Last week, a county public health official in upstate New York swung by CVS after work to pick up some aspirin. In the pharmacy, he was met with a surprise.
The CVS was distributing doses of the COVID-19 vaccine.
The official, who is helping oversee the area’s vaccine distribution, didn’t know that this particular pharmacy was an option for those seeking vaccination in his community.
“I’m not necessarily angry about it, but I would have appreciated having a way to know,” said the official, who requested anonymity due to the potential for reprisal.
The encounter reflects a reality across much of the United States: local public health officials in charge of vaccine distribution frequently lack information about federal distribution efforts, depriving local public health of a full picture of the vaccination effort in their communities.
In some ways, having extra doses of the vaccine in communities is a good problem to have. But the lack of coordination, experts worry, may speak to a broader failure to use the pandemic to create longer-lasting investments in the local public health departments that remain responsible for fighting COVID-19, and will once again be on the front lines of fighting the next pandemic.
Multiple local public health officials around the country told TPM that while the vaccine rollout has been stunning in its speed over the past few months, they often don’t know how many federally distributed doses are going where in their own communities.
This leads to confusion as people call their local public health departments trying to find out where to get vaccinated, and local officials lack complete answers. And it degrades those officials’ ability to target for what public health experts refer to as “equity” — ensuring that hard-to-reach communities get equal access to the pandemic-ending shot.
“We cant do the best job that we’d be able to do in administering the most vaccine to the most people in a short time if we don’t have all the data,” Dr. Patricia Ruppert, health commissioner for Rockland County, New York, told TPM.
The Biden administration has tried to improve the issue by giving local officials access to vaccine distribution data for Federally Qualified Health Centers, and by making funding available for community health workers. But local officials complained that nothing has been done to address the lack of visibility into how many doses pharmacies receive and administer under the federal partnership.
It’s an issue that reverberates across the country.
“You find out vaccine is being given out and you weren’t given information about it beforehand,” Dr. Matt Zahn, head of communicable disease control for Orange County, California, told TPM. “To some degree that’s going to happen, there are so many moving parts, but its generally frustrating if you’re trying to oversee vaccine outreach in the community, and two you want to be a repository of information to the community.”
The issue partly comes as the vaccine rollout has evolved since it began in December under the Trump administration.
Under Trump, the federal government agreed to distribute doses to the states. The only federal program that moved vaccine directly to American arms was a partnership with CVS and Walgreens, which saw the pharmacies send teams into nursing homes around the country to inoculate the residents.
That was when some local officials first noticed that they weren’t in the loop.
Zahn described the problem as both “difficult” and “frustrating.”
“We’ve been working with these facilities on a regular basis, we know where the outbreaks are,” he said. “It was difficult to get a sense of when the vaccine would arrive and where it was gonna go, which facilities was going to get the vaccine and where.”
Other officials described competing efforts to get the word out about the vaccine. Dr. David Bishai, health officer for Harford County, Maryland, has found himself calling community leaders in a bid to ensure that hard-to-reach Americans hear about the vaccine. When he reaches them, however, he’s found they’ve already been talking to state-level officials.
“Is that a problem? So what if a pastor’s phone rings a few extra times a week,” he told TPM. “It’s not really a problem getting in the way of vaccines, but if we want to get ready for another public health crisis, and there’s many more coming, we need to think about this.”
Since Biden was inaugurated, the federal government has taken on a more muscular role in distribution.
The federal presence has expanded nationally to include FEMA sites around the country, a partnership with vaccines available at brick-and-mortar CVS and Walgreens outlets, and shots delivered to Federally Qualified Health Centers.
Since then, the issue has only improved to a small degree, local officials said.
Ruppert, the Rockland county health official, said “I personally do not have the staff to go out and inventory all the pharmacies.”
Ruppert added that she raised the issue on a call with the White House’s COVID task force during the administration’s first few weeks in office, asking why pharmacies were being prioritized over local public health departments.
“They said they were looking to build up the infrastructure of pharmacies because they provide 32 percent of flu vaccines a year, and they wanted to build them up to distribute the COVID vaccine,” she recalled.
In recent weeks, the Biden administration has taken further steps to address the problem. The American Rescue Plan included billions of dollars in funding for state and local public health, both for the vaccination campaign and also for much-needed COVID-fighting functions like contact tracing.
Separately, the administration reportedly plans on using a locally run approach to promote the vaccine.
But questions linger over whether those investments are enough to build out a broader, longer-lasting public health infrastructure for the next pandemic.
“How do you go about solving it?” Zahn asked. “That falls on local public health to directly make efforts that vaccines are provided to those communities.”