Hunting for a shot: As vaccine eligibility expands, some Virginians are competing for doses

Bonnie Hamilton had wanted a COVID-19 vaccine for weeks. The Henrico resident, currently pregnant with twins, said she pre-registered with her local health department as soon as officials introduced the sign-up form. She confirmed her information when Virginia launched its centralized system and browsed the news to stay up-to-date on the state’s rollout.

But when health districts across Virginia began to expand eligibility to new subcategories under Phase 1b — opening the shots to residents under the age of 65 with underlying health conditions, including pregnancy, along with the seniors and certain essential workers prioritized earlier in the state’s campaign —  she started looking for an appointment more seriously. 

“It’s really been a discussion with my OB-GYN and validating with her that she recommends it,” Hamilton said. “Which she did, very adamantly.” The search led her to the Facebook group RVA Vaccination Hunters, which has swelled to more than 7,000 members since its launch in late January. She found other people who were hoping for a vaccine and had tips on how to access one.

“It just helps lead you into different areas where you can get the vaccine” — outside of waiting for an appointment through her local health department — Hamilton said. It was through other members of the group that she found out the supermarket chain Kroger had started booking appointments for people with underlying conditions at its pharmacies.   

On the first weekend in March, she managed to snag a slot for the Johnson & Johnson vaccine in Charlottesville, a roughly two-and-a-half hour round trip from her front door. Hamilton said it took about 90 minutes of refreshing the pharmacy’s sign-up page until an appointment opened up. But the drive to Charlottesville was more reasonable to her than trips reported by other members of the group, some of whom have traveled hours for a shot.

“I know a lot of people are getting vaccinated in Roanoke, and that feels far to me,” she said. “Especially if you’re getting one of the vaccines where you have to go back twice.”

Concerns over equity

As eligibility has expanded across Virginia, the demand for shots — and, in some cases, the impatience — has also risen. And while the state’s allotment of vaccines has increased significantly since January, from roughly 105,000 weekly doses to nearly 200,000 expected this week, they’re still diffused across health districts according to population. 

There are also sometimes big differences in how far each health district has progressed in vaccinating prioritized residents and how many doses they’re allocating for those newly eligible based on underlying conditions. At the same time, new channels for immunization have emerged through hospitals and pharmacies, many of which receive doses through separate allocations from the federal government. 

The result, in some cases, has been a lottery for shots outside of local health departments. 

Technically, pharmacy chains in Virginia are expected to adhere to the state’s guidelines, sticking to residents 65 and older and certain essential worker categories. Recently, that expanded to include teachers and child care workers after President Joe Biden urged states to prioritize them as children return to the classroom, said Stephanie Wheawill, the director of the Virginia Department of Health’s Division of Pharmacy Services.

“If they have open appointments after they’ve opened it up to those populations, they can work off the state’s list to get those 16 to 64,” she said. But over the past couple weeks, many of the state’s pharmacy chains haven’t been doing that. 

Kroger, for instance, opened appointments for underlying conditions on a first-come, first-served basis. Snagging a slot often meant checking the website early in the morning or refreshing the sign-up page over and over to catch appointments that popped up during the day.

Hamilton said there were other tricks, like expanding the search radius and uploading personal data onto the site in advance. “It asks you to book an appointment first, but then it asks you for a bunch of other information like your name, your address, your age,” she said. “But by the time you get through that, if you hadn’t already pre-entered it, the appointment is probably going to be gone.”

The system made her a little uncomfortable, even though her local health district had clearly prioritized residents with underlying conditions. “You have to have the resources — internet, the computer — and time to sit and look at Facebook and refresh all these browsers to see if there are openings,” Hamilton said.

Frequently, it also required the time and means to travel long distances for appointments in other areas of the state. There have been accounts of Virginians getting vaccinated in North Carolina, where some counties are vaccinating entirely on a first-come, first-served basis. But “vaccine tourism” also extends to different regions in Virginia, where some residents — frustrated by the pace of immunization in their own health districts — are booking appointments across the state.

This past week, dozens of “vaccine hunters” in Richmond and Northern Virginia posted that they were able to book appointments through Valley Health — a hospital system in Winchester that opened slots on a first-come, first-served basis. Jason Rotz, a co-owner of the Winchester-based drug store Rotz Pharmacy, said Friday that roughly 50 percent of their vaccine appointments are going to residents from other parts of Virginia.

“This is problematic because every health district is being allocated vaccine based on their population,” he said. But “the directive from Richmond is to vaccinate regardless of residency,” Rotz added, “so that’s what we do.”

There’s been a reaction to the vaccine hunters. Wheawill said she had a conversation with Kroger and other pharmacy partners to reemphasize the state’s guidelines. As a result, many stopped accepting appointments for the 16 to 64 population this week (representatives for Kroger did not return a request for comment).

Valley Health also shut down its appointment system and began working off the state’s pre-registration list on Thursday. Feit said the shift had always been a goal for the health system, which knew open registration functioned “like a lottery” when demand for the vaccine was high.

But Dr. Colin Greene, director of the Lord Fairfax Health District (which includes Winchester and surrounding counties), said Virginia’s ongoing issues with its current appointment scheduling system make things more difficult. Many local health departments and hospital systems depend on a platform called PrepMod to book the shots, but it doesn’t connect with the state’s pre-registration list, which can make it difficult — and time-consuming — to translate sign-ups into real-world vaccine appointments.

