This week, Republican State Senators Jim McClendon, Greg Albritton, Tom Whatley and Randy Price released a letter titled “The COVID Vaccine Distribution Problem in Alabama.”
The senators wrote: We have always known that distributing the Covid vaccine supply would be difficult, especially in the beginning. While the supply pipeline is definitely an issue, our pipeline in Alabama has a kink. The distribution of vaccines to Alabama will continue to be interrupted until Alabama plays by the rules. The rule is simple: The CDC will not authorize shipments to Alabama until they know we are using what we have on hand. Our citizens are paying a deadly price.
When CDC looks at our “inventory” we appear to have more doses than we can administer and with the high demand of vaccines nationally, doses are allocated to states who are reporting accurately. In addition, when vaccines are not entered into the registry the order for the 2nd dose is not triggered. In other words, we must report to the CDC the doses administered in order to get additional doses to the state. Apparently ADPH is unable to provide all of the following information:
- 1. How many doses have we received in Alabama?
- 2. How many doses have been distributed to locations around the state?
- 3. How many doses have been put into arms?
- 4. How many doses put in arms have been reported to the CDC?
In addition, every day, each location should notify ADPH of the number of doses they have remaining on hand. Every day. If the Alabama Department of Public Health does not know the answer {to} these questions, then the CDC certainly doesn’t know, and it makes no sense to send additional doses to Alabama. In a nutshell, ADPH must get every dose that has been administered entered into the registry for the Feds to send us more. While over 200 locations are giving doses, not all are entering them. And to be honest, the doctors, pharmacists, nurses who are giving Covid vaccinations in addition to their daily duties are already doing ADPH’s job, and blaming them for not entering doses into the registry is nonproductive.
The solution seems easy enough. Call all 221 locations and ask for how many doses they have on hand and compare that to what was sent to them. ImmPRINT is Alabama’s version of a statewide vaccine registry, and If those doses are not entered into ImmPRINT the ADPH should request the patient list and ADPH should enter those doses to get the kink out of our supply pipeline. The ADPH also should exercise the authority to require all locations administering the vaccine to keep the registry current, and not be supplied additional vaccine till they comply. Regardless, until we can account for all doses administered we will continue to have supply issues and the risk in Alabama will continue unabated.
In the letter, they blame the Alabama Department of Public Health for slowdowns in administering the vaccine and in failing to accurately record its distribution efforts so far. APR’s Baillee Majors spoke with State Health Officer Scott Harris. He clears up the misinformation surrounding the letter:
Baillee Majors: The senators write in the letter: “The distribution of vaccines to Alabama will continue to be interrupted until Alabama plays by the rules… The CDC will not authorize shipments to Alabama until they know we are using what we have on hand.” But ADPH says that’s not the case?
Dr. Scott Harris: That’s correct. About three weeks ago, HHS Secretary Alex Azar did a press conference with Operation Warp Speed. And he stated in the press conference, he said there may be a point in which they might consider not giving vaccines or have them taken away or shipped to other states. We complained loudly about that. We think this is a policy that takes away from “have nots” and gives to “haves.” We’re a large rural state. We don’t have the same kind of infrastructure as other states. We have counties without hospitals. We have a county without a health department.
That statement was made, but that has never been implemented as policy. Secretary Azar is no longer HHS Secretary. We do not have any indication that that changes at all.
The amount of vaccines that Alabama determines is based on our population. We’re about 1.4% of the population, and we get about the same percentage as the overall amount that’s manufactured. And that number has not changed. We continue to get the same amount, regardless of what we’ve given or not given.
Baillee Majors: Another excerpt from the letter: “When CDC looks at our “inventory” we appear to have more doses than we can administer. When vaccines are not entered into the registry the order for the 2nd dose is not triggered. In other words, we must report to the CDC the doses administered in order to get additional doses to the state.” Again, ADPH says this isn’t the case?
Dr. Scott Harris: There are several different issues I have with that. There are actually three different systems that are being utilized. And it’s just the way that a lot of hodge-podge of things that have been put together during this entire response. But providers who give vaccines are actually required to put those into ImmPRINT, which is Alabama’s immunization data base. We have a lot of providers who are familiar with doing that, but we have a lot who aren’t. There are people who are giving vaccines who aren’t used to doing that, and who aren’t used to reporting. There’s not requirement in Alabama for anyone to ever report the bulk vaccines. Many people, even the people who have given vaccines before aren’t used to reporting. We have some issues with just getting that information on how many vaccines have been given to people.
There’s a completely separate system that’s known as “Vaccine Finder,” and that’s the way that sites manage their inventory. They keep track of how many in there vaccines they’ve given and how many they’ve had on hand. And that’s the number that the CDC is using to calculate what our numbers are. But when they order vaccines, they order vaccines through ImmPRINT. That’s how the order is put in. And that’s what triggers another dose to the shipped. They request more vaccines to be sent to us, then more vaccines are sent to us. That’s for second doses. That’s separate and apart from what our weekly allocation is. We get a weekly allocation, which is set based on our population. The we get basically the same amount of what it’s worked out to be for second doses that comes as a completely second allocation.
Then there’s a completely different third system known as “V Track,” which is how we track the doses as they more from a manufacturer or distributor to reach the state. The statement that was being made in the letter, it’s not correct and doesn’t really understand how the system works.
