Frustration grows with Pennsylvania's 'confusing' vaccine rollout

In the hours after the big announcement, the region’s health systems were inundated with phone calls and emails to clinics, physicians and call centers.

Thousands of people were suddenly eligible to get the covid-19 vaccine.

They wanted it fast.

But the announcement by Pennsylvania officials — expanding the vaccination eligibility pool to people older than 65, and those with cancer, diabetes and many other conditions — came days after health officials learned the federal stockpile of vaccine was depleted, and disruptions in supply were likely to occur as a result.

“We have scheduled all of the vaccine we have available at this point,” said Dr. Amy Crawford-Faucher, chair of family medicine for Alle­gheny Health Network, who, like many health professionals in Western Pennsylvania, said there is not enough vaccine in the region to accommodate the change. “We’re in a holding pattern right now. We’re going to use the vaccine we have for the people we have scheduled, and we expect we will get some amount of vaccine next week. But we don’t have any idea how much it’s going to be.”

AHN and Excela Health said Friday they would not be scheduling any more vaccination appointments for the time being. Like most providers in the region, Crawford-Faucher said, AHN was hardly prepared for the state’s expansion of its first priority vaccination group, which included front-line health care workers and long-term care facilities. The state’s announcement created a bottleneck of eligibility, a free-for-all race of people trying to get their first shots when the doses are in short supply.

“It’s almost unfair to patients, to people in the state, to say ‘millions of you are now (eligible)’ without any plan in place to make it happen,” Crawford-Faucher said.

Last week’s announcement by the state is only one example of flaws in vaccine distribution, though. Pennsylvania is now one of only 17 states still in Phase 1A of the federal vaccine rollout, in a process that has been defined by confusion and lack of communication. Throughout the Western Pennsylvania region, vaccine providers say they still have difficulty scheduling and administering vaccines when they don’t know how much supply they’ll get week to week.

Supply and demand

Pennsylvania is a tough state for implementing a mass immunization plan, said Bridget Calhoun, a public health expert and professor at Duquesne University. With two large urban areas and a lot of rural residents, distributing vaccine equitably and evenly with a uniform approach can be challenging, particularly with the Pfizer-BioNTech vaccine’s ultra-­cold storage requirements. That difficulty is compounded by the fact that the vaccine workforce is tied up with testing and caring for people who are infected, she said.

“From a non-public-health-person-perspective, it might sound easy. You set up a vaccination clinic, and then people go and get vaccinated,” Calhoun said. “But there are so many other things that play into it. The transportation of the vaccine to the vaccination site, and then the supplies: we need syringes, we need needles, we need space. … There’s a lot that goes into it.”

Allegheny County officials said one reason for the slow rollout is the region’s large population of 1A health care workers. A Pennsylvania Department of Health spokeswoman said there also is a “technical process” to implement federal guidance from the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices. She said it involves careful review of CDC documents and addressing any conflicts that might arise.

“It does take some time to go through this process,” said April Hutcheson, the state spokeswoman.

Unlike some other states, including Ohio and New Jersey, Pennsylvania doesn’t have a centralized registration system for people to sign up for the vaccine, nor is there much of a coordinated effort to distribute doses. The onus is mostly on providers — from massive hospital systems to tiny, local pharmacies — to arrange their own vaccine appointments and communicate with the public.

Calhoun said such centralized systems could be real assets to states, if they have the established infrastructure. It’s better for hospitals and pharmacies to handle everything, though, if the website is going to crash when too many people try to register. But many residents ache for the organized guidance a central system would provide.

“There is a dire need for Pennsylvanians to be able ‘sign up’ to be notified of when they are eligible to receive a vaccine and where they can receive it,” said state Sen. Lindsey Williams, D-West View, who on Friday released a lengthy statement calling for transparency and clarity with the state’s vaccine rollout. “While it makes sense to prioritize the very small number of vaccines that we are receiving, our residents still need more guidance as to when and where they can expect to receive their vaccines.”

Six weeks after Pennsylvania’s first allocation, about 3.5% of its population has received a first dose, according to state data, compared to the national average of 4.2%.

The lag is not for lack of action by vaccine providers. The issue lies in the state’s supply. Many federally qualified providers — pharmacies — have not received any supply at all. Several said they don’t know if they ever will.

“I applied for it,” said Alex Micklow, chief pharmacist at Leechburg HealthMart Pharmacy. “I sent an email to the state in December, and I still haven’t gotten a reply. They initially told us we weren’t going to get it until March or April. We don’t know if that’s still true or not.”

Though residents are calling the pharmacy to ask about vaccine availability, Micklow said he is not taking down names or creating a registration list until he is allocated the doses.

“The rollout is really confusing,” he said. “There’s no clear direction.”

Even those that have received vaccines say they’re struggling to schedule appointments from week to week, because they never know how much they will be allocated from the Department of Health or the federal government.

And some providers say they were blindsided by the state’s announcement. Allegheny County Health Director Debra Bogen said Wednesday the health department did not know about the eligibility expansion until the day it was announced. Crawford-Faucher, at AHN, said the hospital network knew an expansion of eligibility was coming, but couldn’t predict what direction the state would take.

With vaccine supply an enigma, some providers wonder why the Department of Health would choose now to expand eligibility. Several say they are still focusing on health care workers, the original 1A group, because that’s all they can do.

“While the state’s announcement that individuals 65 and over or with a condition that puts them at risk for serious disease can now be immunized, our present supply of vaccine does not allow us to inoculate this group at this time,” said Dr. Carol Fox, chief medical officer at Excela Health. “We initially received a supply that we hoped would allow us to offer vaccine to all health care workers. Unfortunately, the community health care worker demand has exceeded that supply.”

