State welcomes changes to vaccine plan

Move to give advance notice of doses will be ‘a game changer’

The Biden administration's new plan to increase its advance notice to states for how many COVID-19 vaccine doses they'll get from one week to three is a major boon, according to Pennsylvania's acting Department of Health Secretary Alison Beam.

A week's "visibility" is insufficient for planning at the department and a "limiting factor" for local providers, because it cramps their ability to set up logistically -- with staff, space and other resources, Beam said Wednesday at a hearing of the state House Health Committee.

Three weeks, however, will be "a tremendous shift," Beam said. "It's a game changer."

The current unpredictability, largely the result of the yawning vaccine shortage, has led to widespread complaints and frustration, as expressed at the hearing.

There's an "incredible level of demand and a really limited supply," Beam said.

That has resulted in "enormous uncertainty," said Susan Friedberg Kalson, CEO of the Squirrel Hill Health Center in Pittsburgh, who testified.

The uncertainty begins at the federal level and gets passed down to the state and then to local organizations, ending "on our doorstep," Kalson said.

Providers like her don't know what to expect from week to week. Once, she asked for 600 doses and got nothing. Another time, she got 300 doses without warning.

A couple of weeks ago, Warren General Hospital ordered 4,000 doses and got 200, said CEO Richard Allen.

The vaccine shortage has helped create an unhealthy "atmosphere of competition," Kalson said.

Her phone system has been overwhelmed and people are becoming increasingly "unhappy and desperate," she said.

Rumors have been flying that vaccines are available at this pharmacy or that, and people feel the need to try to register in multiple places, including hers, Kalson said.

That has led to no-shows, over-ordering of doses, occasional waste and confusion among providers, officials said.

"I am not a logistics expert," Kalson said. "But I know this is not working."

Some states have central registration, but that brings "its own set of challenges," including a lack of "interoperability" between the computer systems of providers like hospitals, community health centers and pharmacies and the state, she said.

There are 1,500 enrolled providers, 600 of which have been receiving vaccines, according to Beam.

The DoH has been allocating doses based on what they say they can administer for the following week, adjusted for the 65 and over population in their territories, along with total cases and total deaths, Beam said.

The allocations tend to reward providers that have "the best throughput," she said about the amount of vaccines passing through a system.

But because of the shortage of doses, "we're still thinly slicing the pie," she said.

If things become more predictable, if providers can plan and provide accurate information to their patients, and if people can register and know they're in line, things "will calm down," Kalson said.

The current situation arose after the massive increase in membership for priority Phase 1A on Jan. 19, when the state adopted new federal guidance. Previously, 1A comprised 1 million Pennsylvania health care workers. Afterward, it instantly swelled to include 3.5 million more people -- everyone 65 and up and everyone 16 to 64 with health conditions that make them vulnerable to COVID-19.

Prior to that date, getting people vaccinated was being done "very methodically," Warren General Hospital's Allen said. Each week, the hospital compiled a list of people to be vaccinated, then ordered doses to match, he said.

When the expansion occurred, "there was an immediate rush," Allen said. "Everyone 65 and over wanted vaccinated and they wanted it immediately."

"It created chaos," said Mark Taylor, Blair County's director of emergency management.

One aggravating factor for the shortage -- and for the state's low ranking in percentage of doses administered as a percentage of doses received from the federal government -- is Pennsylvania's policy of keeping second doses in reserve, officials have indicated.

The state is following that policy to ensure that the second doses are available to provide full immunity to recipients, according to Beam.

Another factor exacerbating the shortage is that some local providers also have been keeping second doses in reserve. That needs to end, Beam said, in answer to a question from Republican House Leader Kerry Benninghoff. Providers don't need to keep second doses, because the state's reserve is "secure," Beam said.

The DoH is trying to nudge providers out of that redundant status by subtracting the number of second doses it directs to those providers from the first-dose allocations it sends, according to Cindy Findley, deputy secretary for health promotion and disease prevention.

The federal government at one time held back second doses, but doesn't anymore, Findley said.

The situation for providers is stressful -- but providers can't shirk their duty, according to Kalson. "Nothing matters more than this," she said. "This is simply the most important work of our careers."