RICHMOND — In the last few weeks of a harrowing year, Virginia’s vaccination campaign was met with a gaping mismatch of supply and demand, fluctuating federal estimates and inconsistent messaging that left it trailing behind the majority of states. For now, its troubled rollout doesn’t reflect the optimistic mass mobilization imagined by state officials.
Yet, as Virginia continues to grapple with the missteps that impeded its efforts in the first place, state officials are promising residents the next phase of vaccinations will begin by the end of January and pressuring Virginia health systems to speed up vaccinations to match the ambition.
It’s unclear whether the state is prepared to manage it. The next phase of front-line essential workers and people over the age of 75 is an expansion of eligibility that could triple the number of Virginians permitted to sign up, as less than 30% of doses available have been given out to the current priority group of health care workers and long-term care residents, which is smaller than the next.
Local health departments are gearing up for large vaccination clinics that emulate their efforts in testing and aim to hit Gov. Ralph Northam’s goal of averaging 25,000 vaccinations per day.
With testing, that took eight months.
Currently, the state is receiving about 110,000 doses a week, enough for about 15,700 injections a day. The most vaccinations in the state in a single day so far is 13,611.
The challenges three weeks into the rollout aren’t isolated to Virginia, and have been seen nationally as the largest and most crucial vaccination efforts in U.S. history have lagged behind federal targets due to complicated logistics and limited notice on what’s next.
Dozens of interviews with health and public officials showed a pattern of holes in federal and state planning, staggered coordination with hospitals that left many with limited guidance and no statewide verification process in place to check whether someone is eligible to receive a vaccine that’s limited in supply.
“Some categories will be easy. Teachers will be easy. Child care centers will be easy. We can verify age for the 75 and overs,” said Dr. Danny Avula, who was tapped this week by Northam to lead statewide vaccination efforts. “There will need to be a little bit more scrutiny to ensure that people do fall into the right prioritization group. … We’re trying to figure out how much will we even need to police. I trust that we all want what’s best for the folks who are at higher risk.”
Reporting glitches muddying the picture of who has been vaccinated persisted Friday, two days after the state’s health commissioner assured they’d be resolved “real soon.” As of Friday night, the Virginia Department of Health could not confirm the system was running smoothly.
Starting Monday, 11 health districts in Northern and Southwest Virginia will move into the next phase to keep statewide pledges of speeding up distribution. Richmond and Henrico health districts are estimated to follow in February but released an interest form this week for health care workers who want a vaccine but had yet to receive a dose.
“The challenge with vaccine distribution for states and localities is maintaining this balance of vaccinating our communities quickly while ensuring that people who are most severely affected or in the line of exposure receive access first,” said Cat Long, spokeswoman for the Richmond City Health District. “Right now, registration is done at a local level.”
Long added that vaccine coordinators follow up in the phased approach with information on how to register. Then individuals can choose an appointment at the health district’s vaccine clinics. Interest forms help gauge the demand and eligibility.
But the next technical hurdle for the state will be the release of a public-facing system informing the public where they can get their doses of the vaccine and how to sign up. Another is making sure the state has enough vaccination sites ready to meet the demand.
Deputy Health Commissioner Laurie Forlano said that only 900 of the roughly 3,500 sites registered with the state to receive and dole out vaccines have cleared federal approval. Right now, there are 110 operational vaccine sites. Most are hospitals, pharmacies and long-term care facilities working to serve those first in line.
Other states have faced obstacles as they’ve sought to expand vaccine availability to a broader public. In Florida, some localities relied on the ticket-purchasing platform Eventbrite to register seniors for vaccine doses. Quickly, scammers saw an opportunity to dupe older adults into paying for vaccine doses by creating fake listings.
Other localities in that state saw their registration sites crash early on, while older residents in Florida have also struggled to navigate digital sign-up systems, impacting vaccinations among the most vulnerable, according to reports.
Asked about how Virginia was preparing to sign people up for vaccines when eligibility expands, VDH spokeswoman Tammie Smith said: “VDH is developing a way for people to register to be notified about vaccine availability. We will have more information to share in coming weeks.”