The Department of Health did not respond to questions about the timing of the expansion.

Delays in 1A

Meanwhile, people in priority groups outside of hospitals described difficulty obtaining the vaccine. Even those considered the state’s highest priority experienced roadblocks when it came to scheduling their doses.

James Tauberg, president of the Pennsylvania Dental Association, said there was miscommunication early on about how dentists should go about getting vaccinated. The state has repeatedly updated its guidance for vaccine distribution, and dentists weren’t always part of Phase 1A. (Though dentists across the state have implemented extensive personal protective equipment and sanitation practices, he said, they do spend a lot of their time about six inches away from peoples’ open, maskless mouths.)

Once dentists were considered a priority, Tauberg said many dentists expected hospitals and other vaccine providers to reach out to them to schedule vaccines, in keeping with instructions of then-Health Secretary Rachel Levine in late December, when the state ordered that at least 10% of hospitals’ vaccines go to unaffiliated health workers. But that proved inefficient, and in the past several weeks, providers have mostly started offering online forms for people in 1A to sign up for vaccines on their own.

Once dentists knew what to do, Tauberg said, the process was pretty straightforward.

“I don’t think it’s a major issue anymore,” Tauberg said. “It just meant more burden on the person trying to get the vaccine.”

Vaccination also has been slow in long-term care facilities, another priority group. Pennsylvania, like most states, opted to participate in the Federal Pharmacy Partnership, giving CVS Health and Walgreens the responsibility of inoculating residents and staff of long-term care facilities. But unlike other states that disbursed vaccines to long-term care residents immediately, Pennsylvania delayed the distribution to nursing homes by two weeks — until Dec. 28 — in favor of first prioritizing hospital and other health care workers.

“There’s been a lot of frustration because the process is taking much longer than expected,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association. “We are looking at other states — our neighboring states like Ohio, West Virginia and even New Jersey — and they are making quicker progress than we are.”

Residents and employees at more than 600 nursing homes have received the first dose of the vaccine since late December, Shamberg said. But the state’s roughly 1,200 assisted living and personal care homes have only just begun getting vaccine clinics scheduled — with some assisted living residents and employees in Western Pennsylvania slated to have to wait until mid-March.

When it comes to long-term care, state officials have said they have little control over the speed of the Federal Pharmacy Partnership, and have given few updates on its progress in the state. But Shamberg said the state is still responsible for deciding how much of the state’s vaccine allocation is given to long-term care. He said some facility operators are concerned about Phase 1A expanding when there are still more vulnerable people in need of immunization.

“Whether it’s Arizona, Ohio, West Virginia or Florida, other states are finding ways to make it work not just for long-term care but for the general population,” Shamberg said. “We are more than willing to work with our state, our Department of Health and the Wolf administration to facilitate this process and get the vaccine out as quickly as possible to long-term care so that we can get the general population vaccinated.”

Preparing for next phase

While the state trudges through the first distribution phase, individuals in 1B and 1C groups have gotten little information about how to prepare for vaccination once they become eligible. The Department of Health did not respond to questions about how it is communicating with these groups or how they should prepare for vaccine rollout.

“I just want Pennsylvania to start moving,” said Nina Esposito-­Visgitis, president of the Pittsburgh Federation of Teachers, who for weeks has been trying to nail down a date for Pittsburgh teachers to get vaccinated.

Pittsburgh Public Schools is partnering with UPMC to vaccinate teachers and staff, said Rodney Necciai, assistant superintendent, and surveys have been sent to gauge interest in the vaccine. Necciai emphasized that while the district has created a strong logistical plan, including five designated vaccination sites and other infrastructure, there is no clear timeline for putting it in place.

The school board proposed another delay to in-person instruction last week, to be voted on this week. The hope is that, by postponing until after spring break, staff will have a greater chance of being vaccinated before returning, said spokeswoman Ebony Pugh.

Many groups in Phase 1B — which, in addition to teachers, includes first responders and grocery and transportation workers — have received little concrete information about when or how they’ll receive the vaccine.

Giant Eagle, for example, despite operating pharmacies qualified for vaccine distribution, is awaiting information from the state about when and how to inoculate its grocery workers, a spokesman said.

“As soon as grocery store employees are eligible, hopefully in the coming months, we are prepared to offer the vaccine to our Team Members,” spokesman Dick Roberts said in a statement. “Recognizing that our communities will not have the opportunity to completely reopen unless most Americans receive the covid-19 vaccine, Giant Eagle is strongly encouraging all Team Members to get the vaccine as soon as it becomes available to them.”

Though Pennsylvania has placed members of the clergy among those in priority 1B, officials at the Catholic dioceses of Pittsburgh and Greensburg said they still are awaiting guidance from the health department and do not yet have vaccines scheduled for either clergy or educators in Catholic schools.

Yet some members of 1B have already received vaccines: two school districts in Westmoreland County, Ligonier Valley and Latrobe Area, arranged vaccinations for teachers and staff through a local pharmacy. UPMC has vaccinated some corporate leaders and employees that have worked from home since March, claiming they, too, are Phase 1A because they’re essential to the system’s ability to provide patient care. Crawford-Faucher said Allegheny Health Network also has inoculated certain first responders, like police and firefighters, who already had relationships with the network.

“Our goal is to vaccinate the public, and it has not been smooth because we’re building this as we go along,” Crawford-Faucher said.

The inconsistencies and deviation from the federal guidelines have created frustration for community members, lost in the process and hopeless to gain clarity on when it will be their turn to receive the potentially lifesaving vaccine.

“Pennsylvanians deserve clear and direct communication from our government about when they will be able to receive a vaccine and assurance that this procedure is being carried out fairly and equitably,” Williams said.

Janet Surma and Natasha Lindstrom contributed to this report.