On a recent Saturday morning, Peggy Hoon took the wheel of her 2011 Toyota RAV4 and made the 300 mile round trip from her home in Raleigh to Charlotte.
After weeks of waiting on hold or hearing about the vaccination events for COVID-19 only after they filled up, the 65-year-old Wake County resident finally got an injection. She considers herself lucky and worries about equity issues that make other elderly people unable to find the doses of the precious vaccine.
State officials say the main barrier to the distribution of vaccines has been a lack of supply. But the NC Watchdog Reporting Network found that, in some cases, healthcare professionals are giving doses to people who are not yet qualified, according to the guidelines of the NC Department of Health and Human Services.
And that means that people like Hoon, among those most at risk of serious injury or death from illness, are waiting.
“This is getting a vaccine from someone who can really make a difference if they get COVID instead of the person (who is passing) through the back door,” said Hoon.
According to DHHS guidelines, only Group 1 – health professionals and residents and long-term care workers – and Group 2 – those aged 65 and over – qualify for the vaccine. When a young person skips the line in front of an elderly person with higher risk factors, the result can be literally deadly. Those aged 65 and over represent only 14% of all COVID-19 cases in the country, but 81% of all deaths, according to data from the Centers for Disease Control and Prevention.
The reporting network found that speed and equity are in conflict with one another, a problem exacerbated by the nature of the vaccine’s rapid expiration and the near impossibility of policing all vaccine clinics.
In short, the vaccine delivery system operates largely on the honor system, and some have taken advantage, risking the health of other North Carolinians.
Millions in need; still limited doses
In Ashe County, at least a dozen people under the age of 65 have been vaccinated. The team at AppHealthCare, the three county health department that includes Ashe, withdrew doses of the vaccine to administer outside the office.
The NC Watchdog Reporting Network confirmed that dozens of doses of the vaccine were withdrawn from the health department against the protocol. A department spokeswoman repeatedly refused to confirm the details of who took the vaccine doses and where they went.
Initially, a health department spokeswoman dismissed vaccinations outside the office as just an effort to discard the remaining doses later in the day.
“Our team used up to 10 doses on different occasions when a bottle of 10 was unused and was about to expire,” AppHealth spokeswoman Melissa Bracey told the network via email last Wednesday.
But she followed up a day later, after the network asked DHHS questions about the situation, to say that the local health department was investigating.
A week later, Bracey said in an e-mail that the department’s investigation found that a total of 40 doses of the vaccine were given outside the agency’s protocols and 13 doses outside groups 1 and 2, but did not elaborate on how.
Clinics across the state and country were told not to let any vaccine go to waste, even if it means giving a dose to a young person.
There were other examples of circumventing state regulations:
In New Hanover, all county commissioners received a vaccine after a commission meeting on January 13, although the state is still in Group 1.
At Chapel Hill, two UNC basketball coaches managed to get the vaccine.
In Charlotte, Atrium Health has scheduled appointments for non-healthcare professionals.
In Durham, some sheriff’s deputies were vaccinated, confirmed the Durham County Department of Public Health. A spokeswoman said they had scheduled appointments under previous vaccine priority guidelines and were allowed to keep their appointments after the guidelines changed
In almost all cases, spokespersons for those who administered the vaccines had reasons that they considered valid for not following state guidelines to the letter.
Coronavirus vaccinations in NC
A New Hanover county spokesman said the commissioners received the vaccine because there were extra doses and later said they were vaccinated because of their position as elected leaders.
“Commissioners are leaders in this community, elected by our constituents to govern New Hanover County, and each of us has been vaccinated in our capacity for public duty and not as private citizens,” said President Julia Olson-Boseman. “I certainly want to keep each person on the board as safe as possible, as they are invited to meet in person as a group and go to the community to do the work that people have elected us to do.”
State and local health officials say these cases are the exception, not the rule. The main reason why elderly people looking for a vaccine cannot find a place in the queue, they say, is simply due to a shortage of vaccines.
“We have millions of people who need it, but only thousands of photos,” Governor Roy Cooper said at a recent news conference.
Groups 1 and 2 total about 1.7 million people. To date, the state has allocated only 1.4 million first doses, and not all have reached the state yet. People aged 65 and over account for more than two-thirds of all first doses administered, a figure that does not include the vaccination program for employees and residents of long-term care facilities.
The need for cold storage requires that doses be used quickly, and many of the vials actually contain an additional dose beyond what is scheduled. The CDC and state health officials have strongly urged clinics not to waste any doses at all, but that does not make clinics exactly sure how many doses they will be able to deliver.
“Some providers have implemented waiting systems, sometimes requiring people to wait outside in line,” said Julie Swann, head of the industrial and systems engineering department at NC State University, which has been analyzing the impacts of COVID-19 in public health. “And the people who are perhaps best suited for this, may be the younger populations who can stand out if it is cold or rainy.”
What to do with tens of thousands of ‘remaining doses’
Analysis of DHHS data shows that there were more than 60,000 doses left in North Carolina. But even these should not be out of the order of priority, according to DHHS guidelines.
“Leaving a priority order must be a very unusual circumstance. It should not be the thing that is happening every time,” said DHHS Secretary Dr Mandy Cohen. “But we don’t want vaccine waste, so we recognize that there are some places where we just want to make sure that we put the vaccine in the arms and don’t waste it.”
The health systems of the Triangle claim that they have implemented alternative plans to distribute the extra doses equally.
Dr. David Wohl, an infectious disease specialist at the University of North Carolina who is overseeing the distribution of vaccines at the Friday Center, described what they call an “energy hour” around 4 pm, when the clinic staff estimates how many doses at the end of the day will receive and how they can be better distributed.
Vaccine tracking has reporting gaps, monitoring
In a way, the clinical team trusts people to be truthful about their eligibility. The teams have been overloaded for a year and it is not their responsibility to police those who seek the vaccine. Wohl said his team is trying to verify eligibility, but acknowledged that he trusts at least a little bit in patients’ self-identification.
“But I would say to you, the vast majority of people we are seeing here are not cutting the line,” said Wohl. “These are people who arrive with walkers, in wheelchairs, you know, walking sticks. We are reaching the right people.”
In the long-term care program, there is less public disclosure that could reveal violations of the protocol. The federal government directly contracts with Walgreens and CVS to distribute vaccines in long-term care facilities. Spokesmen for both pharmacy chains said that individuals are required to “attest” to their eligibility. In most cases, individuals need an identity card to confirm identity, although this does not necessarily prove eligibility for people under 65.
Likewise, state DHHS leaders said they are not monitoring the thousands of individual vaccine containers inserted into the state’s computer system.
In December, Atrium Health in Charlotte scheduled vaccinations for employees who worked in non-health jobs. In response to public outcry, the hospital said the state had approved employees to receive the vaccine.
But DHHS said that was not true.
After news that hospital staff were scheduled out of hours, however, state officials contacted Atrium and dozens of appointments for non-health workers were canceled.
This story was reported and edited jointly by Laura Lee and Frank Taylor, of the Carolina Public Press; Tyler Dukes, Adam Wagner and Jordan Schrader, of The News & Observer; Nick Ochsner of WBTV; Michael Praats of WECT; Ali Ingersoll and Travis Fain of WRAL; and Jason deBruyn from WUNC.