One recent Saturday morning, Peggy Hoon got behind the wheel of her 2011 Toyota RAV4 and made the 300-mile round trip to Charlotte from her home in Raleigh.
After weeks of waiting or hearing about vaccination events against COVID-19 only after it was filled, the 65-year-old Wake County resident was finally shot. She considers herself lucky and cares about the equity issues that leave seniors unable to find doses of the precious vaccine.
State officials say the main barrier to deploying vaccines has been a lack of supply. But the NC Watchdog Reporting Network found that in some cases, health professionals give doses to people who do not yet meet the requirements, according to guidelines from NC’s Department of Health and Human Services.
And that means people like Hoon, among those most at risk for serious injury or death from illness, are left waiting.
“That’s getting a vaccine out of someone who could really change if they got COVID instead of the person passing it through the back door,” Hoon said.
According to DHHS guidelines, only group 1 (health workers and residents and long-term care staff) and group 2 (over 65) meet the requirements for the vaccine. When a young person passes an older person with higher risk factors, the result could be literally deadly. People 65 and older account for only 14% of all COVID-19 cases in the nation, but 81% of all deaths, according to data from the Centers for Disease Control and Prevention.
The network of reports found that speed and equity conflict with each other, a problem exacerbated by the rapidly expiring nature of the vaccine and the near impossibility of monitoring all vaccine clinics.
In short, the vaccine distribution system works largely with the honor system, and some have taken advantage of it, putting the health of other North Carolinians at risk.
Millions of people need it; still limited doses
In Ashe County, at least a dozen people under the age of 65 were vaccinated. Staff from AppHealthCare, the three-county health department that includes Ashe, pulled out doses of vaccine to administer out of the office.
The NC Watchdog Reporting Network confirmed that dozens of doses of vaccine were taken by the health department against the protocol. A spokeswoman for the department has repeatedly refused to confirm details of who took the vaccine doses and where they went.
Initially, a health department spokeswoman dismissed the vaccines outside the office as a simple effort to rule out leftover doses at the end of the day.
“Our staff used up to 10 doses on different occasions when a 10-vial was unused and was about to expire,” AppHealth spokeswoman Melissa Bracey told the network in an email on Wednesday. past.
But he followed up a day later, after the network asked questions about the situation to DHHS, to say the local health department was investigating.
A week later, Bracey said in an email that the department’s investigation found a total of 40 doses of vaccine outside the agency’s protocols and 13 doses outside of groups 1 and 2, but did not detail how.
Clinics across the state and across the country have been instructed not to miss any vaccine, even if that means giving a dose to a younger person.
There have been other examples of state regulations:
In New Hanover, all county commissioners received a vaccine after a commission meeting on January 13, although the state was still in group 1.
In Chapel Hill, two UNC basketball coaches got the vaccine.
In Charlotte, Atrium Health scheduled appointments for non-health workers.
In Durham, some deputy mayors were vaccinated, the Durham County Department of Public Health confirmed. A spokeswoman said they scheduled appointments according to previous vaccine priority guidelines and were allowed to keep their appointments after changing direction.
In almost all cases, spokespersons for those who administered vaccines had what they considered valid reasons for not following state guidelines in the letter of the law.
Coronavirus vaccines in NC
A New Hanover County spokesman said the commissioners had received the vaccine because there were additional doses and later said they were vaccinated because of their position as elected leaders.
“The commissioners are leaders in this community, elected by our members to govern the new county of Hanover, and we were all vaccinated in our public office and not as private citizens,” said President Julia Olson-Boseman. “I definitely want to keep each person on the board as safe as possible, as they are asked to meet in person as a group and go out into the community to do the work that people chose us for.”
State and local health officials say these cases are the exception, not the rule. They say the main reason seniors looking for a vaccine can’t find a place on the line is simply the lack of vaccines.
“We have millions of people who need it, but only thousands of shots,” Gov. Roy Cooper said at a recent news conference.
Groups 1 and 2 are combined for about 1.7 million people. To date, the state has been allocated only 1.4 million first doses, and not all of them have yet reached the state. People aged 65 and over accounted for more than two-thirds of the first doses administered, a figure that does not include the vaccination program for staff and long-term care center residents.
The need for cold storage requires that doses be used quickly and many of the vials contain an additional dose beyond the intended. Health officials and the CDC have strongly urged clinics not to miss any doses at all, but that leaves clinics not exactly how many doses they will be able to provide.
“Some vendors have established waiting systems, sometimes forcing people to wait outside the queue,” said Julie Swann, head of the department of industrial and systems engineering at NC State University, who has been analyzing the impacts of COVID-19 on public health. “And the people who are perhaps best suited for that, may be younger populations who can stand out if it’s cold or raining.”
What to do with tens of thousands of “leftover doses”
Analysis of DHHS data shows that there have been more than 60,000 leftover doses administered in North Carolina. But even those should not be out of order of priority, according to DHHS guidelines.
“Getting out of an order of priority should be a very unusual circumstance. It shouldn’t be what happens every time,” DHHS Secretary Dr. Mandy Cohen said. “But we don’t want the vaccine to be vaccinated, so we recognize that there are some places where we just want to make sure we take the vaccine in our arms and not waste it.”
Triangle health systems say they have implemented backup plans to distribute additional doses equitably.
Dr. David Wohl, an infectious disease expert at the University of North Carolina who oversees vaccine distribution at the Friday Center, described what they call a “power hour” around 4 p.m., when clinic staff calculate how many doses they will have at the end of the day and how they could be better distributed.
Vaccine monitoring has gaps in reporting and monitoring
In a way, the clinic staff trusts people to be true to their eligibility. The staff has been overworked for a year and it is not their responsibility to police those looking for a vaccine. Wohl said his staff is trying to verify eligibility, but acknowledged that they depend at least a little on patient identification.
“But I would tell you that the vast majority of the people we’re seeing here aren’t cutting the line,” Wohl said. “It’s about people coming in with walkers, in wheelchairs, you know, reeds. We’re reaching the right people.”
In the long-term care program, there is less public disclosure that could reveal violations of the protocol. The federal government contracts directly with Walgreens and CVS to distribute vaccines in long-term care centers. Spokesmen for the two pharmacy chains said individuals must “attest” to their eligibility. In most cases, an identification card is required to confirm the identity of people, although this does not necessarily demonstrate the eligibility of people under 65 years of age.
Similarly, DHHS state leaders have said they are not monitoring the thousands of individual vaccine recipients introduced into the state’s computer system.
In December, Atrium Health in Charlotte scheduled vaccination of employees working in non-care functions. In response to the public outcry, the hospital said the state had approved the employees receiving the vaccine.
But DHHS said that was not true.
Although after the news of the hospital’s scheduling off duty, state officials contacted Atrium and canceled dozens of appointments for non-health workers.
This story was reported and edited jointly by Laura Lee and Frank Taylor of Carolina Public Press; Tyler Dukes, Adam Wagner and Jordan Schrader, of The News & Observer; Nick Ochsner of WBTV; Michael Praats of WECT; Ali Ingersoll and Travis Fain of WRAL; and Jason deBruyn of WUNC.