By Outer Banks Voice on February 5, 2021
For the next several weeks at least, North Carolina public health officials say their vaccine distribution policy will reflect more planning and predictability. The big problem remains, however, the very limited quantities of vaccine currently available.
The effort to be more predictable in allotting vaccine followed a recent decision to send numerous doses to mass vaccination events in the Charlotte area. That left Dare County Department of Health and Human Services Director Sheila Davies — and a number of other local public health officials — fuming over what they saw as inequitable distribution. Dare County, for example, was forced to reschedule some appointments at a Jan. 29 clinic after learning the state would only provide half its promised allotment of vaccines that week.
“What we’ve done going forward…to try to give folks more certainty is [to] now guarantee that for the next three weeks, they’re going to get a certain amount, so now for the next three weeks they can plan,” Mandy Cohen, Secretary of the NC Department of Health and Human Services, said in a phone interview with the Voice this week.
“They know exactly what they’re going to get. Now they may get more because we have some doses above the minimum baseline, but at least from a minimum, they know how to plan for the next three weeks,” Cohen added.
The state had reallocated vaccines from local counties to mass vaccinations clinics as part of a short-term push to administer as many shots as possible. That push was in response to the “use-it-or-lose-it” pressure the federal government has begun putting on states to administer shots more quickly or else receive fewer doses going forward.
As The News & Observer reported, the short-term strategy paid off as North Carolina climbed up the CDC’s rankings of states with the highest rate of vaccine delivery — moving from 40th the week of Jan. 18 (3,874 per every 100,000 residents given at least one dose) to 22nd as of Jan. 29 (6,956 per every 100,000 residents). “I think we were all working to get first doses out as quickly as possible,” Cohen said in response to a question about the rationale for re-allocating doses from counties to mass vaccination clinics.
The federal government initially told North Carolina last month it would receive 120,000 weekly doses, but it has since bumped that up to 145,000 doses for the next three weeks, Cohen said. Of those 145,000 doses, the state doles out about 90,000 to counties strictly based on population, according to Cohen, and the remaining 55,000 doses will be targeted to address existing geographical and racial inequities.
“I think we have work to do to make sure we’re reaching our under-served communities, but I think we are very much still prioritizing that equity as we work on speed and I think that differentiates us from other states,” Cohen said.
Once a county’s allotment is determined, the state then divides those doses up within the county based on the number of providers and each provider’s capacity for administering the vaccine.
Dare County will receive a base allocation of 300 doses weekly for the next three weeks, according to Sheila Davies. All of those 300 doses will go to Dare County’s Department of Health and Human Services. The two other registered vaccine providers in the county — The Outer Banks Hospital and Surf Pediatrics and Medicine — will not receive any vaccines over those weeks, she said.
Currituck County will receive 200 weekly doses in that time, according to Amy Underhill of Albemarle Regional Health Services (ARHS), the regional health agency serving Currituck. Currently, ARHS is that county’s only vaccination provider. Luana Gibbs, Hyde County’s interim health director, did not respond to questions emailed from the Voice.
Counties find out how many doses they will receive each week on the Friday before, Cohen explained. Prior to receiving the final number on Friday, the state contacts counties on Thursdays to give them a “draft” number and confirm that the county wants to receive its allocation for the upcoming week, she added.
Once numbers are finalized, the state then tells the federal government how many doses to ship to each provider, and those doses are shipped directly to providers.
“The doses actually never come to the state,” Cohen said. Weekly shipments generally arrive at the provider locations on Wednesdays, she said, noting it may arrive on Tuesday night or Thursday morning.
“The doses arrive at the vaccinating provider, whether that’s the health system or a federally-qualified health center or the health department, and then they are the ones that figure out how they are using it over the course of the week before they get their next shipment,” Cohen said.
Providers are required to use all of their weekly doses before receiving their next shipment, she added.
One additional tool in the vaccine rollout effort was introduced this week when it was announced that the federal government will send vaccine doses to pharmacies across the country. Starting next week, CVS will offer vaccinations at locations in Virginia that include Norfolk, Newport News, and Virginia Beach. Walgreens will offer a total of about 31,000 doses in 300 North Carolina locations — but those locations have not yet been revealed.
Cohen and local health departments agree the biggest limiting factor in North Carolina’s vaccine rollout has been the frustrating lack of vaccine.
“We don’t have enough vaccine. That’s the bottom line,” Cohen said. “At every turn, things could be made better by having more vaccine. I don’t have enough vaccine to give anyone across the state and that is frustrating.”
Underhill said that while ARHS has the capacity to administer 25,000 to 30,000 weekly doses, it is only slated to receive around 1,300 weekly doses across the eight counties it serves for the next three weeks.
Dare County, Davies said, is hurt by the fact that the state’s vaccine allocation formula doesn’t account for many non-resident property owners Dare County provides for. It also doesn’t take into account the fact that Dare County has a higher percentage of residents 65 and older than many other counties.
“There is just not enough vaccine supply to meet the demand,” Davies said.