Planning, communication breakdowns hinder Ga. vaccine rollout

Dr. Lynn Paxton (left), District Health Director of the Fulton County Board of Health, administers a Pfizer vaccine to Karen Schaefer at the mass vaccination site at Mercedes-Benz Stadium on Wednesday. (Curtis Compton / Curtis.Compton@ajc.com)
Caption
Dr. Lynn Paxton (left), District Health Director of the Fulton County Board of Health, administers a Pfizer vaccine to Karen Schaefer at the mass vaccination site at Mercedes-Benz Stadium on Wednesday. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@ajc.com

Health experts say Georgia must take immediate steps to fix its sluggish system

A cascade of breakdowns marred the initial rollout of the state coronavirus vaccination program.

Some hospitals received more doses than they could give out, as others couldn’t get the vaccine or answers about why. Nursing homes, deemed a top priority, waited for word on when help would come.

That was month one.

On Monday, the first day that Georgians over age 65 could get shots, health departments websites crashed. Phones went unanswered. Appointments got overbooked. Some seniors waited in long lines, into the night.

Now, with a post-holiday surge shattering death records and pushing hospitals to the brink, while a more contagious strain of the virus is spreading, there’s new urgency to correct Georgia’s program as it enters its second month.

“Every kind of problem that you can imagine is now cropping up, and cropping up much more visibly, because there’s a panic,” said Mark Rosenberg, a former CDC researcher and former president and CEO of the Task Force for Global Health.

Many of the problems are systemic across the nation, perhaps inevitable given the complex logistics and resources needed with the vaccines. But key breakdowns are the result of flaws in planning, strategy and communication, The Atlanta Journal-Constitution found.

To start, the federal government ignored some experts’ recommendations to distribute shipments based on rates of infection, or to provide more doses to states that skew older or have more hard-hit minorities. Instead, it allocated supplies based on the adult population. Then the Trump administration left it to states to work out how doses would be distributed and administered.

Nurse practitioner Debra Dewitt, with the Fulton County Board of Health, prepares Pfizer vaccines at the mass vaccination site at Mercedes-Benz Stadium on Wednesday. (Curtis Compton / Curtis.Compton@ajc.com)
Caption
Nurse practitioner Debra Dewitt, with the Fulton County Board of Health, prepares Pfizer vaccines at the mass vaccination site at Mercedes-Benz Stadium on Wednesday. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@ajc.com

Credit: Curtis Compton / Curtis.Compton@ajc.com

In Georgia, that left execution of a massive vaccination program up to the same underfunded public health system straining to fight the virus. The general hands-off approach of state leaders compounded the challenges.

State officials pushed much of the responsibility for distribution and administration down to individual providers. Many of them — hospitals, local health departments, clinics — already were overwhelmed battling the pandemic. And the responsibility didn’t arrive with enough resources to carry out the vaccination efforts.

The approach created a Frankenstein’s monster of a distribution system, where levels of access to the vaccine vary from county to county, provider to provider.

Asked by the AJC at a press conference earlier this month why the state expanded vaccinations without the supplies and infrastructure to handle demand, Gov. Brian Kemp said, “They’re eligible for it if there’s supply.”

“What we were simply trying to do is to make sure that we didn’t have vaccine sitting in freezers somewhere,” Kemp said.

The state might have eased the resulting confusion with an effective and coordinated communications effort. “One of the major purposes of communications is to set and guide expectations so people don’t get frustrated, they don’t get angry,” said Glen Nowak, a UGA professor and expert in public health communications who spent 14 years at the CDC. “If they are left in the dark it doesn’t foster participation.”

Instead, communication seemed to be treated as an afterthought. In expanding eligibility to everyone 65 and older, state officials didn’t stress that doses were extremely limited. What’s more, some health providers got little notice of the change before being deluged with vaccine requests and saddled with responsibility to quickly report all the doses administered.

And while the state this week launched a website showing where people could seek appointments, it doesn’t offer the public a way to sign up or information on how they might be notified when doses were available.

Nancy Nydam, spokeswoman for the Georgia Department of Public Health, asked the public for patience as the state looks for ways to make scheduling appointments easier and vaccine distribution more efficient.

The state’s challenge is compounded by having no control over how much vaccine Georgia receives.

“This is a heavy logistical lift, complicated by limited doses of available vaccine and the resources needed for safe administration,” Nydam told the AJC in an email. “As both Pfizer and Moderna ramp up production of vaccine in the coming weeks, supply should better meet demand for each phase of allocation and administration.”

Nydam said the department hopes to launch a statewide scheduling website in the next few weeks. It hasn’t done so already because similar sites in other states had problems handling the heavy traffic.

For now, Georgians are on their own to navigate the nuances of health systems in hopes of securing an appointment.

“Clearly, there’s plenty of blame to go around,” said Dr. Richard Rothenberg, a professor and infectious disease expert at Georgia State University who worked for 25 years at the CDC.

Motorists who preregistered line up for their COVID-19 vaccinations in the drive-thru vaccination site at the Coweta County Fairgrounds, where more than 900 were vaccinated on Thursday. (Curtis Compton / Curtis.Compton@ajc.com)
Caption
Motorists who preregistered line up for their COVID-19 vaccinations in the drive-thru vaccination site at the Coweta County Fairgrounds, where more than 900 were vaccinated on Thursday. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Credit: Curtis Compton / Curtis.Compton@

Infrastructure overwhelmed

John Alton knows the strains on the system all too well. The 76-year-old McDonough resident dialed his local public health office hundreds of times last weekend trying to secure an appointment for him and his wife.

