As Pat Kaczmarek walked through Providence St. Vincent Medical Center in Washington County recently, she was startled to see a COVID-19 vaccination clinic underway.
Through the glass windows, she said she saw only clinic workers standing idly by. No one, it appeared, was in line to receive the vaccine.
Kaczmarek works at a grocery store and is at greater risk of coronavirus complications due to her age, 66.
Kaczmarek said she tried to make a vaccination appointment but was told no: Only healthcare workers – none of them in sight – were eligible.
The rejection stung even more knowing the state had most of last year to plan for the rollout of the vaccine, yet only about 25% to 30% of the sought-after vaccines shipped to Oregon by the federal government have made it into the arms of eligible recipients – with the rest sitting unused in industrial freezers and refrigerators across the state.
“I just feel like it’s an opportunity for more people to die,” Kaczmarek said. “We’ve been waiting for nine months for someone, anyone to get this. For there to be this backlog, it’s just ridiculous. I’m incensed.”
Kaczmarek is among the ranks of Oregonians who’ve grown increasingly angry as hospitals, health systems, pharmacies and other recipients of vaccine shipments struggle to inoculate the first wave of up to 400,000 residents eligible in Phase 1a, which mostly includes healthcare workers and people living in long-term-care facilities.
The state is already well behind its vaccination schedule outlined last month, and Oregon’s initial rollout has been plagued with ineffective planning, inconsistencies about who is eligible and infighting among some about who should be next and how to speed up inoculations.
Those on the outside wonder if the weeks-long delays today will turn to months-long delays later as the rest of the state’s population waits its turn in line.
With an average of 12 Oregonians, and more than 3,000 Americans across the nation, dying daily from the disease, time is precious.
The initial elation and excitement of the vaccine’s Dec. 14 arrival has transformed into worry and uncertainty as numerous cracks in the system emerged. Among them:
- Some large hospitals and health systems say they moved slowly from the start because they received virtually no training or support from the state on how to roll out highly complicated vaccination drives for their workers, with shipments essentially dropped off and staff left to figure it out on their own.
- Inoculation rates vary widely by hospital system, and state officials are only now beginning to fine-tune shipment schedules to ensure that some institutions aren’t receiving much more than they can currently use. Oregon Health & Science University has used more than 70% of its available vaccines and Providence Health & Services nearly 60%, while Legacy Health and Kaiser Permanente are at only 26% and 31% respectively. At least one health system, Salem Health, received more vaccine than it needed to inoculate its entire staff with a two-dose regimen.
- Hospital systems have interpreted the state’s eligibility guidelines unevenly, with some offering vaccines to healthcare administrators, IT technicians or marketing employees who work from home while counterparts at other institutions, including Kaiser and Legacy, were left seething because they hadn’t been vaccinated yet. Some of those still waiting were frontline healthcare workers.
- Health care providers in many smaller clinics, medical or dental offices have been given no vaccine – even though their staff regularly interact with members of the public or directly treat COVID-19 patients. The state has been slow to roll out vaccination sites where doctors, nurses, dentists, hygienists and first responders not associated with major hospitals or health systems can get inoculated, and one that popped up late last week in Salem has been turning away workers who don’t live in Marion County.
State leaders say they’ve never planned such a massive and complicated vaccination campaign but are learning rapidly. They’ve acknowledged an initial decision to only allow frontline healthcare workers and residents of nursing homes to receive the vaccines was too restrictive and was slowing down the process, and they’ve since authorized vaccinations for anyone in the wider Phase 1a wave.
Oregon Gov. Kate Brown has set a daily goal of 12,000 injections by mid-January — nearly triple the roughly 4,300 doses averaged each day over the past week. She’ll tap the Oregon National Guard to help starting next week.
“We’re working as hard as we can,” Brown said Friday. “We are using every single tool in the toolbox. And it’s certainly an all-hands-on-deck moment for Oregon to get as many vaccinations completed as quickly as possible.”
Frustrations boil over
Both inside the healthcare system and out, many workers and residents interviewed by The Oregonian/OregonLive said they’ve seen firsthand how the state’s inadequate planning and direction led to a system of haves and have-nots.
Problems began in December soon after hospitals received their first shipments of vaccines.
A registered nurse at OHSU said the rollout at the facility was mired with confusion. She said that the unit where she works, where she comes into contact with multiple patients a day for extended periods of time, was initially overlooked for vaccinations and workers had to press for transparency about the timeline.
The nurse received her first shot but has lingering concerns over what will happen when the vaccine becomes available to people beyond the healthcare system.
“If this is how it’s going to be when they go to the public, it’s going to be a nightmare,” said the nurse, who requested anonymity for fear of reprisal.