It’s also prompted worries from some residents in areas that have become frequent targets for travel. Liz Thurman, a moderator for the RVA Vaccination Hunters group and a similar page in Northern Virginia, said she’s been concerned by the number of appointments in some areas that have gone unfilled. But some say locals aren’t always aware the appointments are available, and the increased interest from other areas have made it more difficult to snag a spot.

“We’re all struggling to find the same appointments,” said Terri Phlegar, a retired nurse who lives in the small town of Vinton, outside Roanoke. “And what I’m hearing from folks in my community is that they’ll go to their pharmacy and their pharmacists will tell them, we’ve already had four no-shows this morning.”

As Virginians from outside the area book appointments in Roanoke, Phlegar said some of her own neighbors have yet to be vaccinated. Many don’t have reliable internet, she said, and are still waiting on their local health departments for appointments. Others aren’t aware that outside avenues exist.

India Gray, who lives in Stafford County near Fredericksburg, said she registered her 72-year-old mother with her local health department back in January. When Virginia launched its centralized registration system, she was reassured by weekly emails stating her mother was on the wait list and would be immunized once a vaccine became available.

“I didn’t know if I had to put my mother on another list for the pharmacies or if they were going off the list from the Virginia Department of Health,” Gray said. “And I didn’t really want to sign her up for four or five different lists because I was afraid she might lose her place. When you listen to the news, they make it sound like as long as she’s on the centralized list, it will be fine.”

She didn’t start worrying until late last week, when she learned her neighbors had been vaccinated through Mary Washington Hospital. But Gray’s mother, who is Black with underlying health conditions including breast cancer, diabetes, heart disease and high blood pressure, still hasn’t been scheduled for a shot.

“I’m like, this has gotta be a joke,” Gray added. “And what I’m really more frustrated about is that Mary Washington is the hospital distributing vaccines in this area. But my mother’s doctors, who are with the system — well, no one’s called to make sure she’s had an opportunity to sign up.”

Confusion over eligibility

Cindy Jez, who founded RVA Vaccination Hunters, said the push for shots has been driven by confusion over who’s eligible and how quickly they can expect to schedule an appointment. 

Local health directors say the urgency for many Virginians started in mid-January, when Gov. Ralph Northam announced the state would open to Phase 1b and lower the eligibility to those 65 and older. Virginians younger than 65 with underlying medical conditions would also be included, he said.

That followed behind-the-scenes pressure from then-Health and Human Services Secretary Alex Azar, said Dr. Danny Avula, the state’s vaccine coordinator. That month, Azar directed states to expand 1b criteria, telling governors that the Trump Administration was preparing to release a stockpile of reserve vaccines.

But less than 24 hours after Northam’s announcement, The Washington Post reported that no reserve stockpile existed. Local health directors said they were also surprised by the new directive, which came as many were still working through frontline health providers — or just starting to vaccinate residents 75 and older.

“That day and the next day and all the next week and several weeks to follow, I keep getting emails: ‘The governor has said that I’m eligible for a vaccine now. Why aren’t you giving me a vaccine?’” said Dr. Karen Shelton, director of the Mount Rogers Health District in Southwest Virginia. “It has been very difficult to help the public understand that while we value that they definitely need vaccine, we can’t accommodate it yet. I just told them, ‘Well, the governor said you can have a vaccine, but he didn’t give me any more vaccine to give you.’”

For weeks, as many Virginians believed they were eligible for doses and fretted over how soon they’d receive one, local health departments were directed to limit Phase 1b to first responders, teachers, child care workers and corrections officers, said Greene, of the Lord Fairfax Health District and Rappahannock-Rapidan Health Districts. 

Vaccines for the general population were reserved for those 65 and older. And while Northam later clarified how local health departments should distribute the vaccines — 50 percent to seniors and 50 percent to certain categories of essential workers — there was never a public rollback of Phase 1b or explanation that vaccine shipments were markedly lower than what the state was initially promised.

Some of those same issues have extended to 1b expansion. Some far southwestern health districts, including Mount Rogers, opened eligibility to underlying conditions in late February, while New River Valley — just a few counties away — didn’t expand until Friday. And while access to vaccines in Virginia has expanded dramatically in the last two weeks, health districts are also moving at sometimes markedly different paces.

Some Northern Virginia localities, for example, have lower rates of vaccination than more rural areas of the state — even though they receive a higher percentage of doses. Jeff McKay, chairman of the Fairfax County Board of Supervisors, pointed out that the district has delivered more vaccines in total number than any other region but has a larger population than anywhere else in the state.

That reality doesn’t always translate to residents. The district has a process to inform residents where they are on the waitlist, but it’s also difficult to avoid comparisons between different areas. The Richmond-Henrico Health District, for example, opened 40,000 new appointments to residents with underlying conditions last week.

“That was very unexpected,” said spokesperson Cat Long. The district had initially planned to allocate those appointments to seniors and direct doses for the 16-64 population to outside providers to prioritize for patients. But Long said they were able to expand after reserving roughly 15,000 vaccines for seniors but only vaccinating a little less than 8,000 at scheduled clinics. Coupled with growing supply in the district, which has doubled from roughly 6,000 doses a week to an expected 12,000 until the end of March — when total shipments to Virginia are expected to increase significantly — it allowed Richmond-Henrico to vaccinate many residents with underlying conditions more quickly than expected.  

But residents finding vaccines in other areas likely played a role.

“Especially when you look at our equity prioritization to start with folks who are most elderly and folks who are from Black and Latino communities,” she said. “It means that the people who were at the end of the list for the senior section tended to be the youngest seniors. And in some cases, tended to be the most well-resourced seniors. So, it seems likely they might have been able to find other opportunities.”