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Trump administration health officials blindsided states on Tuesday with an abrupt and dramatic shift in how they’ll distribute coronavirus vaccines that may set up new hurdles for the Biden transition team.
The administration plans to punish states that don’t move fast enough on vaccinations or that fail to provide the government real-time reports on inoculations. Trump officials also urged states to immediately start vaccinating anyone 65 and over or with high-risk medical conditions.
Those moves, however, won’t fix the chaos and inequities that have marked the vaccine rollout so far, including low uptake in underprivileged communities hardest hit by the pandemic, public health experts and some officials representing state health departments told POLITICO. And they could put states struggling to vaccinate hard-to-reach communities farther behind.
HHS Secretary Alex Azar told governors on a call Tuesday that President-elect Joe Biden will have to determine how the new vaccination policies unfold, according to notes obtained by POLITICO. Biden’s transition team declined to comment on next steps. But Biden, who is due to outline his plan for distributing vaccines on Thursday, has previously said he will prioritize delivery of shots to the lowest-income communities that have borne the brunt of the virus.
A federal health official defended the decisions to POLITICO, saying the timing was linked to the distribution of billions of dollars to states and a new policy that allows pharmacies to administer Covid-19 shots, so vaccinations wouldn’t rely on overstretched health systems.
“We need doses going to where they'll be administered quickly and where they'll protect the most vulnerable,” Azar said at a press briefing Tuesday.
The administration’s moves essentially tear up a game plan crafted by Centers for Disease Control advisers that states have used to make decisions. Some public health experts on that committee said they’re concerned the new system could amount to a free-for-all that favors the wealthy and connected and could shut out essential workers, teachers and other groups that were previously in the first tiers.
“If you open it up and just base it on age criteria, a lot of people who already have access to good health care can skip to the front and leave other people behind,” said Kevin Ault, a professor at the University of Kansas Medical Center.
CDC Director Robert Redfield downplayed the impact of the new policy, saying the advisory board’s guidance never guaranteed that everyone in those groups would be immunized before moving on to lower-priority groups. And the federal health official said the administration’s intention is not to skip over essential workers.
The changes come amid mounting disagreements over who is to blame for the slower-than-expected rollout of the vaccine. While states have received over 27 million doses of vaccines, just over 9 million shots have been administered. Azar, in touting the new rules, blamed state leaders’ overly strict adherence to federal prioritization guidelines for the lag.
But flooding the system with more vaccine alone won’t work without setting up more vaccination sites and providing more material support, experts say.
“In order for us to efficiently move doses into arms, a strong understanding of how many doses to expect this week, next week, and the following weeks is needed,” Claire Hannan, the executive director of the Association of Immunization Managers, wrote in an email.
Biden’s team late last week had suggested getting more shots out to states and expanding the pool of people eligible to be vaccinated. But it stressed that those changes are just one piece of a complicated puzzle and far from an adequate fix.
Biden’s team envisions a more robust role for the federal government and clearer guidelines and more material support for states. It also plans to set up federal vaccination sites, send mobile units into hard-hit neighborhoods that lack health infrastructure and launch a massive education campaign to dispel misinformation about vaccines and prod people to take the shot.
“The bigger issues are systemic: having more immunizers, broadening who can be an immunizer, training them — those are the supply limitations,” said Vin Gupta, an affiliate assistant professor at the University of Washington’s Institute for Health Metrics and Evaluation who served as an adviser to the Biden team. “Then there are the demand limitations: the widespread vaccine hesitancy. We have to address both sides.”
Each state has final say in how the shots are allocated, and can use discretion in how strictly it checks people’s eligibility and what to do with extra shots. That’s led to a confusing patchwork of rules in the early weeks of inoculations — some too strict and others not strict enough.
The CDC advisory committee "has never wanted the recommendation to serve as an impediment to getting vaccines into arms,” said José Romero, Arkansas’ health secretary, who also serves as the panel's chair. But he added that “the major thing is that we do not disenfranchise any single group.”
Until recently, New York state was threatening doctors with hefty penalties if they gave a single dose to anyone other than a medical worker, which prompted some providers to leave scarce vaccines in storage or even throw them away rather than use them on non-priority populations. Meanwhile, Florida opened up eligibility to everyone 65 and older without first securing enough doses and the staff needed to distribute them, leaving senior citizens waiting in line outdoors overnight in hopes of getting a shot.
Now, some state leaders say they’re afraid the Trump administration’s new policies will create more disorder. Some health officials also fear that basing states’ vaccine allocation on their distribution speed will create perverse incentives — leading states, for example, to defer the slower work of identifying and vaccinating undocumented workers, the homeless, rural residents and other at risk groups.
“The harder to reach populations are in so many ways the most important to reach populations, but that wouldn’t show up on the balance sheet of how fast you’re doing this,” warned Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials. “The more people we get vaccinated the faster we get to herd immunity, but if we’re doing that while we’re perpetuating disparities — getting all the easy folks and leaving the harder folks for later — that’s not a just way to go.”
Casalotti and other officials also stressed that even if they receive more shipments of vaccines, states don’t yet have the resources they need to administer them safely or equitably.
“We are focused on speed but you have to focus on safety too,” said Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials. “That means having the staff to monitor people for allergic reactions after they get vaccinated, and also having enough space at the distribution sites for social distancing. The last thing you want is for someone to get Covid when they’re waiting in line to get the vaccine.”
Some state leaders are also warning that the Trump administration’s decision not to hold back vaccine doses to ensure there’s enough for people to get their second dose could force states to scramble weeks from now, adding freezer storage capacity to the already long list of challenges facing overburdened local governments.
“That adds another planning task and wrinkle in our system,” Kris Ehresmann with the Minnesota Department of Health said in a press briefing on Tuesday, saying she’s still “awaiting information” from the federal government on it.
Brianna Ehley contributed to this report.