OHSU later faced scrutiny on the opposite end of the spectrum as some grumbled the hospital system had vaccinated people with little to no risk of exposure ahead of people who reported to campus every day. A top executive reminded workers they were “not owed a vaccination” by the hospital.
“For many of us, it is an extraordinary privilege to be vaccinated far ahead of others who really need it,” Peter Barr-Gillespie, an executive vice president, wrote in a Jan. 5 email obtained by The Oregonian/OregonLive. “Think of teachers, transit workers, grocery store clerks, or those working in close quarters in manufacturing plants.”
Dr. Maureen Mays, a private primary care doctor with a small practice in Northwest Portland, is among those who haven’t been vaccinated.
She said she’s currently treating two COVID-19 patients and has no idea when she or her staff will get inoculated.
“I basically don’t count. Because I’m tiny,” she said of her 165-patient practice.
Mays said she’s dismayed and frustrated by news that administrative staff, billing representatives and people who don’t treat any patients but work for large hospitals or health systems have been immunized.
Like Mays, other professionals such as mental health counselors, dermatologists and dentists also have been waiting.
One Hillsboro dentist found irony in the state’s decision to stage a choreographed event Dec. 16 at OHSU celebrating the first coronavirus vaccine administered by a dental resident, for the first time in U.S. history, due to newly granted powers by the state.
“That’s fantastic,” said the dentist, who sees about 100 patients per week and asked for anonymity out of fear of retaliation from the large hospital networks that provide dental supplies.
“Yet our profession is not prioritized enough to get the vaccine early, and …you want us to help administer it.”
The lack of coordination and consistency has puzzled even people who’ve successfully obtained the vaccine.
After a Portland-area lawyer learned last week that his healthcare provider authorized vaccinations for anyone in Phase 1a — which includes not only healthcare workers and nursing home residents but also staff who work with jail and prison inmates — the lawyer made an appointment and got vaccinated two hours later.
The lawyer, who requested anonymity for fear of retribution, said he only had to provide his name and insurance information – no photo ID or proof of his occupation. He also told them he has contact with jail inmates he represents.
After returning to the office, he shared his experience with coworkers and one told him that employees at a dialysis center had yet to receive their vaccinations.
“While I deceived nobody, and everything is on the up and up,” he said, “there’s something there that doesn’t seem right.”
What went wrong?
Many critics say the federal government failed to develop the infrastructure to administer the vaccines and instead left the monumental task up to states and their overwhelmed public health departments, reminiscent of the nation’s testing and contact tracing woes earlier in the pandemic.
Dr. Anthony Fauci, the federal government’s top infectious disease expert, noted the rollout of the vaccines just before the holidays also was unfortunate timing. In Oregon, only 13 people were pricked on Dec. 25, compared to the several thousand on most of the days before and after.
Employees of some hospitals and health systems say a big part of the problem has been the lack of instruction, training and support from the state — that each of them had to build a system from the ground up. And with staffing already stretched thin because so many employees are consumed with
daily duties of treating a surge in COVID-19 patients, finding enough employees to run their vaccination clinics has been taxing.
Several hospitals or health systems declined to comment. Becky Hultberg, president of the Oregon Association of Hospitals and Health Systems, said became clear about two weeks ago that everyone from first responders to in-home caregivers and doctors and nurses in private practice had little to no access to vaccinations – and that hospitals and health systems would need to fill the gap.
“We don’t know yet how we’re going to pay for this, but it’s too important to wait,” Hultberg said.
Hultberg said hospital systems aren’t focused on placing blame, rather they only have one mission right now: Increasing vaccinations.
“We will have plenty of time to go back and debrief on this to figure out how we could have made decisions differently,” Hultberg said.
State officials concede that they didn’t adequately plan vaccination clinics where healthcare workers who aren’t associated with hospitals or health systems could go to get immunized.
Dr. Dana Hargunani, chief medical officer of the Oregon Health Authority, announced last week that the state plans to fix that by asking pharmacies, such as Walgreens and CVS, to start vaccinating independently practicing healthcare workers who haven’t had anywhere else to go. Shipments are scheduled to start arriving this week.
“We’re making adjustments and adaptations as we learn,” Hargunani said.
When asked how he thought the state’s vaccination rollout could have been improved, Patrick Allen, director of the Oregon Health Authority, said the state was too stringent in directing hospitals and health systems to only offer doses to a very limited group of frontline healthcare workers at first.
That made filling all available appointments — and swiftly administering shots — challenging. Last week, he lifted the restriction, saying all healthcare workers and others in Phase 1a are now eligible for COVID-19 immunizations.
Allen, however, doesn’t fault his agency for poor planning. He said the Oregon Health Authority expected complications but could only identify precisely what they were once the vaccination effort launched.
“I’m not sure I want to buy the premise that we’re behind,” Allen told The Oregonian/OregonLive.
Allen also disputed that he’d set a goal of reaching 100,000 inoculations by Dec. 31.
