Virginia shifts vaccine distribution strategy, triggering thousands of canceled appointments

Teachers and other frontline employees in Fairfax County received an unwelcome surprise on Monday when Inova — one of the largest hospital systems in Northern Virginia — announced it was canceling COVID-19 vaccination appointments for educators and other workers in the state’s 1b priority group.

New and wow – vaccinations are canceled for employees of Fairfax County Public Schools, Virginia's largest school district, "for the foreseeable future" due to "supply limitations."

22K teachers and staffers, roughly 90 percent of the workforce, had already registered for doses pic.twitter.com/xsZtAE1XmG

— Hannah Natanson (@hannah_natanson) January 25, 2021

As The Washington Post reported, the move affected thousands of teachers and other school employees who had already scheduled appointments through the health system. And Inova wasn’t alone. On Friday, the Virginia Hospital Center in Arlington also announced it was canceling all future first-dose appointments at community vaccine clinics. 

Both health systems pointed to a little-publicized change in how the Virginia Department of Health is distributing vaccines across the state. Until this week, vaccines were flowing to localities through three different channels. One was the ongoing partnership with the pharmacy chains CVS and Walgreens, which are coordinating with the federal government to vaccinate residents and staff at long-term care facilities across the state. 

VDH sets aside doses for that partnership, but has minimal oversight over its execution. The state is directly involved in distributing doses to hospitals and local health departments — the providers responsible for administering the vast majority of doses in Virginia, according to VDH data. 

For the first several weeks of Virginia’s vaccine campaign, both were ordering and receiving doses separately. Health systems were working through the Virginia Hospital and Healthcare Association to place their orders with the state. Health districts — which are mostly organized as local divisions of VDH, with the exception of Arlington and Fairfax County — were placing their orders directly through the department’s central office in Richmond.

And for the first few weeks, both hospitals and local health departments were receiving all, or at least a significant portion, of the doses they ordered. In practice, that meant localities frequently had access to vaccines from both sources. 

As the Mercury reported last week, there have been big differences in the degree to which hospitals used their share to help inoculate priority groups outside their own employees. But some health systems, including Inova and Valley Health in Winchester, took on a significant role in vaccinating non-hospital-affiliated health care workers and a 1b priority group that’s been expanded to include all Virginians 65 and older and anyone with an underlying health condition.

“We’ve had the advantage of having a very close relationship with Valley Health,” said Dr. Colin Greene, the director of the Lord Fairfax Health District, in a phone call on Tuesday. “And they’ve gone out of their way to set up vaccine clinics that have been very well-organized.”

That allocation strategy, however, has changed significantly over the past several days. Local health officials say VDH informed them last week that all new vaccine allotments starting this week would be shipped and distributed through their offices — meaning no separate shipments for local health systems.

Additionally, the state is now apportioning vaccines to local health districts based on their share of the state’s population. Previously, allocations were based on district requests, which often depended on demand and how many doses local health departments thought they’d be able to administer. 

As districts expanded their vaccination efforts and some parts of the state moved into Phase 1b (some as early as mid-January), those requests grew rapidly. At a news briefing last week, Dr. Danny Avula, the state’s vaccine coordinator, said VDH had received almost 300,000 orders but only had 105,000 doses from the federal government to distribute.

“Up until last week, we were able to allocate vaccine to everyone who wanted it,” he said. “But as our allocation has evolved, we’ve had to tweak the way that we do it.” 

In localities like Fairfax, it’s led to a slew of cancelled appointments as hospitals have seen their allocations drop precipitously. Tracy Connell, a spokeswoman for Inova, said the health system received “a fraction” of the doses it had in previous weeks. Jeffrey McKay, chairman of the Fairfax County Board of Supervisors, also cited the state’s revised strategy in a message to constituents addressing the cancellations.

“It is profoundly unfortunate that despite all of our efforts at the local level that we must again ask for patience,” he wrote.

Federal vaccine shortages have played a significant role in the shift — a factor that’s acknowledged by hospitals, health departments and most local leaders. Gov. Ralph Northam expanded the state’s 1b priority group under strong guidance from then-Health and Human Services Secretary Alex Azar, who told state leaders that the Trump administration would immediately release a “reserve” stockpile of additional vaccine doses.

A day later, the Washington Post reported that there was no stockpile of additional vaccines. State and local health officials say the news prompted a whirlwind four-day effort to confirm the report with the federal government. By early last week, state leaders realized that Virginia’s supply would remain static — between 100,000 and 110,000 doses a week — without changes at the national level.

