Pa. had suburban vaccine distribution plans for years. Why didn’t Gov. Wolf use them for the coronavirus? | Maria Panaritis
The rocky COVID-19 vaccine rollout in Pennsylvania skirted plans that four counties outside Philadelphia say were ready to go for their 2.5 million residents.
The plans are there. On shelves across the collar counties of Philadelphia. Local emergency and public health officials even ran multiday drills in recent years to practice them in the event of a mass-scale medical emergency, including a pandemic. They’re on file with the state Department of Health, and the U.S. Centers for Disease Control and Prevention financed their creation and continual updating.
I’m referring to emergency vaccine distribution plans. Medical countermeasures (MCMs), in technical parlance. They are hyperlocal. Tailored to get medicine in large quantities to the residents of these counties, based on how the counties themselves understand it should best be done.
This was supposed to guide how, in theory, a suburban region of 2.5 million people, accounting for one-fifth of Pennsylvania’s population, was to be inoculated under crushing conditions.
It is not, however, how the state, or federal government, chose to proceed.
Conversations with frustrated local emergency and public health officials over the past week brought to light these MCMs. They told me the plans include a distribution roadmap identifying sites where vaccines could be dispensed in mass quantities.
The plans factor in what the greatest barriers may be for residents of those counties. The plans have not been fully activated because of the state’s refusal to send enough vaccine from the federal government directly to the counties themselves to then redistribute. Instead, the state continues to disperse vaccine through a vast matrix of providers.
Many suburbanites in Bucks, Chester, Delaware, and Montgomery Counties have been scrounging for months to get vaccine appointments. Local officials now say that they could have taken on much more vaccine and distributed it through partnerships they built over many months last year while trying to respond to COVID-19 with local hospitals and others.
Instead of pushing vaccine to counties, the state Department of Health and Gov. Tom Wolf have essentially been reinventing the wheel. Trying to figure out how to get vaccines out the door their own way. On Friday, the governor described doing this, in part, with four elected lawmakers he recently named to a vaccine task force from far-flung corners of this vast commonwealth.
For MCM plans to work as designed, the state would have had to push vaccine to counties directly, and then let the counties redistribute them to other providers. Counties, in turn, would have pushed the vaccine into people’s arms where they live: with sites at elementary, middle, and high schools, at community colleges, hospitals, and through employers of large workforces.
The lack of county-level control has meant no one seems to have a handle on who, exactly, has been vaccinated in the four months since medicines hit the market. Local officials gripe of a detached-from-the-ground state approach as problems in suburbia have intensified.
One official told me Wolf’s decision this month to send the single-shot Johnson & Johnson vaccine to state-controlled sites in counties for teachers was not ideal. J&J could have been better directed to hard-to-reach populations — poorer residents, elderly residents — while the two-shot Moderna and Pfizer could have been given to more mobile and tech-savvy school workers.
Even the governor’s announcement Friday, that he and his task force had brainstormed six regional mass vaccination sites for unnamed locations at some point in the future, was a head-scratcher.
Why not just send more vaccine right to the collar counties?
“I definitely think Pennsylvania could use more than six regional sites,” said State Rep. Mike Zabel, whose district includes hard-hit-by-COVID-19 eastern Delaware County.
“If you put a regional clinic in Delaware County,” said State Sen. Maria Collett of Montgomery County, with the same skepticism, “people in Bucks and Montgomery, they’re as out of luck as they have been all along.” It can take an hour or more to drive from one county to another.
“If we take the next few months to get this right, what’s the cost to these communities?” said Tim Boyce, director of Delaware County’s Department of Emergency Services, as I eyed the MCM binder in his Media-area office last week. People are dying in Delco, he said, and should not be sacrificed to trial and error.
“Why hasn’t this response been more coordinated in the way that we have practiced? I mean, we practiced this,” Montgomery County’s Office of Public Health COVID-19 Mass Vaccination Incident commander Megan Young told me. “We are federally required, every five years per the terms of our funding, to practice a full-scale MCM response, including the distribution of medical countermeasures. So why are we not activating what we’re practicing?”
Everything began to go sideways, it seems, in October. The U.S. Department of Health and Human Services under President Donald Trump announced it had entered into a contract with pharmacy chains CVS and Walgreens so they, and not localities, would vaccinate people in long-term care facilities.
This pumped vaccine into nursing homes in Pennsylvania in a way that left county officials uninformed about what doses were coming and who was getting them. The approach sidestepped MCM plans that would have let counties do that job. As recently as 2019, Montgomery County had rehearsed in a five-day drill how to disburse pills in the event of an anthrax attack.
Local officials told me they could have tweaked their plans to handle refrigerated COVID-19 vaccines with a few weeks’ lead time from the state. They had been working all year to secure pandemic testing and had partnerships in place they would have leveraged — even Delco, without a full health department in place. But state health officials did not inquire. They followed the feds’ lead in October and expanded it to include retail pharmacies for regular folks this year.
“Beginning last year, Pennsylvania Department of Health decided to take its cue from the White House’s plan to get vaccine to people by building a network of trusted local vaccine providers,” Health Department spokesperson Barry Ciccocioppo said in an emailed statement. “In the long-term, this strategy will help Pennsylvanians overcome vaccine hesitancy because when supply exceeds demand, all of the trusted local providers will have ample supply and be able to answer any questions people might have before making the decision to get vaccinated.”
County health officials do not know who has been vaccinated under that long-term-care-facilities approach, and state Health Department officials say that even they do not have a complete view of that data.
Nor do county officials or local health departments know who has been vaccinated by pharmacies.
Recently, and on a small scale, modest boosts in vaccine doses to counties have allowed some MCM sites to open, such as at Upper Darby High School this past Sunday.
The county had gotten enough extra Moderna doses from the state that it opened the first of the many schools in its plan, finally, Boyce said. People lined up at 10 a.m. for 1,250 shots that county officials had gratefully received.
» READ MORE: In N.J.’s long-term care facilities, only half of staff have gotten vaccinated. Pa. doesn’t have the numbers.
The Montgomery County MCM plan has 16 such locations, known as “open” pods, or points of distribution. Only two, at the community college and at Norristown High School, are up and running because of insufficient vaccine from the state.
The state Department of Health “sets an allocation of vaccine. They know which counties have MCM plans that can handle distribution for their entire population,” Montgomery County’s Young said in frustration. “We have a plan that serves 830,000 residents. So give us the vaccine and we can do it. ... They have a level of accountability here.”
The Health Department would not field questions from me by phone. Spokesman Ciccocioppo wrote, however, that “none of those plans could have addressed the scale, duration, and complex nature of the COVID-19 global pandemic. This response — including vaccines requiring ultra-cold storage, multiple different vaccines being authorized at different times, and phased prioritization set by federal partners — unfortunately did not mesh well with previously established planning assumptions.”
It seems as though a different set of assumptions may have been at play here as well. The state did not determine what its counties, and what the local health departments in the state, could actually do.
“The question before partnering with pharmacies should have been, ‘Dear Health Departments who cover 43% of the commonwealth population: Are you equipped to handle these vaccines?’ ” Chester County Health Department Director Jeanne Franklin said Sunday.
“We are,” Franklin continued. “We were. We were never asked.”