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Health, Science & Tech

Once ‘Haphazard,’ State System For Allocating Vaccine Evolves As Shot Availability Widens

Virus Outbreak Europe Summit
Francisco Seco
/
AP
FILE - In this Monday, Jan. 4, 2021 file photo, frozen vials of the Pfizer/BioNTech COVID-19 vaccine are taken out to be defrosted at the MontLegia CHC hospital in Liege, Belgium. EU leaders on Thursday, Feb. 25, 2021, during an EU summit video conference, will look at ways to improve the vaccine rollout, as they press pharmaceutical companies to respect the terms of their contracts with the 27-nation bloc. (AP Photo/Francisco Seco, File)

As Pennsylvania moves into phase 1C of its COVID-19 vaccine rollout Monday, hundreds of thousands of new people have begun searching for appointments. On Tuesday, every adult Pennsylvanian will be eligible to get a vaccine. As manufacturers continue to ramp up production, millions of doses of vaccine will flow into the commonwealth over the coming weeks.

But much of the supply chain infrastructure for the biggest vaccination effort in U.S. history is being built as the rollout progresses. So how do doses get from manufacturer to clinic? Here’s what we know about how it works in Pennsylvania.

From the federal government to the states

Every dose of vaccine administered in the United States is allocated by the federal government into one of three different streams. One stream goes to states and other jurisdictions to further allocate to providers. Another goes to pharmacies participating in the federal partnership, and the third goes to federally qualified health centers, or FQHCs. That means CVS, Walgreens or the East Liberty Family Health Care Center receive their vaccine supplies via a different process than UPMC, Allegheny Health Network, the Allegheny County Health Department, and independent vaccine providers, like Spartan Pharmacy.

While the U.S. Department of Health and Human Services has not disclosed how many vaccine doses go to pharmacy partners and FQHCs, a spokesperson said that the doses controlled by states, territories and cities represent the largest portion. (Some cities, like Philadelphia and New York, receive their own allotments, as do U.S. territories.)

The number of doses that Pennsylvania gets to allocate is based on the portion of the state’s population over the age of 18. State health department communications director Barry Ciccocioppo said state officials have requested the maximum amount doses from the federal government since the vaccine rollout began in December. In recent weeks, the Pennsylvania Department of Health has had more than half a million doses to allocate to providers each week.

From the state to providers

Once the federal government has told Pennsylvania officials how many doses they can expect in a given week, the state health department allocates vaccines to providers. How many vaccines a provider gets is based on a couple of factors.

First, what is the need in that county? The department determines a county’s need by looking at the number of COVID-19 deaths and how many residents are over the age of 65. Then, officials consider a county’s total population and the number of COVID-19 cases.

Second, what is a provider’s capacity to administer vaccines? That is, how much did they request, and how effectively have they administered previous shipments of vaccine? The health department has ordered providers to administer 80% of their first doses within seven days of receiving them.

Hospital systems will request supply that gets sent to their flagship hospitals before shipping out to additional locations, sometimes in other counties. This can obscure the actual county-by-county distribution of doses, making it look like one county is getting more vaccines than it actually is, said Ciccocioppo.

Once the state approves a number of doses for a provider, manufacturers ship supply directly to provider intake facilities.

Shipments arrive to providers in boxes filled with dry ice and packaging protecting the trays of vaccine vials. Providers often already know whose arms the doses are destined for, but it wasn’t always that way.

Terri Gritzer, director of pharmaceutical care services at Conemaugh Health System in Johnstown, said there were instances where she first found out about shipments when a distributor like McKessen or Pfizer would send her a tracking number.

“I was delighted to get vaccine, but I did not know it was coming, so that makes it a little difficult to plan ahead,” Gritzer said.

Providers now get a few days heads up on how much vaccine they can expect. Still, challenges remain, in part because vaccines are allocated and shipped on a weekly basis, but the process for requesting, allocating and receiving vaccines lasts between 10 and 14 days. That means ordering and shipment cycles overlap with one another, and when providers submit requests for vaccine allotments, they’re predicting how many doses they can administer two weeks out.

Gritzer said there were times when she didn’t learn about how many second doses to expect during one cycle before the next request form was due to the state. In those cases, she requested the same amount of second doses as the previous week, hoping she got enough supply to vaccinate people whose appointments were already booked.

“Initially it was very haphazard,” said Debbie Albin, assistant director of UPMC’s HC Pharmacy Central. “I think it continues to evolve.”

A spokesperson for the state department of health said processes are still being created as the rollout continues. But hiccups in the distribution process can mean delayed vaccinations for Pennsylvanians.

For example, miscommunication with the state led some Pennsylvania providers to inadvertently administer second doses as first doses in February, straining an already limited supply. Even though providers have to request specific amounts as first and second doses, it’s up to providers to separate and keep track of which vials are which. The boxes are not labeled as first or second doses by the manufacturers, because the vaccine ingredients are the same.

As the supply of vaccines increases in Pennsylvania, scheduling processes are able to firm up, according to Acting Health Secretary Alison Beam. Last week, the department said that supply is increasing quickly enough that providers can have more predictability about how many doses they will receive.

That would be a welcome change to providers like Conemaugh Memorial Medical Center.

“It becomes very difficult to plan a vaccination clinic when you only know a few days ahead of time that you’re going to be getting vaccines,” Gritzer said.

From providers to patients

Once vaccine supply is accounted for, providers can finalize plans for clinics and get shots into arms. Some providers bring the vaccines directly to patients; for example, a hospital vaccinating its workforce, or the County Health Department bringing vaccines into senior high rises.

But the majority of Pennsylvanians will have to place the final piece of the vaccination puzzle themselves. Pennsylvania does not have a central registration portal where providers can reach out to schedule appointments based on eligibility. Eligible people must find their own providers and book appointments through different and separate provider websites.

Larger health systems, like UPMC and Allegheny Health Network, have announced dates for mass vaccination clinics in the area. Appointments at daily clinics in Allegheny County can be found online at provider websites listed below:

A full list of local vaccine providers is available at the Pennsylvania Health Department website. Elsewhere online, Pennsylvanians have offered help for those searching for open appointments. A local Facebook group, Getting Pittsburgh Vaccinated, has several administrators ready to help members find an open appointment.

All Pennsylvanians are eligible for a COVID-19 vaccine beginning April 19.

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