Rapid COVID-19 vaccine rollout backfired in some states
Despite the clamor to speed up the U.S. vaccination drive against COVID-19 and get the country back to normal, the first three months of the rollout suggest faster is not necessarily better. A surprising new analysis found that states such as South Carolina and Florida that raced ahead of others to offer the vaccine to ever-larger groups of people have vaccinated smaller shares of their population than those that moved more slowly and methodically, such as Hawaii and Connecticut. The explanation, as experts see it, is that the rapid expansion of eligibility caused a surge in demand too big for some states to handle and led to serious disarray. Vaccine supplies proved insufficient or unpredictable, websites crashed and phone lines became jammed, spreading confusion, frustration, and resignation among many people. “The infrastructure just wasn’t ready. It kind of backfired,” said Dr. Rebecca Wurtz, an infectious disease physician and health data specialist at the University of Minnesota’s School of Public Health. She added: “In the rush to satisfy everyone, governors satisfied few and frustrated many.” The findings could contain an important go-slow lesson for the nation’s governors, many of whom have announced dramatic expansions in their rollouts over the past few days after being challenged by President Joe Biden to make all adults eligible for vaccination by May 1. “If you’re more targeted and more focused, you can do a better job,” said Sema Sgaier, executive director of Surgo Ventures, a nonprofit health-data organization that conducted the analysis in collaboration with The Associated Press. “You can open it up — if you have set up the infrastructure to vaccinate all those people fast.” Numerous factors stymied state vaccination performance. Conspiracy theories, poor communication, and undependable shipments slowed efforts after the first vials of precious vaccine arrived Dec. 14. But the size of the eligible population was always within the control of state officials, who made widely varying decisions about how many people they invited to get in line when there wasn’t enough vaccine to go around. When the drive began, most states put health care workers and nursing home residents at the front of the line. In doing so, states were abiding by national recommendations from experts who also suggested doing everything possible to reach everyone in those two groups before moving on to the next categories. But faced with political pressure and a clamor from the public, governors rushed ahead. Both the outgoing Trump administration and the incoming Biden team urged opening vaccinations to older Americans. By late January, more than half the states had opened up to older adults — some 75 and above, others 65 and up. That’s when the real problems started. South Carolina expanded eligibility to people in Steven Kite’s age group Jan. 13. Kite, 71, immediately booked a vaccination at a hospital. But the next day, his appointment was canceled along with thousands of others because of a shortage of vaccine. “It was frustrating at first,” Kite said. After a week of uncertainty, he rescheduled. He and his wife are now vaccinated. “It ended up working out fine. I know they’ve had other problems. The delivery of the doses has been very unreliable.” In Missouri, where more than half of adults were eligible for shots, big-city shortages sent vaccine seekers driving hundreds of miles to rural towns. Dr. Elizabeth Bergamini, a pediatrician in suburban St. Louis, drove about 30 people to often out-of-the-way vaccination events after the state opened eligibility to those 65 and older Jan. 18 and then expanded further. “We went from needing to vaccinate several hundred thousand people in the St. Louis area to an additional half-million people, but we still hadn’t vaccinated that first group, so it has been this mad dash,” Bergamini said. “It has just been a whole hot mess.” “It got a little chaotic,” said Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. “We created far more demand than there was supply. That stressed the system and that may have left the system less efficient.” Plescia said the analysis suggests that “a more methodical, measured, judicious, priority-based approach — despite people’s perception — actually can be as efficient, or more efficient, than opening things up and making it available to more people.” In retrospect, health workers and nursing home residents were the easy groups to vaccinate. Doses could be delivered to them where they lived and worked. “We knew where they were and we knew who they were,” Wurtz said. As soon as states went beyond those populations, it got harder to find the right people. Nursing home residents live in nursing homes. People 65 and older live everywhere. West Virginia bucked the trend with both high numbers of eligible residents and high vaccination rates in early March, but the state started slow and built its capacity before expanding eligibility. Similarly, Alaska maintained a high vaccination rate with a smaller eligible population, then threw shots open to everyone 16 and older March 9. This big increase in eligible adults near the end of the period studied led the AP and Surgo Ventures to omit Alaska from the analysis. The analysis found that as of March 10, Hawaii had the lowest percentage of its adult population eligible for vaccination, at about 26%. Yet Hawaii had administered 42,614 doses per 100,000 adults, the eighth-highest rate in the country. Thirty percent of Connecticut’s adult population was eligible as of the same date, and it had administered doses at the fourth-highest rate in the country. In contrast, Mississippi had the sixth-largest percentage of its adult population eligible at about 83%. Yet, Mississippi had administered only 35,174 total doses per 100,000 adults, ranking 43rd among states. Missouri, with 61% of its population eligible, had dispensed 35,341 doses per 100,000 adults. Seven states in the bottom 10 for overall vaccination performance — Georgia, Tennessee, Texas, Florida, Mississippi, South Carolina, and Missouri — had larger-than-average shares of their residents eligible for shots. Among high-performing states, five in
