Chaotic vaccine deliveries stymie pandemic response

Grady Memorial Hospital, the essential health care setting for many of Atlanta’s poor, recently checked on its weekly allocation of COVID-19 vaccination doses to find it would get none at all.

A round of shock and pleading shook loose 220 doses from the state’s overall allocation, still a fraction of the thousands of doses that Grady expected to administer. Meanwhile, DeKalb County’s public health department received 100 doses for the week. Wellstar Atlanta Medical Center, according to records posted by the state, received none.

“We’ve stopped scheduling new appointments,” Grady Chief Medical Officer Dr. Robert Jansen said in an interview Friday. Other systems, he noted, had done the same, as they focused on keeping appointments for patients’ second doses. “It’s incredibly disheartening,”

Health workers were prepared for a vaccine rollout that would start thin and take time. But government watchdogs and those responsible for administering vaccines say that missteps at both the state and federal levels are raising questions about fairness, delaying doses and shaking public confidence.

Vaccines supplies that were supposed to be allocated to states equally on a per capita basis haven’t been. Computer systems that were supposed to update each other seamlessly often have not. Vast reserves of doses turn out not to exist. Vaccination providers have no idea how many doses are coming and when. Told that is changing now, they don’t know who to trust.

Officials at hospitals and on government vaccine teams say there are signs things are improving with the turnover in Washington and new procedures in Georgia. But not fast enough.

Georgia shorted

The U.S. Government Accountability Office in September warned that the nation needed to plan and coordinate how to distribute and administer COVID-19 vaccines. Last week, GAO said that no such plan was fully implemented.

Instead, each state was ordered to submit a plan, then all were largely left to their own devices to organize, ramp up and staff mass vaccination sites, said Alyssa Hundrup, an acting director at the GAO for health care.

“I think there was an expectation that the states have all that,” she said.

Some, however, have been making it clear that they didn’t, she said.

Public health experts question why the federal government allocated billions of dollars to private companies to develop vaccines, but didn’t put the same attention on the next step.

“If they had only devoted a minuscule proportion of that money to developing a distribution system that included an appointment system that could handle this volume, we would be in a much better position,” said Dr. Lynn Paxton, district health director of the Fulton County Board of Health.

Local health departments in Georgia, already overwhelmed with testing and contact tracing, had to adapt their own computer systems for appointments and devise ways to administer the vaccine.

“To everyone’s credit, we have made huge strides in just the period of time we have had to do this, but are we behind the 8-ball? Absolutely,” Paxton said.

Gov. Brian Kemp has said the biggest issue is the shortage of vaccines. It’s unclear if Georgia is even getting its share.

Information on government websites shows an apparent discrepancy between what the vaccine companies had as allocations for Georgia, and what the state reports it has received. The discrepancy leaves the appearance that well over 400,000 doses meant for Georgia may never have arrived. White House officials and the Centers for Disease Control and Prevention didn’t explain the differing numbers.

Moreover, although former U.S. Secretary of Health and Human Services Alex Azar said that doses would be distributed based on adult population, that has not happened. Georgia’s share as of early this week was the 16th worst among states, while Alaska had received nearly double the doses per capita that Georgia had.

Azar also had announced that the federal government would boost allocations by distributing doses it had held in reserve. A few days later, Azar acknowledged there was no reserve.

Communication, IT issues

The Biden administration last week said that by working with vaccine makers to scale up production, it was boosting state allocations by 16%, and on Tuesday said it was boosting the supplies by another 5%.

The administration is also now giving states three weeks’ notice of how many doses they’ll receive.

Still, many Georgia health departments, hospital systems, pharmacists and others trying to get shots in arms say they only know for sure what amount they’re getting a few days ahead.

Credit: Curtis Compton / Curtis.Compton@

Credit: Curtis Compton / Curtis.Compton@

Some hospital officials said the state may be doing the best it can under the circumstances. But the lack of a clear and predictable supply chain, they say, is making it almost impossible for them to come up with a reliable plan for vaccine clinics.

“It’s a day-by-day guessing game about when you’re going to get supplies in,” Grady’s Jansen said.

Phoebe Putney Health System in southwest Georgia said the state should be deciding weeks ahead of time how many doses they’ll give providers. Phoebe Putney put in a new computer system to smooth the way for vaccination appointments, but uncertainty about supplies is undermining the effort, CEO Scott Steiner said.

“You can tell me the bad. You can say we don’t have anything, and we’re not going to for two weeks. I can work with that,” he said. “But if somebody’s going to not tell us anything?”

Uncertainty about supplies isn’t the only issue thwarting vaccination efforts. A computer glitch is being blamed for some providers being shorted on doses.

The Georgia Department of Public Health said Tuesday it bases allocations, in part, on information showing whether providers have given out the doses they received. Asked to explain the scant allocation to Grady, the DeKalb Health Department and Wellstar Atlanta, the agency said an “IT issue” made it appear that some providers had large amounts of doses on hand when they actually didn’t.

So those providers didn’t get a new allotment or as large an allotment, DPH said.

“The issue is being addressed and fixed,” DPH said in an emailed statement.

Problems foreseeable

Whatever the reason for the uncertainties, many vaccine providers wait to post available appointments until a shipment arrives. Then, they may subtract what they need to make promised second-dose appointments.

Only then are appointments opened for those seeking a first dose. Those slots are filled within two to three hours, said Chad Wasdin, spokesman for the health department serving Gwinnett, Newton and Rockdale counties. “Sometimes, it’s a lot faster,” he said.

Many people across Georgia searching for a first-dose appointment simply can’t find one.

DPH told the AJC it has made “good progress in a matter of weeks,” with providers administering nearly a million doses of vaccine as of Tuesday.

But the state acknowledged that the complex rollout has stretched the public health system to its limit. The department cited, among its biggest problems, systems for IT, data reporting and communications that it said were never designed to handle the volume of data and traffic that COVID has forced on them. The failure has struck at the core of the state’s response, hurting its ability to collect and analyze data that are “fundamental to decision making.”

Analysts said that, and much else, was foreseeable.

Hundrup said that GAO had called out some of the problems a year ago, citing the need to plan, to coordinate and to look at lessons learned from past pandemics.

“And yet here we are,” she said.

Credit: Curtis Compton / Curtis.Compton@

Credit: Curtis Compton / Curtis.Compton@