Gov. Ralph Northam at a press conference in October. (Ned Oliver/Virginia Mercury)

Gov. Ralph Northam acknowledged Wednesday that Virginia needs to speed up the pace of its COVID-19 vaccinations, announcing a “you use it or you lose it policy” prodding health care providers to administer the shots to more residents.

“I want you to empty those freezers and get shots in arms,” he said. “When you have vials, give out shots until they’re gone. No one wants to see any supplies sitting unused.”

The governor’s news briefing — his first in nearly a month — came as Virginia experiences its worst COVID-19 caseload than at any other point in the pandemic. The statewide percent positivity rate rose to nearly 17 percent on Wednesday, and Northam pointed out that daily case numbers are currently four times higher than they were in the spring — an average of more than 4,700 new infections every day.

At the same time, Virginia has been grappling with a sluggish rollout of a vaccine described by the governor as “the most powerful tool — the one that’s going to literally change things.” Northam has not announced new restrictions since early December, but has described COVID-19 vaccines as a ray of hope in the ongoing pandemic.

Many states have struggled with administering the shots after the federal government shipped out early doses in mid-December. But until recently, Virginia ranked 46th in the country when it came to the percentage of vaccines administered among states, the Richmond Times-Dispatch reported. The state’s rating has improved, but thousands of vaccines still have yet to make their way into the arms of Virginians.

State health officials also elaborated on reporting issues that have prevented administered doses from appearing on the Virginia Department of Health’s vaccine reporting dashboard. Health Commissioner Dr. Norman Oliver said Wednesday that the department updated its internal immunization reporting system in anticipation of the COVID-19 vaccine, but that some providers, as a result, have struggled to enter data in a timely manner. There have also been technical glitches that have prevented some health systems’ vaccines from hitting the dashboard.

Northam’s spokeswoman, Alena Yarmosky, said that in some cases, providers are reporting vaccinations but the data is appearing inaccurately in the state’s system, requiring VDH employees to go back and verify the numbers. As a result of all the problems, Oliver said that the state’s totals could be undercounting anywhere from 35,000 to 55,000 doses.

“We’re actually doing better than we appear,” he said after the briefing. But even if 55,000 was added to the state’s total number of administered vaccines, it would mean that health providers have given out around 171,247 of the 481,550 doses delivered to the state — around 35 percent.

To address the slow rollout, Northam announced several steps the administration plans to take over the next several weeks.

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

New goals for administering the vaccine

Northam outlined new goals for giving out the vaccine as one of the first steps in his plan to ramp up administration. Currently, he said the state receives roughly 110,000 doses of Pfizer and Moderna vaccine a week, which equates to an immediate goal of delivering 14,000 shots a day to fully use up that supply.

On Wednesday, VDH reported that 2,695 doses had been administered in the last 24 hours. That daily increase has been as high as 12,000 in recent days, but Yarmosky said the large jump was the result of backlogged data. Current reporting delays make it difficult for the department to assess daily progress, which is why resolving those issues is an instrumental part of achieving the governor’s goal, she added.

Longer-term, Northam said he’d like to build up to 25,000 daily doses — a number that also depends on federal officials ramping up shipments to states. Oliver later said the goal was achievable if President-elect Joe Biden delivered on his promise to distribute 100 million shots within his first 100 days in office. Yarmosky also said the state’s daily goal would increase with the greater supply.

‘Lose it or lose it’

Northam’s newly announced policy is directed at health systems, local health departments and other clinical settings that receive doses of the vaccine. The governor said with the next shipment of Pfizer and Moderna doses, VDH would expand its reporting so Virginians can see where vaccines are delivered and how quickly they’re being used.

“Virginians, you deserve this transparency,” he said. State officials will also monitor usage, and sites that don’t fully use their allocated doses could face reduced shipments going forward.

“Don’t save anything,” Northam said. “You’re going to get every dose you need because more is coming. But if you’re not using what you receive, you must be getting too much.” 

A plan for next phases

The governor also unveiled priority groups for Phase 1b and 1c,  the next stages in the state’s vaccination campaign. According to Yarmosky, the current phase — 1a, which includes medical workers and long-term care facilities — should be finished by late January. VDH spokeswoman Erin Beard told the Mercury yesterday that moving onto later phases is based on whether “vaccine supply significantly increases” and “if vaccine demand is less than supply.”

Phase 1b will include essential and frontline workers — “people who work in jobs that keep society functioning,” Northam said. That includes roughly 285,000 teachers and childcare providers, along with first responders, mail carriers, corrections officers and grocery store workers. Essential workers in manufacturing and food production will also be included, as will public transit employees.

All adults aged 75 or older will also be included in phase 1b. 

Phase 1c will cover essential workers in construction, transportation, and food service, such as restaurant servers, as well as adults aged 65 or older and all Virginians between 16 and 65 with high-risk medical conditions. The two groups — phase 1b and 1c — cover about half of the state’s roughly 8.5 million residents, Northam said, before the vaccine will move to the general public.

But the logistics of moving onto different phases — and the details of how state officials will ensure quicker innoculation — are largely unclear. Northam appointed Dr. Danny Avula, the director of the Richmond-Henrico Health Department, to oversee and coordinate statewide vaccination efforts, saying more details would become available in the coming weeks.

Dr. Danny Avula speaks at an event in 2018 during which he was named director of both the Richmond and Henrico County health departments. (Katie O’Connor/Virginia Mercury)

But as the Mercury has reported, some large health systems are vaccinating non-clinical employees who have worked from home since the start of the pandemic — even as some community providers struggle to book appointments with their local health departments. 

Northam emphasized Wednesday that distribution sites should err on the side of vaccinating Virginians rather than holding doses based on prioritization. But Oliver also said that sites should follow the state’s guidance whenever possible “because that’s been well thought through” (he later added that VDH advised against giving out doses to Virginians who aren’t frontline workers, including anyone who can work from home).

What’s not clear is how Virginians in phase 1b and 1c will be notified that they’re eligible for the vaccine and when it becomes available. It’s also still unclear how health systems will manage excess doses. Northam said his administration hasn’t heard of vaccines being wasted, but Oliver later said anecdotal data suggests that only 60 percent of EMS workers and nurses have opted for vaccination.

Whether health systems will assist in vaccinating other priority groups remains to be seen. Oliver said it would require close collaboration with local health departments so that hospitals could redistribute unused doses to other settings.

“Maybe they vaccinate, maybe they just provide the supplies,” he said. “And we would shift the allocations if they weren’t using them.”