Medicaid expansion incentives under review
Alabama Republicans for years have opposed expanding Medicaid eligibility. Now, they may be cracking the door. Alabama Gov. Kay Ivey and legislative leaders said they are reviewing details of the nearly $2 trillion coronavirus relief package that includes new financial incentives for the states that have opted against expanding Medicaid to provide health coverage for more low-income Americans. A spokeswoman for Ivey said the governor is “open to the discussion” on expansion but that state leaders need additional information about the long-term cost projections. “Ensuring every Alabamian has access to quality health care is important to the governor and always has been a priority of hers. However, as she has made clear, the problem has always been how to pay for it. She is open to the discussion, but right now, we simply do not have all the facts,” spokeswoman Gina Maiola said. Alabama is one of 12 states that have taken no action toward expanding Medicaid eligibility under the Affordable Care Act. Previous studies have estimated that expansion would add around 300,000 people to state Medicaid rolls. Republican leaders have in the past expressed opposition to expanding Medicaid, at times citing both political opposition to the Affordable Care Act passed under former President Barack Obama and concerns about cost. Medicaid expansion under the Affordable Care Act allows people with family incomes less than 138% of the federal poverty limit— or around $17,000 for an individual and $29,000 for a family of three to qualify for Medicaid. Currently, Alabama’s Medicaid program covers very few able-bodied adults. “The bulk of the people who will gain coverage are people who are working,” said Jim Carnes, a policy analyst with Alabama Arise, an advocacy group for low-income Alabamians. Already, the federal government would pick up 90% of the cost of the expansion. A 2019 study by a University of Alabama at Birmingham projected the state’s cost would be about $250 million per year, but that the state would see a resulting boost in economic activity. The federal relief bill offers a new incentive by giving states a 5% boost to the federal match over the next two years for the people they currently cover. Democrats in the Alabama Senate have estimated that would generate an additional $900 million for the state. “I just want to say to Governor Ivey, if not now, when?” Senate Minority Leader Bobby Singleton said in the press conference. “I don’t care if we call it ObamaCare. We could call it Kay-Care. It could be Alabama Health Care. We need to expand Medicaid and the time to do it is right now,” Singleton said. Dr. Don Williamson, president of the Alabama Hospital Association, said the calculations are complex because of the intricacies of how Alabama funds Medicaid. The cost will also depend on how many people are added to the rolls. “To me, the most important thing that Medicaid expansion does is it absolutely improves health outcomes. You get earlier cancer diagnosis. You get lower infant mortality rates. You get earlier diagnosis if diabetes,” Williamson said. State Rep. Steve Clouse, the chairman of the Alabama House of Representatives general fund budget committee, said state officials are trying to gather information about the incentives and what would be the state’s share of costs in the long run. Sen. Greg Albritton, the chairman of the Senate budget committee, expressed some skepticism about the incentives. He said the incentives sound enticing but said the state has “got to have the answers” before making a commitment. “I’m not surprised this would be the same old song, the same old dance. … Buying a new car now. Nothing down, but the payment is due in two years,” Albritton said. Senate President Pro Tem Greg Reed said the analysis will continue over the coming weeks. The 12 states that have held out against the Medicaid expansion are: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming. Republished with the permission of the Associated Press.
Alabama National Guard to begin vaccinations at rural sites
National Guard members will begin immunizing rural residents against COVID-19 this week as Alabama tries to improve a vaccination rate that’s trailing most of the nation. Mobile vaccination clinics will be held Tuesday in the cities of Andalusia and Livingston, according to a news release by the state, followed by clinics in Enterprise and Eutaw on Wednesday. Guard teams will provide shots later in the week in Ozark, Greensboro, Abbeville and Marion, and additional clinics are planned elsewhere into April. The National Guard has two teams that are capable of providing at least 1,000 vaccinations per day. It plans to administer about 8,000 doses per week. Appointments aren’t required, and the shots are free. Gov. Kay Ivey said the effort will help as the state looks to get past the coronavirus pandemic. “I encourage everyone eligible to take advantage of this great resource, and please remain patient as we continue working to get our hands on as many doses as we are able from the federal government,” she said in a statement. While more than 1.3 million doses have been administered in the state, statistics from the Centers for Disease Control and Prevention show Alabama and neighboring Georgia are trailing the rest of the United States in the percentage of its adult population that has received at least one dose. The state is expanding the eligibility rules for vaccinations on Monday to include more frontline workers, residents with certain chronic health conditions, and people 55 and older. The move will add more than 2 million people to the groups who can receive a COVID-19 vaccination in Alabama, roughly doubling the number of people who are eligible. More than 10,000 people have died of COVID-19 in the state, and more than 510,000 have tested positive for the virus. Republished with the permission of the Associated Press.
