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Providers and health directors push back on slow vaccine rollout
Officials complain of lack of certainty and funding
 
Published Monday, January 18, 2021
by Rose Hoban | North Carolina Health News

PHOTO | ROSE HOBAN
Licensed practical nurse Angela Horton, who usually works in a UNC Health dermatology clinic, got pulled in to do vaccinations at a mass clinic in Chapel Hill this week. She went through paperwork with Chapel Hill resident Robert Engler, 76, as she prepared to give him the first dose of vaccine.

It’s hard to tell that the mass vaccination clinic set up by UNC Health was only a few days old.


There was no crush of patients at the door. Instead, a steady stream of gray-haired people, some on canes, walkers or in wheelchairs, arrived at the Friday Center on the campus of UNC Chapel Hill to find a registration desk to check their appointments once they got inside the door.


Then people moved through a series of lines marked by ropes and circles on the floor denoting the correct distance to stand apart from the other people in the queue. Then to a phalanx of a dozen desks where people sat to give information and answer questions to a pair of lines feeding into the vaccination room, which had 15 stations.


Finally, people were escorted to an observation area, where they waited 15 minutes to be sure no one had an allergic reaction.


There was even a branded cloth that people could stand in front of to take their vaccination selfies. About 45 minutes for a round trip.


“It’s all worked out really well,” said Robert Engler, 76, from Chapel Hill who got his first dose of Moderna vaccine on Thursday morning. His wife received the Pfizer vaccine at the same location on Tuesday. “We heard all the horror stories about Florida and people were having to stay in line for nine hours overnight. And this has been perfect.”
As people walk out the door, they have in hand a card with their second dose appointment time on it.


“We’re able to see 600 new patients today, we’re hoping to ramp up to around 1,500 patients a day,” said Elizabeth Ramsey, who was managing the operation.


She explained that UNC Health has gotten different allotments of vaccines. Thursday it was Moderna. Earlier in the week, the site had been distributing the Pfizer/BioNTech jabs. She also said there’s been some uncertainty about future allotments of vaccine, and whether the UNC mass vaccination site would receive enough in several weeks’ time to administer both first doses and accommodate people who need their follow-up shots.


Slow ramp up
On Tuesday, Mandy Cohen, secretary of the Department of Health and Human Services got a grilling from legislators who complained that North Carolina trails the pack when it comes to getting vaccines into the arms of an eager public.


“Most of us don’t feel that this process has not moved as quickly as it could or should have to this point, and we’re wanting to deal with it,” said Sen. Ralph Hise (R-Spruce Pine).


He reminded Cohen that in the past, the state’s emergency management director Mike Sprayberry had critiqued a storm disaster response system as using counties for getting aid out to and rebuilding damaged properties to each hard-hit site.


“He said we have learned from experience that many local governments lack the staff expertise and capacity to administer disaster relief, and further, said that a lack of a uniform process can cause inefficiencies,” Hise said. “Why did we choose that administrative structure for that was something that we knew would be problematic from history?


“We merely handed it over to basically 100 county health departments and hospitals and said, ‘Have fun.’”


Cohen pushed back, noting that some county agencies have done, “spectacularly well” calling out health departments in Iredell and Robeson counties and the Albemarle Regional Health Services, which encompasses eight northeastern counties.


“Then there are others that aren’t doing as well and that is our job at the state to support them in improving,” Cohen added, noting the challenges of getting vaccines to some of the most remote corners of a state with 80 rural counties. “I think for us at this stage, we needed to rely on the infrastructure that we have.”


Scaling up quickly
The announcement came this week that the state would open high-throughput vaccination clinics with large institutional partners, which included the UNC site in Chapel Hill and one in Hillsborough.


UNC Health infectious disease physician David Wohl said that while his institution knew for a long time the vaccines were coming, a lot was unclear until they were finally approved.

“It got released on us like a ton of water. And we just had to stand up systems really quickly,” he said.


The experience of operating high throughput testing sites all year gave UNC and other institutional entities the needed knowledge to get up and running quickly.


“UNC, Duke, Wake Forest, we know how to do that,” he said, gesturing around the Friday Center site, which practically hummed with efficiency. “We have systems, people, we can make that happen. Smaller places, I just feel for them.”


He pushed back against lawmakers’ critiques.


“We’ve been hamstrung by the availability of supply of vaccine, we’ve had to close down scheduling in the future because we don’t want to schedule people for vaccine that we don’t have right now,” Wohl said. “There’s just not enough supply of vaccine here in a state. I feel like if we had more vaccine, people wouldn’t have to be more parsimonious about how to get it out to the different places.”


He said he believed North Carolina has been penalized because the state followed federal rules and guidelines about getting the vaccines out, whereas other states did their own thing.


“We’ve been following the phased approach. We haven’t taken just anyone who comes along and vaccinated them like they do in other states,” he said. “We’re following the rules by registering people in the system that the federal government and the state is now complying with that as an extra step.”


“We’ve done what we were supposed to do.”


High-speed hamster wheels
Some health directors in smaller counties also pushed back on the idea that they had been slow, or disorganized.


“I think it’s hard for everyone across the state to understand the complexity of planning these events so that we keep our most vulnerable populations to COVID-19 as safe as possible as they’re being vaccinated,” said Lisa Harrison, who heads Granville Vance Public Health.


Harrison was speaking from a mass vaccination clinic at the Granville County Convention and Expo Center in Oxford on Thursday morning where her team planned to give out about 500 doses of vaccine to older seniors and members of their households.


“This is not like when you were a kid, and everyone got polio vaccination at a gymnasium in a school. There’s very different constraints here,” including COVID being highly transmissible through the air and the population in the room being especially vulnerable if they contract it, she said.


“People have to understand that there are systems that have to be in place to do this very safely,” she said.


Harrison also pointed out that there’s a limited supply of staff to administer the vaccines, especially inrural areas. She had to tap all the public health nurses, school nurses and staff from the senior center to get it all done.


“We have real staffing challenges, especially in local health departments where we received the vaccine on top of already working 12 to 14 hour days on COVID response,” she said. “You know, the same people who are expected to give vaccines every day, all day, are the same people who are doing case investigation and contact tracing, data management, outbreak investigation, community outreach and communications.”


All without additional funding.


“We’re a mighty staff, but we’re still pretty small and so having to get off one high-speed hamster wheel of response all day, every day, seven days a week, holidays and weekends… and get on another hamster wheel of high-speed response for vaccination, it’s taken a minute,” Harrison said.


That was a point Wohl also made.


“A lot of thought went into let’s invest billions in these different companies, like pre-purchasing vaccine,” he said. “Great, but not a lot of thought went into how are people going to actually deliver the vaccine.”


Harrison planned to administer 1,500 doses by the end of the weekend. But uncertainty about future allocation of vaccine second doses made her hesitate to schedule too many extra people.


“We have over 7,000 individuals over 75,” Harrison said. Now, federal officials have said doses could be given to those over 65, which she said increases the potential demand to more than 11,000 people. “We [also] have to get through a lot of frontline and essential workers, and school teachers, and the staff of our local jails.”


Harrison has also had to send three nurses out to the dozens of long-term care facilities and group homes in her two-county area, providing vaccinations on-site for staff and residents.


She predicted that to get through all the current priority groups would take most of February and March, based on the speed of the allocations her department has received.


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