KY’s COVID vaccine rollout is happening out of order. Here’s why that’s inevitable.
When it comes to getting the COVID-19 vaccine in Kentucky, where some people live and work appears to matter as much as what priority group they belong to. And that’s not likely to change.
Kentucky is still slogging through phase 1A of its vaccine distribution plan, which reserves doses for health care personnel, and residents and staff who live and work in nursing and assisted living homes. The state expects to shift its collective focus to the next tier of people — K-12 personnel, first responders and people over age 70 — at the end of the month.
But state pressure on providers to distribute doses as quickly as possible, coupled with population variation and local discretion — health care organizations and public health departments have a fair amount of autonomy over how they dole out doses — is making the state’s early rollout process disjointed and lopsided.
The North Central District Health Department, for example, has already begun vaccinating people ages 70 and older in Shelby, Spencer, Trimble and Henry Counties. But people in that same population living about 45 minutes away, in Frankfort, may not get their first dose until March, the Franklin County Health Department told residents earlier this month.
This disparate access isn’t surprising to personnel in charge of administering it. “When you’re getting [tens of thousands] of doses a week and you’ve got a population of 4.5 million, there’s nothing that’s going to be pretty or simple about this,” Lake Cumberland District Health Department Director Shawn Crabtree said. “It’s inevitable that there’s going to be some mistakes.”
‘We’ve got to right-size’ vaccine amounts
CVS Health and Walgreens are responsible for vaccinating long-term care facility staff and residents, but it’s slow-going. The majority of nursing home staff and residents are waiting on both pharmacy chains to immunize their residents and staff, who are in the first priority tier. Only 23 percent of the 93,600 doses the state has received for this population have been given out, according to state data.
At the same time, some hospitals and health departments have vaccinated most of their health care workers (the other priority group in phase 1A) and have jumped ahead to other priority groups, while others lag. St. Claire Healthcare in Morehead is giving out 700 doses this Thursday and Friday by appointment only to people in 1A as well as anyone age 70 and older.
The Lexington-Fayette County Health Department hasn’t begun vaccinating that age group yet. But at the University of Kentucky, research faculty who don’t care for patients and are younger than 70 are being offered a chance at the vaccine as early as this week, according to an internal staff email.
Other higher education institutions have reported similar out-of-sequence rollouts. In a statement Monday, President Eli Capilouto said UK is moving to vaccinate high-risk faculty, staff and students in the university’s health care colleges, including those who “work in research settings.”
Thousands of other Kentuckians who don’t qualify as high priority signed up for a vaccine over the weekend following a mix-up at Baptist Health, while K-12 teachers, who are in the second priority group, have yet to be immunized en masse.
Some health departments, like Louisville Metro, are giving doses by appointment only, while people over age 70 in Livingston County last week showed up in droves to get a vaccine on a “first-come, first-served basis” at their local health department in the Pennyrile district, according to a Facebook post. “BE PREPARED to wait in your vehicle for up to three hours once in line,” it warned.
Early shipments of the vaccine during the state’s first month of immunizations weren’t necessarily tailored to population, Gov. Andy Beshear said Monday, which is what’s contributing to uneven levels of completion. “It shows we’ve got to right-size the amount of vaccine and where it goes,” he said.
‘Everyone’s going to get it, eventually’
The governor has called on entities administering doses to do it faster, since only about half of the roughly 262,950 doses the state has received in the last month have been injected into people’s arms. But that process has started to speed up. Last week, the state received a little over 88,000 doses, and more than 70 percent were given out.
That shift is in part because Beshear and Kentucky Public Health Commissioner Steven Stack have turned up the pressure on vaccine providers to use at least 90 percent of their shipments within seven days of receipt — an ask that is contributing to the out-of-order apportionment.
“It’s a likelihood that when you’re pushing that hard, you’re going to get out of sequence,” Crabtree said. “But even if you have to go a little bit out of sequence here and there, it’s better to use it.”
At his 10-county health department district in south-central Kentucky, which is for the most part only inoculating people in 1A, staff are fielding frequent questions from confused and frustrated residents wondering why different counties are vaccinating some groups more quickly than others.
Per state guidelines, all counties are “supposed to be” focused on group 1A, but in counties with fewer people, out-of-sequence dosing is likely to happen more often.
Since Moderna vaccines arrive in shipments of 100 doses, if a county needs 120 doses, it’s going to get a shipment of 200, Crabtree said, which means there may be some surplus that day.
“There may be some leftover vaccine from week to week where phase 1A recipients can’t be found,” he said. Not wanting to waste the doses, the surplus is given to folks in 1B, like teachers, first responders, and people older than 70.
That’s the case in Owsley County, where on Monday, Kentucky River District Health Department Director Scott Lockard said he had four more vials of the Moderna vaccine (each carries 10 doses) and only four more health care workers to vaccinate. Surplus doses, then, were given to people who are 70 and older.
Vaccine availability is bound to vary from county to county, Lockard said. “It’s just limited supply, [but] everyone’s going to get it that wants it, eventually.”
This reality, which other states are also experiencing, reaffirms for some health directors the need for more flexibility in state and federal guidelines. Clayton Horton, director of the seven-county Green River District Health Department in Western Kentucky, said the priority phases “make a lot of sense.”
“But trying to stick to those groups too rigidly slows the process. We saw that in our first week,” he said. “I think that’s why you have seen this shift nationwide to a strategy of taking the priority phases in consideration, but also showing some flexibility so that the vaccine is administered quickly.”
The state Department for Public Health and Beshear support providers using surplus doses they ordered for 1A on group 1B, but they’re still urging departments hold off on ordering doses for next-phase groups until more counties are caught up.
The goal is to divide out future doses in a more population-based way to ensure more equity in the process — “theoretically, [counties] should be completing [the vaccination of] groups at or about the same time,” Beshear said.
President-elect Joe Biden’s plan to release almost all available doses of the vaccine to states after he’s inaugurated later this month may complicate the state’s abilities to coordinate swift distribution. On Tuesday, the Trump Administration changed course and began urging states to immediately begin vaccinating groups in lower-priority areas, including people 65 older and some younger people with specific health issues, U.S. Health and Human Services Secretary Alex Azar announced earlier in the day.
In the meantime, as providers await further guidance from the state, “we’re ready to go to 1B whenever [the state] will authorize us to start ordering,” Crabtree said.
Herald-Leader writer Bill Estep contributed to this story.
This story was originally published January 12, 2021 at 2:20 PM.
