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COVID-19 vaccination distribution is moving faster in North Carolina now than in prior weeks, but more than half of the state’s doses remain unadministered — a lag that could harm the state’s ability to receive vaccine doses in the future under new regulations by the federal government.
Under the current state vaccination plan, health care workers and individuals ages 75 and older are eligible to receive the vaccine, but data through Tuesday shows that 72 of the state’s 100 counties used less than 50% of the dose allocations they received.
Of the more than 415,000 first doses distributed to hospitals and health departments throughout the state since mid-December, only about 190,000 doses have been administered, according to N.C. Department of Health and Human Services data.
The slow process could have a negative effect on the future dose allocation to North Carolina by the federal government because U.S. Secretary of Health and Human Services Alex Azar announced Tuesday that, beginning in two weeks, federal allocation will be determined “by the pace of administration as reported by the states and by the size of the 65-and-over population in each state.”
While some North Carolina providers are doing a good job administering doses, others are letting doses sit on the shelf, DHHS Secretary Dr. Mandy Cohen said in her comments to the Joint Legislative Oversight Committee on Medicaid and N.C. Health Choice on Tuesday.
Calling the delays, “not acceptable,” Cohen said her team is reaching out to determine what is slowing the process.
“What is it that’s holding them back?” she said. “Is it staffing? Is it data? Is it just a data lag that we don’t understand? What is it that we can help them with to prioritize?”
Each hospital and county health department manages its own administration of the doses it receives in the state’s weekly allocation. Some providers require appointments, and others allow walk-ins.
Some lawmakers questioned the county-by-county approach. Cohen explained the decision to not create a centralized appointment system.
“Many hospitals and many health departments have appointment systems that they’ve been using for a very long time,” she said. “We didn’t feel like adding another layer to this was going to be something that was ultimately going to be successful.”
The state prioritized distribution to all 100 counties to ensure access to doses for residents across the state, she said.
To increase the speed of vaccine administration, state officials are establishing 10 large-scale “high throughput” sites this week to distribute 45,000 doses. The allocation of those doses comes from the overall allocation to the state, which Cohen has estimated to be 120,000 doses per week for the rest of the month.
“I think that we are going to try to find the middle ground here, which is we want to empower every single county to have access point for vaccination, but we also know we’re going to need to centralize to some high throughput sites,” Cohen said.
Another change in the order?
The federal government also announced a new prioritization order for COVID-19 vaccine distribution on Tuesday, but North Carolina officials are still considering the possible changes.
Azar instructed the states to move individuals 65 and older and those younger than 65 years old with a medically documented comorbidity to the front of the line.
“We’re telling states today that they should open vaccinations to all of their most vulnerable people,” he said. “That is the most effective way to save lives now. And some states’ heavy-handed micromanagement of this process has stood in the way of vaccines reaching a broader swath of the vulnerable population more quickly.”
In a press conference Tuesday afternoon, Gov. Roy Cooper said his administration had not yet made a decision about changing the prioritization.
“There’s been no decision yet for North Carolina about whether we are going to follow the recommendation that we just got a couple of hours ago,” he said. “We want to take time to look at it and talk with our partners, but I think that maybe we would want to do that.”
The initial vaccine plan submitted by the state to the national Centers for Disease Control and Prevention in October prioritized individuals 65 and older with two or more comorbidities. When the CDC changed its recommendations in late December to include individuals 75 and older and front-line essential workers, Cooper changed the state plan in accordance with those guidelines.
Karla Holloway, a professor of English and professor of law emerita at Duke University whose scholarship focuses on race and bioethics, expressed concern about the December change to prioritize 75-and-older populations, noting a potentially disproportionate outcome for nonwhite individuals. Mortality tables show nonwhite individuals are less likely to survive to and past 75 years old, she said.
“With due consideration of the compelling narratives about health inequities and this virus, it would seem that the effort should make a deliberate effort not to contribute to or exacerbate racial inequity,” she said.
Cohen spoke about the disproportionate effects of coronavirus on Black and Hispanic North Carolinians at the press conference, saying that age alone is not sufficient to address the inequities.
“That is why we also wanted to take into account exposure to this virus, particularly for those who are on the front lines of needing to leave their home to go to work and, even when they do that work, can’t be socially distant,” she said.
Cooper said that if state officials determined an alteration in prioritization is needed, they would move quickly to make those changes before the rollout of the next phase of distribution, which is currently set to include front-line essential workers ages 50 and older.
Editor’s note: The story and map were updated to reflect new vaccine data from Jan. 11, 2021 at 11:59 p.m. per NCDHHS. The new data shows approximately 190,000 first doses administered and 72 counties using less than half of their allocations.