Virginia pushes back estimate for vaccinating all residents for COVID-19

Every Virginian vaccinated by early to mid-summer?

Many experts say it’s no longer likely. Gov. Ralph Northam has also readjusted earlier — and more optimistic — estimates from late November, when he spoke to NPR about the state’s COVID-19 vaccination plans.

“Phase three will be the general population and hopefully by, you know, early to midsummer have everybody in Virginia vaccinated,” he said at the time. But after a slower-than-expected rollout — both in Virginia and across the country — the administration has slightly revised its targets.

“The governor is still hopeful that everyone will have the opportunity to be vaccinated by mid-summer to fall,” spokeswoman Alena Yarmosky wrote in an email on Tuesday. The administration’s prospective timeline includes a few caveats, including the fact that children under 16 — or roughly 2 million Virginians — won’t be included in the overall total because a vaccine hasn’t yet been approved for them.

The goal also assumes that some of the state’s residents will decline the vaccine (“although we’re hopeful that is not a large percentage and will decrease further as this process continues,” Yarmosky wrote). And ultimately, it means Virginia will need to be administering at least 50,000 doses a day, which is contingent on new vaccines entering the market and an increase in federal shipments.

Yarmosky pointed to recent changes that have inspired optimism from state leaders across the country. One, announced Friday, is that the Biden administration plans to begin releasing available vaccines immediately, rather than holding back a second dose from shipments from Pfizer and Moderna.

But even with the change in administration, many experts say there needs to be a rapid shift in how COVID-19 vaccines are distributed and administered in order to meet a late-summer to fall target. Mark Capofari — who worked for Pfizer and spent more than a decade as the director of global logistics at Merck before becoming a full-time lecturer at Penn State — thinks vaccinations will be ongoing well into the third quarter of the year, which stretches from July to September.

Thomas Denny, the chief operating officer of the Duke Human Vaccine Institute, said it might take even longer for most of the public to get inoculated — possibly not until October or November.

“I got a bit more optimistic when it looked like vaccines were coming and we’d have a good number of doses to start out with,” he said. “But then in between late December and so far in January, just about every place has missed its mark with using the amount of doses they’ve gotten.”

“I’m now back to thinking that it’s not likely by the summer that we’ll achieve it,” he continued.

When the vaccine will be accessible to most Virginians has been a major question since the state received its first doses in mid-December. The Northam administration has tentatively predicted that Phase 1a — when vaccines are prioritized for health care providers and long-term care facilities — could conclude by the end of this month. But there’s already been some overlap with Phase 1b, which includes first responders, correction officers and teachers, followed by other frontline personnel such as grocery store clerks and mail carriers. 

On Friday, the Virginia Department of Health announced that 11 local districts across the state were beginning Phase 1b early after vaccinating the majority of their medical workers and long-term care residents. Scheduling an appointment would “depend on the supply of vaccine available,” the department warned, and the phase is likely to take “several weeks to months” even with an early start.

But at a briefing last week, Northam also outlined prioritization plans for Phase 1c, the next step of the state’s vaccine campaign, which will include other essential workers in construction, transportation and utilities. 

Providing a clear timeline for all the different subgroups can be complicated. VDH guidelines set a clear order for frontline workers in Phase 1b “because there is not sufficient supply at this time to vaccinate everyone at the same time.” But Virginians aged 75 and older are also included in Phase 1b, and it’s unclear where they fall in the order of prioritization.

Northam emphasized flexibility in his briefing last week, saying he’d rather see providers administer more doses than hew strictly to the state’s guidance. But given the state’s current pace, it’s unclear when the next two phases — which cover about half of the state’s roughly 8.5 million residents — will fully get underway. 

As of Friday, the state had received 481,550 doses of vaccine and administered nearly 150,000, or about 30 percent of its total allocation. Health Commissioner Dr. Norman Oliver said Tuesday that the Virginia Department of Health’s vaccine reporting dashboard could be undercounting anywhere from 35,000 to 55,000, which would push the state’s total closer to 40 percent.

Bloomberg’s vaccine tracker ranks Virginia above nearby states including Pennsylvania, North Carolina and South Carolina, but below neighbors such as Maryland, Kentucky, Tennessee and West Virginia (which has an administration rate more than double the Old Dominion’s). And some experts, including Denny and Bruce Y. Lee, a professor at the CUNY Graduate School of Public Health and Health Policy, say the haphazard rollout of vaccines across the country is mainly attributable to poor federal planning.

“When it comes right down to it, very few states have the wherewithal or the resources for the kind of coordination that’s required,” said Lee, who also works as the executive director of CUNY’s Public Health Computational and Operations Research. “That needed to come from the federal government.”

But Capofari said that state planning also played a major role, pointing to sometimes drastically different vaccination rates across the country. Funding makes a major difference, as does intensive planning and coordination between different agencies and providers. 

He pointed to hospitals and local health departments — two settings where the state has routed a significant number of vaccines, though the Virginia Department of Health still can’t say which vaccines went where. If hospitals are going to play a role in vaccinating groups other than their own employees, Capofari said they need clear guidance on who to prioritize and how to reach them. And if hospitals are expected to transport any surplus doses to other settings, there needs to be clear communication and a plan of action, from which facility is responsible for transporting the vaccine to the equipment they’ll use to preserve the doses to when the delivery will be made.

“I think there’s still a lot of uncertainty still as to what the plans are and even where to do the inoculations and how to go about it,” he said.