A provider with Augusta Health administers a dose of the Pfizer COVID-19 vaccine this week. (Courtesy of Augusta Health)

Virginia’s first doses of COVID-19 vaccine, distributed and administered at hospitals across the state, were greeted with accolades — and relief — by health care providers, state leaders and a public that’s endured nearly 10 months of a deadly and disruptive global pandemic.

But neither the state Department of Health nor the Virginia Hospital and Healthcare Association, a key partner in distributing the vaccine, will disclose the names of the 18 hospital facilities that received the state’s initial doses — or the health care systems to which they belong.

Some of those systems have chosen to publicly announce their first deliveries this week, often through coordinated news conferences that allowed reporters to watch frontline hospital workers receive the long-awaited injections. At least seven hospital systems issued news releases, including UVA Health, Carilion Clinic, Sentara Healthcare, Fauquier Health, Valley Health, Augusta Health and VCU Health. 

Vaccines were also received and administered at INOVA in Northern Virginia and Ballad Health, which covers much of Southwestern Virginia and Northeast Tennessee. Some systems, including Riverside, acknowledged they received the vaccine, but declined to name the specific facilities where it was shipped.

Erin Beard, a spokeswoman for the Virginia Department of Health, said Thursday that the 18 locations weren’t being named “primarily for security reasons.” Julian Walker, the vice president of communications for VHHA, said hospitals had the option to disclose the shipments but might be hesitant to attract wide public attention.

“The normal business of providing medical care to patients, including non-COVID-19 patients, is still ongoing during the pandemic,” he said. “So as not to create a spectacle, so as not to create public confusion — I think for all those reasons and for others, there just hasn’t been the desire to publicly identify every facility that’s received an allocation of vaccine.”

But other medical providers in Virginia say the lack of transparency is troubling, especially given the role health systems in Virginia have been given in deploying the vaccine. Like the rest of the country, Virginia is administering doses from Pfizer — currently the only pharmaceutical company that’s received an emergency use authorization from the U.S. Food and Drug Administration. (Another vaccine by Moderna is expected to be approved as early as Friday).

While VDH orders the vaccine, it’s shipped directly to the 18 facilities selected by the agency in partnership with VHHA. State health officials have said hospitals were chosen largely based on their geographic locations — important when it comes to distributing doses to the rest of the state — and their ability to store the vaccine, which requires ultra-cold temperatures around -94 degrees Fahrenheit.

A worker with UVA Health moves doses of the Pfizer COVID-19 vaccine into ultra-cold storage. (Courtesy of UVA Health)

Walker said there’s an explicit understanding that health care systems will share the allotment among staff at their own facilities and with outside providers — including other hospitals (those that weren’t tapped to receive shipments) and health care professionals who operate independent practices.

“That’s part of the deal,” he said. “The clear understanding was that this is the allocation Virginia is getting, these are the sites that are capable of receiving it, and these sites that receive it understand a portion of what they receive is for them and a portion of it is for other facilities.”

State Epidemiologist Dr. Lilian Peake described it as a “hub and spoke” model for distribution. But as of Thursday, she didn’t have data on how widely — or extensively — the 18 sites spread the vaccine outside their own walls.

Some doctors say the lack of transparency gives individual hospitals and health care systems a wide degree of latitude to distribute the vaccine however they see fit. And it’s still uncertain when Virginia will be able to vaccinate all of its medical providers. 

Earlier this month, VDH announced it expected nearly half a million doses by the end of December — enough to cover nearly every health care professional (including professions like dentists and therapists, Peake said) along with the state’s entire population of long-term care residents. But so far this week, the state has received 72,150 doses of the Pfizer vaccine.

Walker said that’s not enough to immunize Virginia’s entire population of hospital employees — a workforce of more than 130,000. With such a limited initial allotment, the state has issued more specific guidance directing the very first doses to go to critical health workers “who directly engage in the care” of COVID-19 patients, including frontline ICU nurses and physicians.

The second tier includes providers who interact with patients at higher risk of infection. Those include emergency medical service workers, dialysis center employees and staff at residential care facilities. It doesn’t include employees at skilled nursing homes, assisted living facilities, veterans homes or residential centers for patients with developmental disabilities — all of whom will likely be vaccinated through a federal partnership with large pharmacy chains.

Some outside practitioners say that guidance hasn’t been applied uniformly across the state. Dr. Mike Martin, president of the Virginia chapter of the American Academy of Pediatrics, said he’s spoken to an independently practicing dermatologist who’s already been given the vaccine by his local health system. Martin also works for an independent practice — Einstein Pediatrics in Tysons Corner — but said his local hospital told him not to expect the vaccine until the end of January.

“That makes no sense in many ways,” he said. “One of which is that VDH has indicated we’ll have adequate supply to vaccinate most of the health workforce by the end of the month.”

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For many primary care providers, it also conflicts with the understanding that prioritization is based mostly on risk of exposure to the disease. “What’s been frustrating some providers in the field is that as some hospitals are individually letting people know what their priorities are, one of those priorities is whether you’re an employee of that hospital system,” Martin said.

In some cases, it’s led to feelings of incongruity. Martin’s practice has been providing COVID-19 tests for months. But he said outpatient clinics at his local hospital system are likely to be vaccinated before he and his colleagues are — despite the fact that they don’t offer in-house testing.

“I’m testing COVID patients every day and taking care of COVID patients every day,” Martin said. “I’m wearing the appropriate gear, but my exposure risk — they call it outward-facing. I am outward-facing, taking care of patients that are confirmed to have the disease.”

He said the state’s refusal to name facilities that received the vaccine has been problematic in other ways. For doctors in areas with more than one hospital system, there’s been confusion on who to ask for the vaccine — and whether hospitals or VDH are spearheading immunization among independent providers.

But much of the frustration is also based on the currently limited supply of the vaccine, along with growing exhaustion among all health care providers — from frontline ICU nurses to primary care doctors who face potential exposure every day. 

Things are expected to change quickly on the supply side. An independent FDA advisory committee recommended late Thursday that the federal agency greenlight a second vaccine from the pharmaceutical company Moderna. That authorization could come as early as Friday, which means Virginia might receive its first doses as early as next week.

Peake said the state has already placed an order for roughly 146,000 doses (both the Pfizer and the Moderna vaccine require two shots, and the government is reserving a doses to ensure early recipients can receive the full schedule). The state is also waiting to hear from Pfizer on how many doses it can order next week. Some states are reporting lower volumes than initially anticipated, though Walker is holding out hope that Virginia will receive the full 480,000 doses it was told to expect by the end of this month.

The current workload for health providers, though, is unlikely to diminish until the vaccine is available to the general public. Martin said the pandemic has been like a second job on top of his usual schedule, requiring both additional services — like testing — and constant planning to keep both patients and employees safe. 

“That’s what makes this troubling,” he said. “This is a vaccine that has been paid for by the public. It’s not the hospitals’ vaccine, and they should be sharing it appropriately.”

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