‘Like the Hunger Games’ out there: How Florida’s COVID vaccine distribution went haywire
“Sometimes plans don’t work out,” Florida Emergency Management Director Jared Moskowitz said.
Florida had a phased, orderly, step-by-step plan in place for distributing the COVID-19 vaccine to the public, starting with the most vulnerable months before a vaccine was even approved for emergency use.
Following guidance laid out by the Centers for Disease Control and Prevention, the state would focus on long-term care residents, hospital workers at the front lines of the coronavirus battle, workers essential to the running of society, and people with medical conditions that put them at higher risk of getting the disease.
The plan outlined procedures for distribution, inventory management, storage and handling, second-dose reminders, provider recruitment and enrolling, and communication with the public.
More:Gov. Ron DeSantis asking for double allotment of COVID-19 vaccines as momentum picks up
Florida Emergency Management director Jared Moskowitz, who was put in charge of the logistics of distributing the sparse amounts of doses, said at the time, “We have a solid plan.”
Before the first week of vaccinations had even finished, Gov. DeSantis was going off script, pushing for more vaccines to go to elderly populations in nursing homes sooner than scheduled, and excluding folks in other long-term care facilities.
A week later, he was opening up availability to everyone in Florida 65 and over, and going against the recommendations of the CDC by leaving out essential workers.
Chaos ensued as allotments were directed all over the state and accusations of favoritism started flying. Hospital systems and gated 55-plus communities were accused of giving the vaccine to their board members.
County health department websites crashed. Folks couldn’t get through on the telephone. Older Floridians stood in line overnight for hours where counties had decided to offer the vaccine on a first-come, first-served basis.
And seniors who are the intended target of those modifications are angry. They complain they are not able to get information from the state or county health departments and local hospitals.
“Sometimes plans don’t work out,” Moskowitz said during a Zoom conference call Wednesday night hosted by Democratic state Rep. Anna Eskamani of Orlando. “Situations on the ground change.”
A ‘hitch in the giddyup’
The two biggest “situations on the ground” that affected the rollout were beyond the state’s control, Moskowitz said: Getting only a one-week advance notice on the amount of doses shipping to the state, then watching that expected shipment slashed in half.
The confusion and lack of information from state and county health officials has sparked criticism from legislators, seniors and others. But Florida isn’t the only state experiencing a “hitch in the giddy-up,” as Democratic Sen. Linda Stewart of Orlando put it, contradicting DeSantis that the process was going smoothly.
All states have been stymied by a system set up by Operation Warp Speed, the federal government’s nationwide vaccine distribution program.
Instead of helping get the vaccine distributed faster, DeSantis said he’d take allotments away from hospitals and pharmacies that aren’t vaccinating people fast enough. (New York Gov. Andrew Cuomo, a Democrat, went further: He said he’d fine hospitals $100,000.)
“It’s so frustrating to see that the distribution is as botched as the containment of this virus,” said Dr. Leo Nissola, a cancer specialist who works with the COVID Act Now tracking project. “It isn’t a surprise ... honestly, (both) President Trump and Gov. DeSantis downplayed the virus.”
Watching his colleagues debating giving half doses or parsing the dosing schedules is “appalling,” said Nissola, who practices medicine in San Francisco.
“Fining hospitals and providers when the health care system is at a breaking point is tyrannical,” he said. “They are pushing their failures in the logistics of the distribution onto those who worked harder than anyone this (past) year.”
It isn't entirely the fault of state and local health providers, though.
“Thus far, millions of vaccine vials are sitting in warehouses, approved life-saving immunotherapy therapeutics are going unused, while thousands die from the novel coronavirus every day,” Nissola said.
National Institutes of Health Director Francis S. Collins told The Washington Post that the nationwide distribution got off to a “rocky beginning.”
“We had this remarkable plan that (Operation) Warp Speed had put in place to have doses ready to go the very next day after the FDA approval, but that’s a lot of logistics,” Collins told the Post. “So maybe we shouldn’t be too shocked that it didn’t go like clockwork.”
Now, at a time when the state and nation are experiencing a surge in new cases, hospitalizations and deaths, the pressure is on health care workers to immunize as many people as possible in the coming months. That’s even as they start to give the critical second dose, or booster shot, to those who already received their first shot during the first week of the rollout.
And the public is struggling to get answers. USA TODAY NETWORK – Florida examined the COVID-19 vaccination draft plan for Florida, which hasn’t been updated since it was published and submitted to the CDC in October, to figure out where the state strayed and where it stayed on course, and where the best laid plan diverged from reality.
More:'I'll tell you what I know and what I don't': Inside a chaotic COVID-19 vaccine rollout | Column
‘You can’t do any long-range planning’
One of the biggest problems, according to Moskowitz, is that the system set up by Operation Warp Speed gives states a one-week advance on their scheduled allotments.
“Nobody thought we’d only have a seven-day look ahead,” Moskowitz explained. “You can’t do any long-range planning when you can only see as far as next week.”
He said he couldn’t “confidently say the second dose was coming on time.” The “Pfizer Five,” the first five hospitals in Florida to get the vaccine during the first week of the rollout, did get their second doses.
“We want them to get those doses out,” Moskowitz said, explaining the rationale for reallocation. “Vaccines sitting in freezers are not going to end the pandemic.”
Uncertain of those future doses, he said, hospitals have been reluctant to run through their initial allotment, holding some back for those critical second doses.
Also, the state assumed after the second week that it would be receiving around 500,000 doses a week, enough to warrant opening distribution to all Floridians 65 and older even before all the state’s nursing home residents had been vaccinated.
