Pennsylvania’s COVID-19 Vaccination Response: We Deserve Better

Disclaimer: The views and opinions expressed here are my views only and do not in any way reflect the views and opinions of the medical center, its Board of Directors, Staff, other affiliated persons, or anyone directly or indirectly referenced within.

As of March 01, 2021, Becker’s Hospital Review ranked Pennsylvania 48th out of 50 states in the percentage of vaccines administered; the 3rd worst in the nation. Yet Pennsylvania ranks 8th in the US for the number of people age 65 and older, accounting for 18.2% of that demographic, according to the Population Reference Bureau. While this age group is not the most infected, they do account for the highest percentage of deaths. The New York Times, as of February 18, 2021, shows that 11.5% of Pennsylvanians have received the first dose of the COVID-19 vaccine; only 4% have received both the first and second dose. Now, Pennsylvania is short on second doses of the Maderna vaccine because of, in my opinion, poor communication and deficient leadership.

Does anyone else sense a bad ending?

Many long-term care facilities were fortunate to participate in a program where CVS and other national private pharmacies procured and administered the vaccine for residents and staff, and for many long-term care facilities in Pennsylvania, vaccination is complete.

What about the rest of the state? Who in Pennsylvania is currently eligible for vaccination? Adults 65+, adults 19 to 74 who have certain comorbidities, teachers, grocery workers, and other “essential workers”. “High Risk” adults appear to be eligible in all counties. For grocery workers, and other essential workers, only those in Philadelphia, which is classified as a different vaccine jurisdiction, are eligible. Governor Tom Wolf announced on March 03, 2021 that supplies of the recently approved Johnson & Johnson vaccine will be ear marked for school personnel. Here in western Clinton County, school employees must travel over an hour to Centre County to get their vaccine; the first round will not be enough to vaccinate all school employees. It also poses the problem of covering classes for the day while the teacher is getting vaccinated.

Philadelphia is the only Pennsylvania county to be in phase 1b, the rest of the state is still in phase 1a after more than 8 weeks: There is no timeline for when phase 1b will begin. People age 65 and older and adults with certain medical complications were moved to Phase 1A in a January revision to the vaccination plan. If it took 8 weeks to get first vaccinations into 11% of the population, how long will it take to cover the entire state? Nearly 1.5 years. For the second dose at the current pace? About 4 years. Pennsylvania has administered second doses to about 4% of the population compared to the 7.51% average across the nation.

As of February 15, 2021, the median number of vaccines delivered per county is 1,138 per 10,000 of population. You might think that those doses are distributed evenly across the counties by population. You would be wrong. You might think, then, they were distributed first to areas with the highest positivity rates. Wrong again. OK, areas with the highest percentage of deaths? No. I can’t identify a clear method to vaccine distribution in Pennsylvania. According to USA Today, vaccine availability in Pennsylvania ranges from a low of 149 per 10,000 of population in Snyder County to a high of 3,778 per 10,000 of population in Elk County. Pike and Clinton Counties round out the bottom three while Lehigh and Mifflin take second and third.

It’s been no secret that over the first 8 weeks of vaccination distribution, only about 65% of the vaccines distributed to Pennsylvania were actually administered. While some think it could be due to a distribution issue, many believe that providers are retaining doses to insure an adequate supply for the second shot. Numerous providers have shared that they can not rely on what they expect to receive since their experience has been receiving fewer vaccines than expected. Pennsylvania, though, vigorously urged providers not to hold back doses and provided assurances that the vaccine supply was sufficient to guarantee second doses. That wasn’t entirely true. An order from Acting Secretary of Health Alison Beam dated February 12, 2021 stated, “At a minimum, vaccine providers must administer 80 percent of their first doses of vaccine received within seven days of receipt of those doses.” The order goes on to say, “The department may reduce or temporarily suspend a Vaccine provider’s allocation of first doses for failure to comply with guidance from the federal government and state law, including failure to comply with this Order.”

On Wednesday, February 17, 2021, Acting Secretary Beam said that since early January 2021, providers had been giving out second doses of the Maderna vaccine as first doses. Did I miss something? If you are required to use at least 80% of the vaccines you receive within 7 days of receiving them, how can each provider have a supply on hand adequate to meet the demand for second doses? The Department of Health later admitted it was sending out first doses separately from second doses. The problem? There was no indication with each shipment if it was intended for first or second doses, and many providers were not aware of the distinction between first and second dose shipments, so they used 80% or more of their supply within 7 days of receipt, as directed. This could explain why Pennsylvania is not willing to identify the providers who did not “follow the guidance”. While providers were assured of an adequate supply, then chided for retaining vaccines to assure availability for second doses, Pennsylvania does not have enough supply to provide second doses to tens of thousands of people.

