On a recent Saturday morning, Peggy Hoon got behind the wheel of her 2011 Toyota RAV4 and made the 300-mile drive to Charlotte from her home in Raleigh.
After weeks of waiting on hold or hearing about the COVID-19 vaccination events, only after they were full did the 65-year-old Wake County resident finally get a chance. She considers herself lucky and is concerned about equality issues that prevent other seniors from finding doses of the costly vaccine.
State officials say the main barrier to vaccine rollout is lack of supply. But the NC Watchdog Reporting Network found that in some cases health professionals are administering doses to people who are not yet eligible, according to NC Department of Health and Human Services guidelines.
And that means that people like Hoon, among those most at risk of serious injury or death from the disease, are waiting.
“That’s taking a vaccine away from someone that could really make a difference if they get COVID instead of the person getting it through the back door,” Hoon said.
Under the DHHS guidelines, only Group 1 – health professionals and long-term residents and staff – and Group 2 – people 65 and older – are eligible for the vaccine. When a young person jumps the line for an older person with higher risk factors, the result can be literally deadly. Those aged 65 and older represent only 14% of all COVID-19 cases in the country, but 81% of all deaths, according to data from the Centers for Disease Control and Prevention.
The reporting network found that speed and fairness are at odds, a problem exacerbated by the rapidly expiring nature of the vaccine and the near-impossibility of monitoring every vaccine clinic.
In short, the vaccine distribution system works largely according to the honor system, and a few have taken advantage of it and endangered the health of other North Carolina people.
Millions in need; still limited doses
At least a dozen people under the age of 65 were vaccinated in Ashe County. The staff at AppHealthCare, the health department of three counties that Ashe falls under, took doses of vaccine to give outside the office.
The NC Watchdog Reporting Network confirmed that dozens of doses of anti-protocol vaccines had been taken from the health department. A department spokeswoman repeatedly refused to confirm details of who took the vaccine doses and where they were going.
Initially, a health department spokeswoman dismissed the absentee vaccinations as an attempt to discard the leftover doses at the end of the day.
“Our staff has used up to 10 doses on several occasions, while one vial of 10 was not used and was about to expire,” AppHealth spokeswoman Melissa Bracey told the network in an email last Wednesday.
But she followed up a day later, after the network questioned DHHS about the situation, saying the local health department was now investigating.
A week later, Bracey said in an email that the department’s investigation found that a total of 40 doses of vaccine had been given outside of the agency’s protocols, and 13 doses outside of Groups 1 and 2, but did not explain how.
Clinics in the state and the country have been ordered not to let any vaccine go to waste, even if it means that a younger person needs to be given a dose.
There are other examples of skirting board regulations:
In New Hanover, all provincial commissioners were given a vaccine following a Jan. 13 commission meeting, despite the state still in Group 1.
In Chapel Hill, two UNC basketball coaches were given the vaccine.
In Charlotte, Atrium Health has scheduled appointments for non-health workers.
In Durham, some sheriff’s deputies were vaccinated, the Durham County Department of Public Health confirmed. A spokeswoman said they had scheduled appointments according to previous vaccine priority guidelines and were allowed to keep their appointments after the guidelines were changed
In almost all cases, spokespersons for those administering the vaccinations had, in their opinion, valid reasons for not following the state guidelines to the letter of the law.
Vaccinations against the coronavirus in NC
A New Hanover County spokesman said commissioners got the vaccine because of extra doses, and later said they were vaccinated because of their position as elected leaders.
“Commissioners are leaders in this community, chosen by our constituents to run New Hanover County, and we are all vaccinated in our capacity as public service and not as private citizens,” said Chairman Julia Olson-Boseman. “I definitely want to keep every person on the board as safe as possible as they are asked to meet in person as a group and go out in the community to do the work that the people have chosen us for.”
State and local health officials say those cases are the exception, not the rule. The main reason seniors looking for a vaccine cannot find a place in the queue is simply due to the scarcity of vaccines.
“We have millions of people who need it, but only thousands of shots,” said Governor Roy Cooper at a recent news conference.
Groups 1 and 2 together form about 1.7 million people. To date, the state has received only 1.4 million first doses, and not all have arrived in the state. People aged 65 and over account for more than two-thirds of all first doses administered, a figure that does not include the vaccination program for staff and residents of long-term care facilities.
The need for cold storage requires doses to be used quickly, and many of the vials even contain an extra dose beyond what was planned. The CDC and state health officials have strongly urged clinics not to waste absolutely no doses, but that doesn’t let the clinics know exactly how many doses they can give.
“Some providers have put in place watch systems, which sometimes require people to wait outside in line,” said Julie Swann, NC State University’s chief of industrial and systems engineering, who analyzed the public health implications of COVID-19. “And the people who might be best suited for that could be younger populations who can stand out when it’s cold or rainy.”
What to do with tens of thousands of ‘leftover doses’
Analysis of DHHS data shows that more than 60,000 remaining doses have been administered in North Carolina. But even those should not be out of the order of priority according to DHHS guidelines.
“Leaving a priority order should be a very unusual circumstance. It shouldn’t be the thing that happens every time,” said DHHS Secretary Dr. Mandy Cohen. “But we don’t want vaccines to be wasted, so we recognize that there are some places where we want to make sure we get vaccine in the arms and don’t waste it.”
Health systems in the Triangle say they have implemented backup plans to distribute extra doses fairly.
Dr. David Wohl, an infectious disease expert at the University of North Carolina who oversees the distribution of vaccines at the Friday Center, described what they call “ power hour ” around 4 p.m., when hospital staff estimate how many doses they are taking. end of the day and how it can best be distributed.
Vaccine tracking has gaps in reporting, monitoring
In some ways, clinic staff trust people to be honest about their eligibility. Staff have been overworked for a year and it is not their responsibility to monitor those seeking a vaccine. Wohl said his staff are trying to verify their eligibility, but acknowledged that they rely at least somewhat on patients’ self-identification.
“But I would tell you that the vast majority of the people we see here don’t cut them,” Wohl said. “These are people coming in with walkers, in wheelchairs, you know, walking sticks. We’re reaching the right people.”
In the long-term care program there is less disclosure that could reveal violations of the protocol. The federal government contracts directly with Walgreens and CVS to distribute vaccines in long-term care facilities. Spokespersons for both pharmacy chains said individuals should “attest” to their suitability. In most cases, individuals are asked for an ID card to confirm their identity, but that doesn’t necessarily prove eligibility for people under the age of 65.
Likewise, the state’s DHHS leaders have said they do not monitor the thousands of individual vaccine recipients that have entered the state’s computer system.
In December, Atrium Health in Charlotte planned to vaccinate workers who did not work in health care. In response to the public outcry, the hospital said the state had approved the workers who received the vaccine.
But DHHS said that was not true.
After news of the hospital’s planned employees broke out of turn, government officials contacted Atrium and dozens of appointments for non-health workers were canceled.
This story was jointly reported and edited by Laura Lee and Frank Taylor of Carolina Public Press; Tyler Dukes, Adam Wagner and Jordan Schrader, from The News & Observer; Nick Ochsner of WBTV; Michael Praats from WECT; Ali Ingersoll and Travis Fain from WRAL; and Jason deBruyn from WUNC.