Is Bureaucracy Causing Federal-State OWS Vaccine Confusion?

Is Bureaucracy Causing Federal-State OWS Vaccine Confusion TrialsiteN

On January 19, ProPublica took a look at, “How Operation Warp Speed Created Vaccination Chaos.” Noting that many states are required to put together their vaccination plans with only a week’s notice regarding the number of doses they will be getting from the federal government, the authors also reported that the, “incoming Biden administration is deciding what to do with this dysfunctional system.” Meanwhile, clinics across the nation are canceling vaccinations due to the Trump administration advising states of their vaccine allotments “only one week at a time, making it all but impossible to plan a comprehensive vaccination campaign.” General Gustave Perna, OWS’s chief operating officer, made this decision as he did not want to rely on supplies that were not known to be ready.

Fluctuation Doses, Frustrated Officials

State official report that the fluctuating shipments have led to some chaos, including an inability to use up the doses received while they are still fresh. And the week-by-week system complicates the planning for necessary second doses required at three to four weeks after the first vaccination. “It’s a huge problem. When you’re setting up clinics and registration systems, you have to have some idea of the supply,” offered Lori Freeman, CEO at the National Association of County and City Health Officials. “If you’re starting and stopping all the time, it can lead to confusion in the community — they’ll think you don’t know what you’re doing.” One the Biden front, members of his team have made it clear that they know the distribution has been a problem, and they have set a goal of 100 million in vaccinations in 100 days. Virginia has reported not only week-to-week variations, but also day to day changes. Dr. Danny Avula, the COVID-19 coordinator for Virginia reported that in the middle of last week that it could get 80,000 doses, but for unknown reasons the shipment went up to 106,000 doses by Thursday. This has made it difficult to, “give local health providers consistent information about how many doses they’ll receive at their clinics and hospitals….” Dr. Marcus Plescia who is chief medical officer at the Association of State and Territorial Health Officials, opines, “States don’t know what they will get week to week—-The locals get frustrated with states, thinking the states have all this information, but the states are in the same position as the locals.”

Confusing Process

OWS has left it to states to actually hand out vaccines, and this relates to the early Trump administration plan of passing responsibility to the states during the early pandemic. Many feel the root of the current problem is that the system was fashioned around weekly shipments, and Perna has said, “he set up the system this way because he wanted to act on only supplies in hand, not predictions.” He goes on, “Every week I get an update, I know exactly what has been approved by the FDA for final distribution—–I will not allow those estimates to go forward for speculation because I want people to focus on what is actually available.” Pfizer and Moderna are both slated to supply 100 million doses by the end of March, but given that only 31.2 million doses have been delivered as on January 15, the two firms will need to boost production in order to meet their goals. They report that the feds give them weekly or daily updates on production numbers per their contracts. Then OWS takes this total and divides them up among the states. State-by-state allocations are plugged into “Tiberius,” a software system built for the government by the data firm Palantir.

One Day’s Notice for 60,000 Doses

And the allocations are not final. Adjustments can lead to daily changes, and “the system subtracts out doses that are set aside for long-term care facilities which are administered by Walgreens and CVS” in addition to making “any corrections from the prior week, including doses that weren’t ordered by states in previous weeks, or doses shipped to states accidentally that CDC needs paid back.” Then a maximum order “cap” is formulated for the week and placed into a different system, VTrckS. In December Perna apologized when states got fewer doses than he had led them to expect. At the time he said it was a one-time mistake due to changing the day of the week for vaccine releases. “This is a herculean effort and we are not perfect,” he offered. “It looked very good on paper. Paper plans are very good. Execution is where we learn and we adapt it.” Yet the issue of unpredictable metrics has continued, “as states continue to grapple with last-minute adjustments to their allocations.” In one example, Michigan was told it would get 62,400 doses of Pfizer’s product this coming week, and then on Wednesday they were informed they would be getting another 60,000 doses of the Moderna vaccine. So, the health department had only one day to determine how to allocate the extra doses.

Government Failing to Take Responsibility?

In the layers of infrastructure for the vaccines’ distribution, state are in charge of how to allocate their doses to specific vaccination sites, and they normally have about two day to determine this. Local government gets its allocation numbers on Tuesdays, and then each must submit an order by VTrckS by Thursday and shipments come in the following week. The second dosses are ordered on Sundays to further complicate the issue. “For the past three weeks, jurisdiction allocations have remained relatively steady around 4.3 million total doses (or just over 2 million first doses) of both Pfizer and Moderna, which has provided additional predictability,” HHS said. “Operation Warp Speed is committed to providing as much planning time as possible, while balancing manufacturing schedules and maximizing doses available.” With President Biden inaugurated Wednesday, stakeholders are hoping for improvement and clarity, according to an unnamed insider. “The government can point at the manufacturer, but it’s like asking the [Defense Department], ‘How many planes do you have?’ and them saying, ‘I don’t know, ask Boeing,’” the person said. It is key that the government know the number of available doses at any time and also “how many are coming through the pipeline.” The anonymous commenter added, “How can this not be known?” he asked. “It’s the most basic question.”