People in phase 1a of the vaccination plan. The people determined by the Department of Health as crucial for early vaccination. The people with the highest risk for a poor outcome if infected with COVID-19. Ultimately, this will affect more than 100,000 people who’s first and/or second shot will be delayed, probably by weeks. Conveniently, new guidance from the CDC now says that instead of 21 days between doses for Pfizer and 28 days between doses for Maderna, it’s ok to have up to 42 days between first and second doses for both.

So, how did this “mistake” occur? The Department of Health, in part, blamed un-named providers, then added that the Department of Health was also partially to blame. What about conflicting information and lack of guidance? Don’t hold back doses. You used all of the doses? You shouldn’t have done that! In reality, it’s lack of communication and a lack of leadership. The same lack of leadership that has, and continues to, plague both federal and state responses to the pandemic. It is important to recognize that Acting Secretary of Health Beam largely inherited this problem when she took office in January, however, she is accountable for the response moving forward.

Now, the Administration revealed a plan to reduce the number of vaccination sites. If you have over 1,000 locations where people can get vaccines, what can you do to be more efficient at vaccinating people? Yep, reduce the number of locations by about 80% to between 200 and 300 locations state-wide. Most of the providers chosen for moving forward are large health systems and national pharmacy chains. Are there areas in the state not served by large hospital systems and national pharmacy chains? Rural Pennsylvania. Many questions remain unanswered. Will there be at least one location in every county? How far will rural citizens need to travel to get vaccinated? Will there be transportation available for our moderate to low income population? What about seniors? Because Pennsylvania has ranked so low in its roll out of the COVID vaccine, this seems like an attempt to focus attention on urban areas, where they can vaccinate large numbers of people more quickly, improving the overall vaccination rate. What that really means, though, is that it is a plan to improve the vaccination rate at the expense of our rural communities.

Republicans blame the democrats. Democrats blame a shortage in supply. Pennsylvania is at the bottom of the list for getting our residents vaccinated and once again, our elected officials choose to point fingers and place blame rather than to work together for a solution. Maybe I don’t understand; how does pointing fingers and placing blame accomplish anything? We’ve been down this road before and we know the answer: Nothing.
Beam said they have formed a “task force”; clearly what we need is one more level of bureaucracy to improve communication and accountability. This task force met three times so far, and it seems they have…agreed to Beam’s plan. Governor Wolf, on the other hand, stated “We will look for ways and find ways to make the system work even better.” Why can’t he say we are looking for, or we have been looking for and have found? Because it isn’t true. Make the system work even better? Really? Pennsylvania’s performance with the vaccine places it at 48th out of 50. The third worst in the nation. We are nowhere close to “Even better”; almost anything is even better than where we are today. Shouldn’t we be setting our goals a little higher? My best interpretation of this is; we haven’t really done anything yet, but we will. Honest, we will.

Once again, we see problems with no real action, just accusations and talk. What has been done so far? A task force has been established to agree with the plan Alison Beam shared with them, and we have drastically reduced the number of locations where vaccines will be available. Why is no one looking at the disparity in how doses of the vaccine have been distributed through the state? Why are our elected officials blaming providers for using the supply of vaccines when they had no way of knowing some shipments were for first doses while other shipments were meant for second doses? Of the situations I am aware, health systems took it upon themselves to plan for first and second doses: Many were chastised for that approach. In hindsight, it is exactly what needed to happen because our state government seems unable to piece together an effective distribution plan. Why is there no sense of urgency that the residents of our counties and our state deserve better? Why do our elected officials continue to blame others rather than to work side by side with the common goal of providing an appropriate response to a pandemic?

We need someone in our state government who is able to clearly communicate; someone who is able to plan ahead; someone able to coordinate efforts; and, mostly, someone willing to take responsibility for Pennsylvania’s pandemic response. Until that happens, Pennsylvania will continue to wander through this global crisis without direction. So, I urge you that come election time over the next eight years, if the incumbent state or federal official on the ballot is not leading the response, if the best they can do is blame someone else, and if they never participate in bipartite votes and efforts, they need replaced.