On Monday, the Centers for Disease Control and Prevention ranked Virginia 46th in the country among states when it came to the percentage of doses administered. By Friday, it was the 38th.
Dissatisfaction with the results thus far drove Northam to partially blame health systems for the slow vaccine rollout in a media briefing Wednesday and to threaten a “use it or lose it” policy that would reduce the number of doses facilities can provide if they don’t administer the ones they receive.
“When you go out onto the battlefield, you’ve got all these great plans, but when you look and see what’s happening, you have to make adjustments,” Northam said in an interview Friday. “That’s why we decided to make the announcement we made, to lean on our health care system and to lean on our health departments.”
As of Friday, nearly 70% of shots given have been administered by Virginia hospitals, according to the Virginia Hospital and Healthcare Association.
Part of this is due to the prioritization of health care workers, but hospitals are leading Virginia’s vaccination efforts with limited detailed guidance from the state.
While they had a general understanding of what the next two tiers of vaccinations would look like and volunteered to help funnel through those efforts, many learned of the definitive priority breakdown for the second and third phases along with Virginia residents when VDH released outlines Wednesday.
Earlier that day, Northam had said “there’s a clear prioritization of who should get shots first and who should get them in what order.”
The hope of speeding up vaccinations by widening eligibility could strain a system that might not be ready for the demand. VDH indicated people in the next priority groups would be able to receive vaccinations through doctor’s offices and health care providers that may have never administered vaccines at this large a scale.
There are at least 760,000 people in the state’s essential industries, according to a profile from the Commonwealth Institute of Fiscal Analysis, and census data shows more than 1.3 million Virginians are over the age of 65, a population prioritized in the third phase.
Even hospitals, which are currently some of the best equipped to handle the unusually fragile vaccines that require ultra-cold storage, are facing increased stress on their medical infrastructure as cases surge and hospitalizations continue to trend upward.
“To the extent that our members can be partners and can help out further, they’re willing to do so,” said Julian Walker, director of communications for the Virginia Healthcare and Hospital Association. “But also understanding that responsibility cannot be, and is not, solely on the shoulders of the response of the hospitals.”
In the last three days, VCU Medical Center has vaccinated more than 8,250 team members. The hospital began operating its second-dose clinics this week and will administer about 2,000 in the next few days.
Bon Secours Richmond, another major health system in the area, has vaccinated at least 6,000, half of its total workforce. First priority went to about 3,660 high-risk front-line staff — efforts that hospital representatives called “intensive work in a short period of time.” Readiness planning for them began last summer.
Adding to the difficulty moving forward is reticence and skepticism about the vaccine among health care workers first in line to receive it.
State Health Commissioner Norman Oliver said anecdotally that about 60% of nurses have signaled interest in receiving the vaccine, leaving a large number unserved. Citing data from the Office of Emergency Medical Services, Oliver said the rate is similar among medical first responders, who have opted in at a 60% rate.
“The other thing to say on that, however, is that we’ve been noticing — now that we’re three weeks in — is that there’s a lot of positive peer pressure,” Oliver said, adding that it seems willingness has increased with time.
The hesitancy has meant vaccinators move through to someone who might not be as high-risk, which has spurred frustration and confusion across the U.S. For Richmond resident Alex Guzmán, that’s meant hearing of friends who’ve worked from home receiving the vaccine before his mother, who’s a cancer patient in a hospital.
One of the most recent who skipped the line was a 51-year-old Washington, D.C., resident who walked into a Safeway grocery store and left vaccinated because a dozen doses of the Moderna vaccine were set to expire. In a call with reporters on Dec. 30, the former head of VDH’s immunizations, Christy Gray, said that while the guidance is provided and requested to be followed, “the most evil in this situation is wasting vaccine.”
Once the vial is thawed for administration, it has a shelf life of a few hours.
“We would not expect our vaccinators to just schedule people that are in less priority as others, but if they happen to be in the office and that vaccine is going to get wasted, we’d rather that person get vaccinated,” Gray said.
Those instances could be tougher to track once the state veers into the next phase, a concern that leaves some questioning the state’s ability to follow up on their promises to do better.
“It just feels like they could have gone about this in a more nuanced way and thought about the equity implications,” Guzmán said. “And I’m not sure that they did.”