Baillee Majors: One of the senators mentioned his constituents are having a hard time getting through to ADPH. The department said they were working to fix issues with the COVID-19 Hotline that has been flooded with calls. Have there been any improvements?
Dr. Scott Harris: I believe there is. We’ve certainly aware that people are having trouble getting through. We’ve heard from many people who are frustrated by that. We certainly acknowledge that and share some their frustrations. After the first day, when the hotline received around 1.1 million calls the first day, we worked with the vendor that provides that service to rise to add additional capacity. We have actually about 165 lines that are open for people to call. We know from the people who have gotten through, more than half of the calls we get are from people who aren’t eligible for the vaccine, so that’s been fairly challenging because it certainly keeps people from getting through otherwise who are eligible for the vaccine.
The hotline vender will refer those people to a local health department so that we can collect their information and contact them later when they are eligible to receive the vaccines. But it certainly does create a problem for people. We’re aware of that. We’re planning on online portal so that people can schedule themselves online that we hope will be up in the next few days. We want to encourage people to only call that number to schedule if they are actually eligible to receive a vaccine.
I will say, in spite of all the frustration that people have in getting through and making many, many calls sometimes to get through. We actually have scheduled all of the vaccines we have in our county health department. The doses that haven’t been given yet by the health department have names on them. They’re in some cases first doses for people who haven’t come in yet for their appointment, but a lot of them are second doses as well.
Baillee Majors: ADPH says the biggest obstacle to vaccination in Alabama is the limited supply of vaccine? Can you explain?
Dr. Scott Harris: Right now, we’re trying to vaccinate our health care workers and nursing home residents, which combined is around 330,000 people. And we’ve also added a group of first responders, which is a little over 40,000 people. As well as persons over age 75, which by itself is around 350,000 people.
Those aren’t completely mutually exclusive. There could be some overlap. You could have a person who is over 75 who fits into another one of those categories, like nursing home residents for example. But generally speaking, we have somewhere between 650,000 to 700,000 who are currently eligible to receive the vaccine.
We have not even got to a full Phase 1B rollout yet. The over 75 group and the first responders are priority groups that we’ve taken out of 1B to go ahead and start vaccinating them. So, we’ve not gone to a full Phase 1B.
Those almost 700,000 people or so, if we were to vaccinate them, each need two shots. So, about 1.4 million shots to reach that group. We certainly won’t be able to reach all of them. But our goal would be to have that amount of shots for that group. We’ve received at this point, around 440,000 or so doses in the state. We’re getting 50,000 to 60,000 doses a week. We’ve been told that will not change for the foreseeable future. That’s Alabama’s allocation based on our population. At that amount of shots a week, trying to get to 1.4 million shots, you can see is going to take quite a while.
Baillee Majors: Alabama is currently low ranking on vaccine rates in the country. What’s being done to improve this ranking?
Dr. Scott Harris: I would say we have a little bit of issues with those numbers, but I certainly wouldn’t argue that we’re one of the best. We absolutely can be doing better, and we’ve implemented some things recently to try an improve what we’re doing.
One of the issues in Alabama particularly, is people having access to care. A lot a rural areas where we don’t naturally have a lot of providers. In some places, the county health department may be the only site in a county for a vaccine to be given. But people do have transportation issue, people do have access to care issues. To some degree, we know that we have vaccine hesitancy. I think we’ll learn more about that as we start to offer this vaccine to more and more people. But we have some counties that don’t have hospitals. As I mentioned, we have a county that doesn’t have a health department. We don’t always have a lot of places for people to go and do this. It’s just becomes more complicated for a state that’s large and rural like Alabama.
Baillee Majors: Do you feel like the senators are overstepping in their letter? It’s clear there’s been some misinformation circulated with our lawmakers. Should they have gone about this a different way? Did they contact ADPH with these concerns before publishing the letter?
Dr. Scott Harris: I was not contacted by anyone about it. I didn’t know about it until I was asked about it by the press. We are in regular contact with the legislators. We’ve done many Zoom calls and telephone calls with them. I think it’s perfectly valid for legislators to ask these questions that their constituents are asking them. That’s their job to represent their constituents. And it’s certainly our job to provide answers to those questions.
The exact questions that were answered there about the type of data they thought we ought to be producing, we have every day present on our website. The CDC data that they mentioned is on the CDC website, but the rest of it is information that we update and post every day. I didn’t talk to them about it or even know about it until it came out.
Baillee Majors: If an issue like this comes up again, how would you like to see people proceed?
Dr. Scott Harris: Again, I think anyone in the state of Alabama is perfectly in their rights to reach out to us for information and ask for an explanation for things. That’s our job, we’re here to serve the people of Alabama. We do everything we possibly can to be transparent and to give the people the information they want. The volume of the request we’re getting is pretty incredible right now, and all of us are getting hundreds and hundreds of emails from the public on a daily basis, or certainly I am.
We have groups of people who handle certain categories of requests, and many of them I respond to myself. But I think people naturally tend to reach out to their legislators. That’s the people who represent them. When people have those kinds of questions or concerns, I think it’s very appropriate for them to reach out to their legislators.
