has threatened to waive state rules and start vaccinating essential workers.
“The state has to give in here,” the Democratic mayor said on Friday, before Cuomo updated the state’s vaccine policy. “They created a situation that is creating fear and confusion and where doctors cannot act, even when they know that someone is vulnerable.”
New York County officials, meanwhile, have warned that the state’s “use it or lose it” policy, along with penalties announced for providers who intentionally allocate doses incorrectly, has only added to the confusion. They also pushed for the opening of vaccination to the first respondents and older residents. These concerns were not lost on state lawmakers.
“The launch of the vaccine, as we know it, was extremely disappointing,” New York Senate majority leader Andrea Stewart-Cousins, a Democrat, told reporters.
In California, where officials set up a 60-member working group and advisory committee to try to make the distribution fair, Newsom on Monday rejected criticism that these efforts are slowing down the process.
“We are not losing sight of the issue of equity, we are not losing sight of the imperative to prioritize the most vulnerable and the most essential,” the Democratic governor told reporters.
California officials spent the past week trying to organize ways to distribute doses – a problem that surfaced when a broken freezer compressor at a Northern California hospital forced the team to use the 830 thaw doses as quickly as possible, injecting members out of state guidelines to prevent any vaccine from spoiling.
Newsom acknowledged that his current strategy “is not going to get us where we need to” quickly enough. But he maintained his goal of vaccinating 1 million more people until this weekend, for a total of more than 1.4 million immunizations across the state. To get there, he offered mass vaccination sites, the ability of vaccinators to move to other levels, if they had exhausted vaccinations at the current stage, and expanded health professionals authorized to administer the vaccine.