After a litany of busy signals and automated voice answers, he finally got through, only to have the person hang up.

“I yelled and screamed and cussed,” Alton said. “The amazing thing to me is that, gee, they’ve only had six months to prepare for this.”

Alton eventually secured an appointment at a pop-up site on Tuesday at Atlanta Motor Speedway.

The Department of Public Health’s District 4 spokeswoman, Hayla Folden, said it has enlisted every staffer possible, 15 people, to answer phones.

“Our infrastructure is just not set up for this kind of volume,” she said.

And the district, which includes Henry and 11 other counties, is now out of vaccine doses and is uncertain when more will arrive, Folden told the AJC on Thursday.

Health experts say the broader logistical and administrative problems could continue to dampen the program unless they are corrected.

“To me the bottleneck is, does the state have the funds and the plan in place to have enough personnel, enough freezers, and enough outreach to handle the number of people with the vaccine and the number of vaccines that are going to be delivered over the next 30 days?” said Ted M. Ross, director of the University of Georgia’s Center for Vaccines and Immunology.

Ross said state and federal officials still have time to to get a comprehensive program with the goal of getting 50 percent of the population vaccinated by late spring.

“It needs to be coordinated and large,” he said. “It needs to be obvious, like people are noticing this happening.”

Gov. Brian Kemp returns to his office following a press conference about COVID-19 at the Georgia State Capitol on Tuesday. (Alyssa Pointer / Alyssa.Pointer@ajc.com)
Caption
Gov. Brian Kemp returns to his office following a press conference about COVID-19 at the Georgia State Capitol on Tuesday. (Alyssa Pointer / Alyssa.Pointer@ajc.com)

Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com

Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com

A faulty strategy?

One of the state’s foremost computer modeling experts said the flaws in the system run even deeper. Eva Lee, developer of the RealOpt computer planning system that helped the CDC respond to the H1N1 and Ebola virus outbreaks, said that with the variant strains spreading, national and state leaders should rethink the phased rollout plan that has the most vulnerable residents receiving doses first.

Lee said about half of the available vaccine stock should be set aside immediately for the general population — younger people who are moving about in communities, spreading the virus.

“If we just vaccinate all the high-risk individuals first, our total infection will be a lot higher than if we strategically split them,” Lee said.

But Jennifer Kates, director of global health at the Henry K. Kaiser Family Foundation, said that while vaccines have been shown effective in preventing illness, whether they prevent infection and spread remains to be seen. “So therefore you want to target people who are most likely to get sick if they get infected and die from this,” she said.

Kates said Georgia will have a chance to streamline its system with its next allotment of federal CARES Act money for vaccine distribution. The state received $10.5 million toward the effort in 2020. This year, Georgia will receive $96 million. On Thursday, President-election Joe Biden proposed an additional $20 billion — on top of the $8 billion Congress already approved — to help states with the vaccine effort.

At a briefing Tuesday, Georgia Public Health Commissioner Dr. Kathleen Toomey said one tool they are using to vaccinate in large numbers are mega-sites across the state.

Mercedes-Benz Stadium is one. Though doses are only for those with appointments, since Monday a steady stream of seniors have gone through the facility. On Thursday, 800 people were vaccinated.

Fulton’s district health director Dr. Lynn Paxton said they are hoping to expand daily capacity once they secure more doses and the medical staff to administer shots.

“Some of my fellow health directors have very much described it as sort of building the plane as we fly it,” she said.

Fulton County Board of Health registered nurse Greer Pearson gives Brenda Malik a Pfizer vaccine at the mass vaccination site at Mercedes-Benz Stadium on Wednesday. (Curtis Compton / Curtis.Compton@ajc.com)
Caption
Fulton County Board of Health registered nurse Greer Pearson gives Brenda Malik a Pfizer vaccine at the mass vaccination site at Mercedes-Benz Stadium on Wednesday. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@ajc.com

Credit: Curtis Compton / Curtis.Compton@ajc.com

For Georgians like Brenda Malik, the shot couldn’t have arrived soon enough. The retired middle school teacher, who is 71 and lives with her daughter in southwest Atlanta, has been worried as the death toll keeps rising. Her daughter scrambled to secure her an appointment Wednesday at the Mercedes-Benz site.

“I don’t want to be one of those numbers,” Malik said, minutes after receiving her first dose. “This means a lot. It means I’m going to live. I just want to live.”

Staff writer J. Scott Trubey contributed to this story.

Grocery stores have the vaccine, but appointments fill up quickly

Publix, Kroger and Ingles pharmacies are administering free COVID-19 vaccine shots in Georgia. But with overwhelming demand, finding an appointment slot isn’t easy.

Publix said it would offer the shots starting Saturday in 33 Georgia counties, but Friday morning a website to book appointments showed every county “fully booked.” Kroger said it has the Moderna vaccine at all its pharmacies, but its website showed appointments to be either scarce or nonexistent throughout the state. Ingles’ website on Friday listed 32 store locations with the vaccine and placed those who registered on a waiting list.

All three grocery chains are offering the vaccine to Georgians who are currently eligible: people over age 65, their caregivers, healthcare workers, first responders and residents and staff of long-term care facilities.

To try to register for an appointment at a Publix store, go to https://www.publix.com/covid-vaccine/georgia.

To try for a Kroger store, go to https://www.kroger.com/i/coronavirus-update/pharmacy.

For Ingles, go to https://www.ingles-markets.com/pharmacy/pg1/pharmacy-sub/vaccinations.