But in a recorded, live-streamed news conference on Dec. 22, Allen said: “In total, by the end of this month … we continue to remain hopeful our hospitals and other partners can administer first doses to approximately 100,000 people in Oregon.”
By the time Dec. 31 had passed, only about 44,000 Oregonians had received their first dose of a two-dose regimen.
Oregon not alone
States across the country have struggled to vaccinate Americans swiftly. The federal government estimated 20 million inoculations coast-to-coast by the end of the year. But the number Jan. 1 was estimated at only 2.8 million.
According to figures provided by the U.S. Centers for Disease Control and Prevention, Oregon ranks 40th in the number of residents vaccinated per capita, slightly ahead of California but behind Washington.
About 29% of available vaccines in Oregon had been administered as of Friday — or roughly 75,000 of 262,000 doses, according to figures provided by the state and CDC.
But several states have performed much better. Among them are South Dakota and North Dakota, which at points last week led the nation by using up to 70% of their vaccines on hand, according to a tracking site by Bloomberg.
Dr. Tim Ridgway, dean of the University of South Dakota’s Sanford School of Medicine, attributes South Dakota’s performance to good planning and communication by the state’s public health department. The state’s major hospitals and health systems weren’t left to figure out a myriad of details on their own, he said.
“They have just been phenomenal in education and leading the charge,” Ridgway said.
Both Dakotas led the nation in positivity rates this fall, and Ridgway wonders if a sense of urgency also pushed his state and its health systems to develop an effective vaccination campaign.
“I think it shocked the whole country,” he said.
Although the populations of South Dakota and North Dakota are a fraction of the size of Oregon’s, Tennessee’s is larger. Most days last week, officials there used more than 50% of available vaccines.
Dr. Scott Strome, executive dean of the College of Medicine at the University of Tennessee Health Science Center in Memphis, said he thinks his state did “a little bit better than terrible” in vaccinating its first wave of healthcare workers. That’s in part because of a well-planned effort that included tapping a volunteer workforce of medical, pharmacy and nursing students to administer injections, he said.
The first wave has gone so smoothly that Tennessee has opened up immunizations to the next group, people age 75 and older.
That’s six weeks ahead of the Oregon Health Authority’s current estimate for when the next phase of Oregonians will get their turn in line: mid- to late February.
Where does Oregon go from here?
Oregon’s governor’s office has said K-12 school employees and prison inmates will all be a part of that next group, but it’s possible she could add other residents to the list based on the recommendations of the state’s Vaccine Advisory Committee. It held its first meeting Thursday and is expected to send recommendations to the governor by mid-February.
Meanwhile, Washington’s Department of Health has already announced that residents age 70 and older — as well as people age 50 and older living in multigenerational households — should be able to start receiving their vaccinations by the end of January. Essential workers age 50 and older who work in high-risk settings such as grocery stores and K-12 schools could start vaccinations in February and people with underlying health conditions in March. Younger essential workers are expected to be eligible in April.
But Allen, the Oregon Health Authority director, said the timeline for Oregonians is still very uncertain.
He’s uncomfortable with national estimates that the general healthy population of Americans could start getting the vaccines in April and herd immunity could be reached by June. Allen thinks Oregon won’t reach herd immunity, or the point that a critical mass of people become immune and the virus can no longer freely spread, until fall.
“This is going to take a while,” Allen said. “I think it’s been challenging to hear that messaging from us when the federal government has been much more optimistic about its messaging.”
But welcome signs of progress began popping up last week. At the Oregon State Fairgrounds Thursday, Salem Health opened what might be the first large community vaccination site in the state — offering drop-in inoculations for anyone in Phase 1a who lives or works in Marion County. The state plans to shuttle 10,000 doses to the site later this week.
Saturday, OHSU started its first vaccination clinic for 2,000 home health care workers and others who aren’t OHSU employees.
And the governor said the National Guard will play a key role in staffing some of these new vaccination sites, which eventually are expected to start offering immunizations to new waves of Oregonians as they become eligible.
One Portland woman, who asked that her name not be used citing her prominent role with a healthcare organization, said she feels privileged to have made use of Salem Health’s vaccination site.
She said she had been at wit’s end trying to find out when her parents, who live at a long-term care facility in Marion County, would get vaccinated as part of the state’s push prioritizing them as part of Phase 1a.
She hurriedly ferried her 89-year-old mother and 95-year-old father, a World War II veteran, to the pop-up clinic on the first day it opened.
“The sad part though is that my parents are fortunate,” she said. “They have me and my sister looking out for them. I am concerned for all the other people in long-term care that are just waiting.”
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Brad Schmidt, Andrew Theen, Kale Williams and Fedor Zarkhin contributed to this report.
— Aimee Green; firstname.lastname@example.org