The federal government’s about-face on vaccine policy may be too little, too late, local health officials told CNN Tuesday.
City and county health departments are already running at a deficit, and will continue to struggle to get vaccines out to people, the National Association of County and City Health Officials said.
The US Department of Health and Human Services changed course on Tuesday in its Covid-19 vaccine rollout guidelines for states, which then get passed down to local health departments. Those changes include new plans to release reserved second doses of vaccine and recommendations to vaccinate anyone 65 and older.
“The concerns outweigh the benefits here,” NACCHO CEO Lori Tremmel Freeman told CNN.
“The money and the funding support that would allow this to happen successfully are coming after the vaccine has already been distributed — so already our local health departments are at a deficit,” she added.
HHS Secretary Alex Azar framed the changes, which match the approach previously announced by the incoming Biden administration, as something that had been part of the plan all along. A senior administration official told CNN on Tuesday the shift follows two Operation Warp Speed meetings Azar held over the past 48 hours on how to ramp up the lagging rollout process.
Opening up vaccinations to those 65 and older could help in areas where there have been more doses than people eligible or willing to receive them — in some cases leading to extra doses going unused, expired and being tossed away. And releasing reserved second doses could benefit areas where there has not been enough vaccine for everyone eligible and willing.
“For a portion of our membership that has had issues with needing more dosages because the demand has been high, this will definitely be an asset to them,” Blaire Bryant, associate legislative director for health at the National Association of Counties, told CNN on Tuesday.
Local health officials are moving to get health care workers in place for a flood of additional Covid-19 vaccine doses — but many of those departments are understaffed and under-resourced, NACCHO’S Freeman said.
“The release of all of the second doses and removing that hold back is not necessarily seen as a solution to getting the vaccine out faster. We have existing issues still — logistical issues — with how to plan and staff this mass vaccination effort,” she said.
‘There’s a balance that’s required’
On both the state and county level, the supply and demand don’t always line up for the Covid-19 vaccine.
Out of the more than 25 million doses of Covid-19 vaccine that have been distributed to hospitals, health centers and pharmacies so far in the United States, only about 9 million people had received their first dose as of Tuesday morning, according to data from the US Centers for Disease Control and Prevention.
The two vaccines that have been authorized for emergency use in the United States — Pfizer/BioNTech’s and Moderna’s — are administered as two-dose shots, 21 and 28 days apart, respectively.
With the Trump administration’s new rollout guidelines, Freeman said, there are concerns about mixed messaging to the public about how important it is to receive a second dose of Covid-19 vaccine and when.
“What message is that going to send around the original guidance that we’ve been given where you have 21 to 28 days to get your second dose? What if that doesn’t happen?” Freeman said. “There’s a balance that’s required between wanting to get as many people as possible immunized and making sure that we are able to successfully do the second doses of vaccine and have enough supply.”
Another concern on the local level is tracking of who has received their first and second Covid-19 vaccine.
During Tuesday’s news briefing, Azar said that second doses would still be available to those who need them.
‘We are still in the midst of the pandemic’
At the local level, some health departments might decide not to change their plans.
The city and county of Denver, for instance, has been administering Covid-19 vaccines under Colorado’s Phase 1a and 1b prioritization, which means health care workers, first responders and people who are ages 70 and older are the only groups currently eligible to receive the vaccine.
To make any changes to that phased approach, such as lowering the eligibility age to 65, “I think it would be a state-level decision,” Dr. Judith Shlay, associate director of Denver Public Health, told CNN on Tuesday.
“Our governor would have to make that decision. I’m not sure we’ll do that at the moment, because we really have a lot to do with what we’re trying to do at the moment,” Shlay said.
Some states have decided to open vaccination to more people.
Idaho will be opening Covid-19 vaccinations to all residents age 65 and older starting February 1, Gov. Brad Little announced Tuesday afternoon. “We do not want to create a bubble or backlog,” Little said. “Once we get a handle on capacity, we will be able to get to the 65-and-older population.”
Meanwhile in Mississippi, Gov. Tate Reeves announced that Mississippians that are 65 and older, or those with pre-existing medical conditions can make appointments for Covid-19 vaccinations.
But Shlay said the undertaking is huge.
“What we have to build is the infrastructure that can then be available consistently for months at a time. This is going to probably be nine months or a year to get this all rolled out,” she said.
The American Hospital Association said that simplifying the process and pushing out more vaccines can help speed vaccination.
However, “for this initiative to succeed at the speed in which we need it to, there needs to be a robust infrastructure in place across every state and jurisdiction capable of accommodating a high volume of people receiving both their first and second shots in a timely manner,” Rick Pollack, AHA’s president and CEO, said in a statement emailed to CNN on Tuesday.
‘Our local health departments have not always been front and center’
While speaking to CNN on Tuesday morning, Freeman said that she was on her way to a meeting with President-elect Joe Biden’s transition team to discuss the Covid-19 vaccine rollout.
She said local health departments have been left out of the federal decision-making.
“Throughout this pandemic, our local health departments have not always been front and center,” she said.
“It’s disheartening to us that this kind of decision would be made without fully integrating the public health system response to such a decision, especially because our health departments are so under-resourced and understaffed and doing really outstanding work despite that,” she added.
“With every layer of complexity that comes along, the weight on the shoulders of our health departments is just becoming unbearable. They want to do a good job — they want to protect and immunize their communities and do it efficiently, effectively — but this doesn’t necessarily help them to do that.”