It’s still uncertain if that timeline will shift. While Avula said last week that supply was unlikely to change until March or April, the White House announced Tuesday that President Joe Biden will increase weekly vaccine shipments to states, Tribes and U.S. territories from 8.6 million doses to a minimum of 10 million. Biden also announced plans to purchase an additional 100 million doses from both Pfizer and Moderna, “expected to deliver this summer,” according to the release.

Exhausted vaccine reserve could unravel plans for Phase 1b expansion in Virginia

Local leaders, though, have remained frustrated by coordination and communication on the part of state officials. For weeks, Virginia has consistently been ranked among the bottom 10 out of 50 states and Washington, D.C. when it comes to the number of doses administered per 100,000 residents. That only appeared to change on Tuesday, when the U.S. Centers for Disease Control and Prevention bumped the state to 27th place. 

VDH’s public vaccine dashboard still shows that just under 50 percent of the doses distributed in Virginia have actually been administered. It’s a gap that state officials have struggled to explain. Avula said Friday that around 226,000 doses have been reserved for the federal pharmacy partnership — taking them out of the state’s hands. Officials have also estimated that anywhere between 90,000 and 100,000 doses have been administered but haven’t been entered into the state’s reporting system.

Avula there will likely always be a gap of 100,000 doses in the state’s database as providers work to administer the doses they received that week. But even with all those doses factored in, there remain more than 100,000 vaccine doses in Virginia that the state can’t account for. 

Shipping doses directly to hospitals — which sometimes redistributed vaccines to other providers — made that harder. There’s been wide frustration among many Virginians as some large health systems have vaccinated work-from-home employees even as independent health care providers struggled to book appointments. The state also can’t say whether hospital systems have used all of the vaccines they initially received.

 Local health officials say they’ve been told to direct local providers to use up any of their remaining doses by the end of the week.

Some districts and local leaders say the state’s messaging has also made it harder to curb expectations. Earlier this month, VDH launched a statewide survey to help Virginians determine their prioritization for the vaccine. It’s easy to be sorted into Phase 1b, which — according to the survey — includes smokers and anyone who’s overweight.

Until last week, the survey also collected contact information, which some local leaders assumed would be used to help health districts register people for appointments. But the Chesterfield County Board of Supervisors said it only learned Friday that their local health district would be responsible for developing its own registration tool.

“We learned this just as we were positioning our libraries to help serve those in need of a computer and assistance to register,” the board wrote in a letter to Northam, first reported by NBC 12. The board also called the state’s vaccine effort “totally defective.”

“On this issue, we have run out of patience and tolerance,” the letter reads.

INBOX: Chesterfield County Board of Supervisors sends scathing letter to @GovernorVA over COVID-19 vaccine issues. @NBC12 pic.twitter.com/EijInucalh

— Henry Graff (@HenryGraff) January 26, 2021

VDH spokesperson Logan Anderson said the statewide survey is currently being revised to direct Virginians to the registration systems developed by their local health departments. “The previously entered data, however, is being distributed to local health districts to enable them to conduct outreach to eligible individuals in whatever way makes the most sense for their vaccination strategy,” he wrote in an email on Monday.

In reality, though, the state’s limited vaccine allocation means that most of the 1b population will be waiting weeks — if not months — to be eligible. The Richmond-Henrico Health District, for example, is currently directing 50 percent of its shipments to residents aged 65 and older and another 40 percent to essential workers such as teachers and first responders. Ten percent of doses are going to congregate living facilities including homeless shelters and prisons. 

Currently, the department is receiving roughly 6,400 doses a week. There’s no specific stream for residents who are younger than 65 with chronic health conditions. 

Hospitals have also quietly urged the state for more transparency and communication on how and where vaccine doses are being distributed. Those calls started in mid-January when hospital executives told Northam that shipments to facilities had dropped by 60 percent with little explanation from the state. Hospitals have also questioned an apparent lack of collaboration in the state’s plans to construct separate, free-standing mass vaccination clinics — even as some local health systems develop similar infrastructure that’s already serving their local communities.

“We are confident that greater transparency in both vaccine supply and delivery across Virginia will be beneficial not only to the citizens of the commonwealth, but also the public health infrastructure, hospitals and others entrusted with delivering COVID-19 vaccine to those eager to receive it,” Connell, the Inova spokeswoman, said in a statement.