But doses dropped from just under half a million the second week to fewer than 300,000 the third week, and around 250,000 a week since.
“Nobody thought our allocation would decrease 50%,” Moskowitz said, defending the governor’s decision to open up the drug to the senior population, which is responsible for more than 80% of the deaths from COVID-19 in Florida.
It’s reminiscent of the early days of testing, Moskowitz said, when demand outstripped supply: “We are doing our best, working out kinks. We can write the best plan but can’t always anticipate the curveballs.”
A phased allocation
The plan envisioned a phased allocation around the availability of the vaccine. Based on federal guidance at the time, the first groups targeted were health care personnel, essential workers, people with underlying medical conditions that put them at high risk of getting the coronavirus, and people 65 and older.
That’s a big group: More than 1.1 million licensed health care staff, 154,000 long-term care residents, 220,000 long-term care staff, 4.5 million people 65 and over, and tens of millions of essential workers ranging from police and firefighters to utility workers and electricians, teachers and even journalists.
When it became clear that only 2.9 million doses would be available for nationwide distribution, and that Florida would get about 180,000 doses of the two-dose Pfizer vaccine in the first go-round, the CDC recommended giving them to health care personnel and long-term care residents.
Florida further narrowed that to hospital staff that had direct contact with COVID-19 patients, and nursing home residents and staff.
When more doses became available in the second week, and Florida was slated to receive nearly 500,000 doses of both Moderna and Pfizer, the CDC’s Advisory Committee on Immunization Practices recommended the vaccine be offered to people 75 and older, and to essential frontline workers not in the health industry.
The committee also recommended that seniors 65-74, people 16-64 with high-risk medical conditions, and essential workers not included at first be offered the vaccine.
No timeline was offered for when those phases should be initiated, but the state’s draft plan contemplated that the state would expand its offering as more vaccine became available.
DeSantis pushed back against the recommendation to offer the vaccine to millions of essential workers, issuing an executive order prioritizing people 65 and older.
Up until now the state has focused on its 700-plus nursing homes at the neglect of residents of the 3,000-plus assisted living and other long-term care facilities. Those institutions will start seeing vaccine distributed to their residents starting Monday, Moskowitz said.
More:Florida assisted living facilities given OK to schedule COVID-19 vaccinations
Low supply, growing demand
Moskowitz said the state’s vaccine distribution plan is sound and ready to deliver whatever the federal government sends them. It’s really a question of supply available to meet the pent-up and growing demand.
DeSantis triggered that demand when he opened the vaccine to everyone in the general population 65 and over, well before the hundreds of thousands of folks identified for the first round of vaccine had been completely inoculated.
A week after the governor opened the door to some 4.5 million seniors, the federal government cut the state’s allotment in half.
The plan called for a centralized state-coordinated distribution of the vaccine, using as a template the state’s already well-established vaccination program, forged by lessons learned during the H1N1 pandemic, seasonal flu vaccinations and the recent Hepatitis A program.
The state also activated Florida’s immunization information system, called Florida Shots, and is coordinating with hospitals, pharmacies, county health departments and emergency medical service organizations to help distribute the vaccine.
Moskowitz explained that while the vaccine is being distributed through the state health system, it is not being delivered directly to the Department of Health or Division of Emergency Management.
“We are not a pass-through system,” he said. “Vaccinations are being done through the health system, which is locally led. It is a decentralized effort among 67 health departments and over 300 hospitals.”
Getting vaccines through ‘concert ticket system’
Some counties, like Orange County, have done an excellent job registering people for appointments, Moskowitz said. But other counties that created a first-come, first-served “concert ticket system” didn’t do as well, he said, making older citizens either stand in long lines or sit in their cars.
Distribution has fallen short, with about 29% of some 1.15 million doses actually put in people’s arms, Moskowitz said. That’s below the national average of 30.6%.
The decentralization has caused a lack of oversight, with reports around the state of county health departments giving portions of their allotment to gated 55-plus communities while firefighters and police are left unprotected.
To help goose distribution and get more of the available vaccine out, DeSantis has announced deals with hospital systems, the Publix supermarket chain and black churches to get people inoculated.
He’s also ordered Moskowitz to hire 1,000 contract nurses to help with the effort, 800 of whom are already deployed through the long-term care local pharmacy program.
Meantime, teachers, prison inmates and corrections officers, migrant workers, Native American communities, the uninsured and people with developmental disabilities wait for their turn to be put on the list.
“I can’t point to who’s going to be next,” Moskowitz said. “When the vaccine allotment increases, I will be happy to share our thought process then. Right now, it’s like walking and chewing gum at same time.”
With such a low and unreliable supply, an inability to plan more than a week ahead and the high demand, Moskowitz acknowledged, “It’s like the Hunger Games out there.”
ROLLOUT BY THE NUMBERS
First Week — 179,400 doses, all Pfizer
Second Week — 495,000 doses (127,000 Pfizer, 396,000 Moderna)
Third week — 289,000 doses (162,000 Pfizer, 157,000 Moderna)
Fourth Week — 253,000 doses (evenly split between Pfizer and Moderna)
Fifth week — 254,000 doses (split evenly between Pfizer and Moderna)
Total by Dec. 15 — 1.3 million doses (500,000 to hospitals, 500,000 to county health departments, 118,000 second shots in third week, 103,000 second shots in fourth week)
Jeffrey Schweers is a statehouse reporter for the USA TODAY NETWORK-Florida. He can be reached at jschweers@gannett.com. Follow him on Twitter @jeffschweers.
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