States delay ordering all the vaccine doses available to them despite outbreaks

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When Michigan Gov. Gretchen Whitmer (D) last week asked White House officials if they would consider sending more vaccine doses to her state during a deadly surge, the state had not ordered 360,000 doses then available, puzzling federal officials who instead advised her to work with experts to make sure Michigan’s supply was being deployed effectively.

Michigan’s Chief medical executive, Joneigh Khaldun, said late Friday the number of unordered doses offers only a single-day snapshot, noting the federal government had deposited a large number of doses in the state’s account in anticipation of their later use at a mass vaccination site. She said other doses were being preserved to address a mixup of first and second doses by some providers.

But Michigan wasn’t the only state leaving doses on warehouse shelves. At one point last week, 13 states had more than 100,000 doses apiece available and not ordered, according to a federal official familiar with the figures who, like others, spoke on the condition of anonymity because of the matter’s sensitivity. Indiana had only pulled down 90 percent of doses available to the state, leaving 306,000 on the shelves. Texas had ordered 95 percent of its share, leaving 673,000 doses temporarily untouched.

The delays have gained notice inside the federal government, where officials have discussed whether performance metrics, including how quickly states are ordering and using their vaccine doses, and getting them to vulnerable groups, should be part of allocation decisions, according to three people familiar with the issue. Any new approach, however, would need sign-off from the White House, which has been at pains to avoid the appearance of penalizing some states while boosting others, including by directing additional doses to virus hot spots.

“The fair and equitable way to distribute the vaccine is based on the adult population by state, tribe and territory,” Jeff Zients, coordinator of the White House’s coronavirus task force, said during a Friday briefing. “That’s how it’s been done. And we will continue to do so. The virus is unpredictable. We don’t know where the next increase in cases could occur.”

Experts argue that four months into the immunization campaign, and with more transmissible variants of the virus spreading throughout the country, states should no longer be encountering bottlenecks preventing them from making use of their full vaccine allotments.

“States and their health-care providers need to have the capacity at this point to deliver the vaccine doses available to them each week,” said Jason L. Schwartz, an assistant professor of health policy at Yale University and a member of Connecticut’s vaccine advisory committee. “We shouldn’t be leaving vaccine doses on the table during this time.”

State and county officials offered different explanations for not ordering their full allocations each week. Many cited the difficulty of matching first and second doses. Others pointed to reduced demand, staffing challenges and inadequate communication between state and local officials. Mouhanad Hammami, director of the Wayne County Health Department in Michigan, said a sharp and unexplained drop-off in the county’s share of Moderna doses meant it couldn’t operate one of its clinics, ordinarily capable of administering 2,000 doses per day to people in the Detroit area.

Sarah Verschoor, a spokeswoman for the Indiana Department of Health, said doses not ordered had been “earmarked for businesses, higher education and local health department clinics that are set to start vaccinating in the coming days.” Chris Van Deusen, a spokesman for the Texas Department of State Health Services, said last week that the state’s balance would be gone by last Friday, by which time orders for second doses would be placed. But 145,000 doses remained at week’s end.

In North Carolina, which ended last week with 426,000 doses not ordered, state health officials did not respond to requests for comment. All state residents 16 and older became eligible for the shots on Wednesday. Lisa Macon Harrison, health director for Granville Vance Public Health in the northern part of the state, said orders dipped last week because of spring break.

“This past week was spring break for a lot of communities, and teachers and students and nurses alike had a little break planned,” she said. “In some places, school nurses were not available [to administer shots], and staffing levels across the nation were going to look a little different.”

Michael Fraser, chief executive of the Association of State and Territorial Health Officials, said some states not ordering their full allocations are experiencing soft demand and are developing new strategies to boost interest in the shots. He argued it was too soon to redistribute…



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