Eligibility rules leave vaccines going unused
Okanogan County has received more than enough COVID-19 vaccine to vaccinate people who are currently eligible, but health officials are constrained — and frustrated — by state guidelines that prohibit vaccinations for anyone except those in the approved phase.
That means some vaccines are sitting in freezers at hospitals and clinics because the local pool of currently eligible people isn’t big enough to use the supply, according to local health officials.
“Our area was very fortunate to get an early jump on vaccinating our first phase,” said John McReynolds, CEO of North Valley Hospital in Tonasket. The hospital is one of three approved vaccine recipients in Okanogan County, and has received about 3,900 doses of the Pfizer-BioNTech vaccine since mid-December.
As of Monday (Jan. 11), the hospital had given 925 doses, and sent 1,675 doses to other facilities in eastern Washington, leaving it with about 1,465 doses, McReynolds said.
“There has been an incredible level of cooperation and partnership to make sure we tackle the Phase 1A group throughout the county,” McReynolds said. Under state guidelines, Phase 1A provides for two groups, A1 and A2, which include front-line health care workers, first responders, people working in health care facilities, and residents and staff of extended-care facilities. Those are the only people in Washington currently approved to get vaccinated.
“It is frustrating to have vaccines and capacity that could be used more broadly, but the state Department of Health needs to balance equitable access and speed of delivery,” McReynolds said.
The Department of Health (DOH) released guidance last week on future phases of vaccinations in Washington. The next eligible group in Phase 1 — called B1 — would include people 70 or older, and people 50 and older who live in a multigenerational household (two or more generations). That phase is expected to begin by the middle of January, according to DOH, but had not begun as Tuesday (Jan. 12).
John McCarthy, who retired on Jan. 1 as health officer for Okanogan County Public Health, expressed frustration that people outside of the 1A and 1B categories can’t get access to vaccines that are not being used.
“The longer it sits in the freezer, the longer it’s doing the community no good,” McCarthy said at a meeting of the Okanogan Coalition for Health Improvement on Dec. 31. He urged creating a “queue” so that if all eligible people in one phase have received a vaccination, the vaccine would be made available to others outside that phase.
“Quite a few (county) residents are asking if they can get the vaccine now, even though they don’t qualify under Phase 1A, and we’re unfortunately not able to do that,” said Jennifer Best, a spokesperson for Three Rivers Hospital in Brewster. Three Rivers Hospital has received 400 doses of the Moderna vaccine, and anticipated another 100 this week. As of Monday, it had given 175 vaccinations, Best said.
“Last week, the Department of Health reiterated to hospitals the importance of adhering to the timeline they’ve laid out. It’s hard for us to turn away people who are high-risk but don’t fall under 1A, but I think nearly every health facility with the vaccine is encountering this issue,” Best said.
Urban areas like Seattle have large hospitals and medical centers with thousands of health care workers that qualify for vaccinations in the current phase. But that is not the case in rural areas like Okanogan County, with small public hospitals and limited medical facilities. DOH, however, is requiring that vaccination guidelines be followed uniformly across Washington.
“We have far fewer 1A category people than the urban areas, so while we’re still capturing people in 1A, we’re also waiting for the more populated parts of the state to get further along in this phase before we can all move on to the next one,” Best said. “The DOH has asked hospitals with extra, unused vaccine to send their supply to areas in greater need, she said.
McReynolds said Three Rivers Hospital has followed DOH’s request and has sent some of its vaccine to other facilities in eastern Washington.
“We’re in a unique situation in Okanogan County where we … have more vaccines and available capacity to give the shots than we do eligible individuals. To ensure we are ethical stewards of this opportunity we have shared vaccine out of the region to support other areas getting the 1A individuals vaccinated as quickly as possible,” McReynolds said.
“We’ve sent vaccine to Wenatchee, Ferry County, and the Tri-County Health District (Colville). We’ve retained enough to ensure everyone gets their second dose, and any A1 or A2 people that haven’t signed up can still get immunized,” he said.
North Valley Hospital must receive authorization from DOH for every transfer of vaccine. The Pfizer-BioNTech vaccine must be kept frozen at ultra-cold temperatures of minus 94 degrees Fahrenheit, so mobile temperature trackers and data loggers are used to ensure the vaccine is protected during transport, McReynolds said.
Family Health Centers, headquartered in Omak, has received 600 doses of the Moderna vaccine, and has used it for internal and county health care providers and first responders, as well as at the Harmony House nursing home in Brewster for staff and patients, said James Wallace, chief health officer for Family Health Centers and for Okanogan Public Health. He estimated that Family Health Centers has given 120 vaccinations as of this week.
Covering Phase 1A
Hospitals and clinics that have the vaccine have worked together to provide “nearly all eligible and willing Phase 1A workers with at least the first dose of vaccine, and some have begun receiving their second dose,” Wallace said. The Pfizer-BioNTech vaccine requires two doses three weeks apart, and the Moderna requires two doses four weeks apart.
“At this point we can increase our advocacy to move from Phase 1A to Phase 1B of the Washington DOH vaccination plan, to vaccinate a broader segment of our population,” Wallace said. County health officials need to continue providing access for eligible people, along with education on vaccine safety and effectiveness “to overcome some remaining hesitancy to get vaccinated.”
Many residents are far from hesitant, and are keen to get vaccinated as soon as possible, health officials said. “Some members of our team spend all day fielding calls and responding to voicemails,” said Best.
“Many people view this as the beginning of the end of the pandemic,” McReynolds said. “They want the shot as soon as they can get it.”
North Valley and Three Rivers hospitals and Family Health Centers are preparing to move into Phase B1 as soon as the state gives permission. Both hospitals are providing information on vaccination phases and developing online registration forms on their websites that will allow people to sign up to get vaccinated when they become eligible.
“A registration form and waiting list will be launched for Phase B1 this week, and we have a staffing plan to be able create up to 700 appointment slots per week,” McReynolds said. The hospital is currently giving 30-60 shots a day and has the capacity to do more, he said.
Family Health Centers is “generating lists for future phases with regard to age and medical comorbidities,” Wallace said.
Future vaccination phases after B1, as described by DOH, are:
• B2: High-risk critical workers 50 years or older who work in a variety of congregate settings including agriculture; food processing; grocery stores; K-12 (educators & staff); child care; corrections; prisons, jails or detention centers; public transit; fire; law enforcement
• B3: People 16 years or older with two or more co-morbidities or underlying conditions
• B4: High-risk critical workers under 50 years who work in certain congregate settings (see B2); people, staff, and volunteers in congregate living settings, including correctional facilities; group homes for people with disabilities; people experiencing homelessness that live in or access services in congregate settings
DOH has created an online tool called “Phase Finder” that allows people to assess their eligibility for a COVID-19 vaccine. It is being tested and is expected to launch on Jan. 18, DOH said.
Washington’s vaccination plans could be impacted by an announcement Tuesday (Jan. 12) from the Trump administration, calling on states to immediately expand the pool of eligible people to anyone 65 and older and to anyone with underlying health conditions that make them more susceptible to COVID-19.
In a press briefing Tuesday, Health and Human Services Secretary Alex Azar said the administration would stop holding back vaccine for a second dose in order to speed the pace of vaccinations. While the decision about who is eligible to get a vaccine is up to states, many, like Washington, have followed guidelines recommended by the federal government.