States struggle for control of chaotic vaccine rollout

States scrambling to deploy millions of coronavirus vaccines are resorting to drastic measures as they wait for federal aid to help speed mass inoculations.

With about 4.8 million of the approximately 17 million doses shipped out by the federal government administered, state leaders like New York Gov. Andrew Cuomo are threatening steep fines for health providers that don’t use up all their shots this week; others are calling on retired health care workers, dentists and even veterinarians to staff vaccination sites. And many are reworking their carefully crafted distribution plans on the fly to get older Americans the shots sooner amid spiking infection rates and news that a more transmissible strain of the virus has reached the U.S.

The patchwork of responses comes as desperate governors are facing a vacuum of federal support, along with dire funding and workforce shortages that are hampering the pace of the rollout. Though Trump administration officials predict vaccination rates will pick up this week, the White House’s coronavirus task force has not convened a call with governors since Dec. 21. States have not yet seen the nearly $9 billion Congress approved to help vaccine distribution in a late December relief package.

“What we need from the federal government is for them to have started vaccine distribution planning much earlier in the year last year,” said Casey Katims, a federal liaison for Washington state.

Trump administration officials say getting shots into arms is states’ responsibility. But it’s not clear whether states’ emergency measures will be enough to get the most ambitious inoculation campaign in U.S. history back on track. And the mishmash of state approaches is creating growing disparities around the country in who can get the vaccine. Some pharmacists have started offering leftover doses of the coveted vaccine to the general public before they spoil. In other parts of the country, people at high risk — including frontline workers — are still waiting for their shots.

“The distribution is moving slower than people had hoped,” said Clay Marsh, West Virginia’s Covid-19 czar. “We are not satisfied because we want to get vaccines in every West Virginian’s arm, but this is a massively complicated process.”


Officials with Operation Warp Speed, the Trump administration’s vaccine accelerator, have said that holidays, snowstorms and a significant reporting lag contributed to the smaller-than-expected vaccination numbers in December. More than 2.6 million people were inoculated out of the 20 million the federal government had repeatedly promised.

Administration officials rejected the notion that they have not given states adequate support. Federal officials talk to states multiple times a week and monitor statewide data to “learn how we can better assist future efforts,” a Department of Health and Human Services spokesperson said. And Vice President Mike Pence’s office said that the White House coronavirus task force is planning a call with governors for later this week or early next after not convening over the holidays.

In the meantime, federal health experts including Surgeon General Jerome Adams and infectious-disease researcher Anthony Fauci have said that the pace of vaccination is now picking up. The White House estimates that half a million people are getting vaccinated each day — but the scene on the ground is different in each state.

While random shoppers in a Washington, D.C., grocery store lucked into getting soon-to-expire shots over the last few days, seniors in Florida are camping overnight to secure their doses.

By contrast, West Virginia is on track to complete vaccinations of nursing home residents and staff before some states even start them — largely because West Virginia health officials broke with the federal strategy to rely on Walgreens and CVS to distribute shots to long-term care facilities.

But West Virginia also had an embarrassing stumble last week when 44 people, many of them seniors, were dosed with a Regeneron antibody treatment rather than the intended vaccine. It was a good reminder that the nationwide vaccination rollout “is more complex than a military operation,” said Marsh.

At the federal level, a drive to supply more shots has divided officials. Warp Speed chief Moncef Slaoui said Sunday that the government is in talks with vaccine maker Moderna to halve doses of its shot for many adults — only to be rebuked late Monday night by a Food and Drug Administration statement calling for providers to stick to science.

“We know that some of these discussions about changing the dosing schedule or dose are based on a belief that [doing so helps] get more vaccine to the public faster,” wrote Commissioner Stephen Hahn and FDA vaccine chief Peter Marks. “However, making such changes that are not supported by adequate scientific evidence may ultimately be counterproductive to public health.”

State health officials are also wary of the half-dose approach. “We will not change the way the vaccination is given, it will follow manufacturers’ directions,” said Angela Ling, incident commander for Nebraska’s Department of Health and Human Services, at a press conference Monday.

But state and local authorities are still desperate for more vaccines and support, and in the absence of federal direction are striking out on their own.

“Governors are talking to other governors, chiefs of staff to chiefs of staff, looking at logistics, sharing best practices, what’s working, what’s not working,” California Gov. Gavin Newsom said at a press conference Monday. The state has administered just about one-third of its 1.2 million shots.

Public health experts say Trump’s team put too much responsibility on cash-strapped state health departments already grappling with a raging pandemic.

An HHS spokesperson said in a statement that the Trump administration began planning with states in September; has given jurisdictions necessary supplies, like needles; and has sent $340 million so far to help states plan for distribution, with another $8.75 billion on the way.

“We strongly encourage states and jurisdictions experiencing slow vaccine uptake to expand their administration efforts across all priority groups to ensure vaccines are reaching these populations as quickly as possible and doses are not going unused on shelves,” the spokesperson wrote.

President-elect Joe Biden has pledged a more robust federal partnership with states, arguing the Covid-19 vaccination effort is “falling behind” and promising to amp up federal support and funding along with his bid to distribute 100 million vaccines in his first 100 days.

“All of this — vaccinations, testing, protective gear — will require more funding from Congress, more than was just approved,” he said in an address last week. “That is why I will propose a Covid action package early next year and challenge Congress to act on it quickly.”

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