PROVIDENCE, RI – Public health officials have sounded the alarm for months, complaining that they do not have enough support or money to put COVID-19 vaccines on the ground quickly. Now, the slower-than-expected start of the biggest vaccination effort in the history of the United States is proving that they are right.
While working to step up action, US state and local public health departments cite a variety of obstacles, most notably the federal government’s lack of leadership. Many employees fear they are wasting precious time at the height of the pandemic, and delays can cost lives.
States regret the lack of clarity about how many doses they will receive and when. They say more resources should have been devoted to educational campaigns to lessen concerns among people who do not want to receive the injections. And while the federal government recently approved $ 8.7 billion for the vaccine effort, it will take time to get to places that could have used the money months ago to prepare to deliver vaccines more efficiently.
These complaints have become a common refrain in a country where public health officials have been left on their own to solve complex problems.
“The recurring theme is the lack of a national strategy and the attempt to pass the ball down, lower and lower, until the poor who receive the money have no one else to send the ball to,” said Gianfranco Pezzino, who was the public health officer in Shawnee County, Kansas, until he retired last month.
Operation Warp Speed, the federal vaccine program, promised to distribute enough doses to immunize 20 million people in the United States in December. He missed the target, and as of Friday, about 6.6 million people had hit the first shot. About 22 million doses were delivered to the states.
The American Hospital Association estimated that 1.8 million people need to be vaccinated daily from January 1 to May 31 to achieve widespread immunity by the summer. The current rate is over 1 million people a day below that.
President-elect Joe Biden on Friday called the launch a “farce”, noting the lack of a national plan to put doses on guns and reiterating his commitment to administering 100 million injections in his first 100 days. He did not share details and is expected to discuss the effort this week. His office announced a plan to release most doses immediately, instead of keeping second doses in reserve, the most conservative approach taken by the Trump administration.
The Trump administration has defined its primary role as developing coronavirus vaccines and distributing them to states, which would then take over and ensure that doses of the vaccine travel “the last mile” in arms. Each state had to develop its own plan, including issuing guidelines for who would be vaccinated first. Several health experts have complained about this approach, saying it has generated confusion and a patchwork response.
“Let’s just say that I was disappointed with how they handled the tests, and the vaccine implantation reminded me of how disappointed I was when they handled the tests,” said Dr. Mysheika Roberts, health commissioner in Columbus, Ohio.
Several public health officials and experts say they believe that some of the initial shortcomings are being mitigated. Marcus Plescia, medical director of the Association of State and Territory Health Officials, said the slow start should not be surprising, given the immense scale of the task.
“It wouldn’t be perfect,” he said.
Still, Plescia said the federal government could have done more before implementation – such as releasing billions of dollars earlier to help with personnel, technology and other operational needs.
An ongoing investigation by The Associated Press and Kaiser Health News detailed how state and local health departments have been underfunded for decades. Public health officials have warned since spring that staff, money and tools to implant a vaccine were lacking. The money was only approved in late December.
The distribution of the vaccine involves a long and complex chain of events. Each dose must be tracked. Providers need to know how much staff they will need. Eligible persons must be notified to schedule their vaccines, taking into account the requirements for handling the vaccine and the need to observe people for 15 minutes after the injection – all while observing social distance.
It is difficult to plan ahead because the number of doses the state receives can fluctuate. Hospitals cannot administer vaccines to all employees on the same day due to possible side effects and staffing problems, so they must be spaced out.
Rhode Island health officials said it could take up to seven days to distribute doses to people as soon as they are received. Officials in several states, including Rhode Island, Pennsylvania, Kentucky and New Jersey, said a lack of supplies is one of the biggest obstacles to getting more people vaccinated.
Some communities have seen a large number of medical professionals postpone the injection, although they are first in line. Columbus, Ohio, had less than expected demand among high-priority groups, including emergency medical workers.
A public education campaign could have helped deal with the hesitation among healthcare professionals that delayed the implementation of the first vaccines, said James Garrow, a spokesman for the Philadelphia health department. Instead, officials spoke for months about the speed with which they were developing the vaccines – which did not help to ease concerns that it was not safe.
“There just weren’t any good messages about security and the purpose of security protocols,” said Garrow.
The federal government has done little to provide information resources that local authorities can adapt to their own communities, to address the concerns of people like pregnant women or black men living in rural areas, said Dr. Michael Osterholm, an infectious disease specialist. from the University of Minnesota, which is a member of Biden’s COVID-19 advisory board.
“You don’t need 50 different states trying to do this kind of work. What you want is a hodgepodge of information sources that address different populations that any state can use, ”said Osterholm. “This is what we don’t have now.”
Some states are getting creative. Oregon held a mass vaccination event at the state fairgrounds with the help of the National Guard. The governor said he aims to vaccinate 250 people an hour. New Jersey planned to open six vaccine megasites, where officials hope that more than 2,000 people a day will eventually be able to receive their vaccines.
But without a federal plan, these efforts may amount to “throwing spaghetti on the wall to see what sticks,” said Chrissie Juliano of the Big Cities Health Coalition, which represents metropolitan health departments.
What is needed is a national wartime effort to distribute vaccines to as many people as possible, several experts said. Medical emergencies can be attended to 24 hours a day, seven days a week, said Pezzino, who is also a senior member of the Kansas Institute of Health. Why not make vaccines available at this time?
“It’s possible. It’s feasible,” he said. “I don’t see the level of urgency, the feeling of urgency in anyone around here. And that’s really, honestly, that’s the only thing that can make a difference.”
Join our Facebook group for the latest coronavirus updates in Colorado.