More doses, fewer ‘blind spots’: What states say they want from the federal government on vaccines

The COVID-19 vaccine rollout started as a trickle. But the pace has steadily picked up each week, more than tripling in the first month under the Trump administration and reaching President Joe Biden’s goal of 1.5 million shots per day just about three weeks into his term.

But some aspects of the federal rollout plan leave states wanting more.

CNN recently reached out directly to all 50 states to understand any roadblocks or speed bumps they’ve experienced throughout the vaccine rollout. For states that did not respond, CNN also tracked recent public statements by governors and state health department leaders.

States say they’re ready for the floodgates to open — for both physical supply of vaccine and communication from the federal government.

Over the past week, leaders in most states have stated publicly or in interviews with CNN that vaccine supply is the key — or only — holdup to increasing the pace of vaccinations.

In West Virginia, about 14% of the population has received at least one dose of COVID-19, according to the latest data from the US Centers for Disease Control and Prevention, one of the highest rates in the country.

Gov. Jim Justice said he has tried everything to get more vaccine sent to his state.

“Other than me just running up there and sitting on somebody, we’re doing everything — it’s coming from all fronts,” Justice said during a news conference this month.

The same sentiment is true in Alabama, one of five states where less than 10% of the population has received at least one dose.

“Current vaccine supply does not meet the demand of persons desiring to be vaccinated,” Dr. Karen Landers of the Alabama health department told CNN. At least 1.6 million people are eligible to be vaccinated under the current phase of the state’s allocation plan, she said. CDC data shows the state has received just about 1 million doses so far, barely enough to fully vaccinate 500,000 people.

There have been moves to increase doses available and ways to distribute them.

Nationally, allocations to states increased about 16% in the first week of February, and about 5% more each of the two following weeks. On Tuesday, the Biden administration announced it’s again increasing the weekly COVID-19 vaccine supply sent to states to about 13.5 million doses per week, White House press secretary Jen Psaki said. That’s a 57% increase from inauguration levels.

Many providers have been able to squeeze an extra sixth dose out of some Pfizer vials with special syringes, and a new federal program launched last week will bring additional doses into states through pharmacy chains that have partnered with the federal government. Another federal program will bring doses to federally qualified health centers.

But even as the Biden administration aims to increase vaccine shipments to states, officials acknowledged the supply is severely constrained and will likely remain that way for weeks to come. The administration has taken steps to ramp up the supply, such as sending more specialized syringes to states to extract as many doses as possible from vaccine vials and using the Defense Production Act for supplies related to the Pfizer vaccine. But there’s no quick fix for America’s vaccine shortage.

On Tuesday, Dr. Anthony Fauci said on CNN that it would likely take until at least May for vaccine doses to be available to the general public, a delay from his earlier predictions that vaccines could be more readily available in April.

“The critical issue is that the demand far outweighs the supply. That is the issue,” Fauci said on CNN. “We have a good plan how to get the doses into people’s arms, we just need more vaccine.”

‘Unnecessary confusion’ around vaccine data

While the vaccine supply available to states and their residents has grown recently, struggles over communication and data transparency between states and the federal government remain.

Things like the federal retail pharmacy program that launched last week are “still a little bit of a black box,” Dr. Lee Norman, secretary of the Kansas Department of Health and Environment, told CNN.

On Monday, governors of nine states sent a letter to Biden outlining two areas of concern with the vaccine rollout, specifically regarding those federal programs: clearer data reporting by the CDC that distinguishes between state-run and federal efforts and better coordination between them.

In the letter, the governors wrote that “the CDC reporting mechanism has created unnecessary confusion” by summarizing data from multiple programs in a misleading way.

They also warn of “redundancy and inefficiency” if the federal government does not consult with states on plans to distribute to pharmacies and health centers, citing the need for local expertise on the needs and capacity of providers.

“Due to the anxiety created by the demand and supply of the vaccine, it is imperative that the American people fully understand the process,” read the letter from the executive committee of the National Governors Association.

The bipartisan group of governors — from states on both ends of the efficient vaccine administration spectrum — signed.

Officials from at least nine other states expressed similar concerns to CNN, including the need for more visibility and the effects that misleading data reporting can have on public confidence.

Norman of the Kansas health department said the biggest challenge is having the state system talk to the federal system. “Our vaccination program has been extremely successful, but it doesn’t show up that way on the CDC COVID Tracker,” he told CNN.

According to the CDC Data Tracker, Kansas is near the bottom of the list in terms of vaccines administered per capita, but Lee says the gap between the number of doses he knows has been administered and what is published by the CDC can create a “crisis of confidence and accountability in your populace.”

Kris Ehresmann, infectious disease director with the Minnesota health department, also said this discrepancy between data sets is a challenge.

She told CNN, they appreciate that CDC is allocating second doses with plenty of time, “but then those doses get allocated, and they look like they’re sitting around, and we’re not using them.”

“Occasionally data that we submit doesn’t get uploaded and of course that makes us look terrible, and that’s definitely frustrating,” Ehresmann added. “Yet those data are used by multiple news organizations for comparison, so that’s one thing that I honestly did not think that we would be dealing with.”

Frontline staff feel last in line of communication

Multiple states also informed CNN that they had learned about changes to federal programs secondhand through the media or with very little advance notice, leaving them scrambling to adapt.

“I feel like our systems are doing well, but any time there’s a change that comes from the feds without any warning, that really puts states at a disadvantage,” Ehresmann said.

Dr. Lisa Piercey, Tennessee’s health commissioner, said at the start of the rollout, her state sometimes had fewer than 48 hours’ notice about changes to their vaccine supply.

“We have a whole team of folks who they just constantly look at allocations,” to coordinate with hundreds of vaccination sites across the state, only a quarter of which are state-run, Piercey told CNN.

As eligibility opened up to more members of the general public, a wave of interest in early appointment timeslots and preregistration overwhelmed the medical infrastructure in many states, leading to reports of endlessly busy phone lines at call centers and people waiting for hours outside of clinics, some forced to leave without being seen.

Leaders in some states say a little more foresight could have helped that.

The federal government shared a three-week allocation forecast with the state department of health for the first time this month, Kristen Maki, public information officer for the Washington health department, told CNN on Friday. Before then, the state “did not receive weekly allocation numbers until Tuesday morning, making it difficult for our staff, providers and the public,” she said.

Norman said, the longer lead time they get from the federal government, the smoother their state vaccinations go.

“And when something is not smooth or credible, it undermines confidence,” he said. “People are fearful enough as it is, people are frustrated.”

Norman says it’s their job to be good.

To be good “requires consistency of messaging, consistency of performance, and I think with the cadence we’ll get there, we’re just not quite there yet.”

Blind spots coming into focus

And still, states say they are confident in their abilities to vaccinate many more than the current supply allows, especially as communication with the federal government improves.

Keith Reed, Oklahoma’s deputy health commissioner, said as the states try to make “good data driven decisions” about vaccine availability, the lack of federal insight creates “a blind spot that can be pretty frustrating.”

But, Reed told CNN, “bottom line, it has improved.”

“We have a better idea, and maybe that’s just the natural evolution of a very difficult program … more steady production, so that we can anticipate better, or if it’s just that the teams that are helping plan are maturing in their processes,” he said. “It could be any number of things. I’m just thankful that we get more visibility on what’s coming down the road.”

Minnesota’s Ehresmann is equally confident.

“We know that our health care system has great capacity to deliver more vaccine. You know, we are well below what we could be doing,” she said. “So it certainly is not at any concern about the capacity of our system to deliver vaccine.

Throughout the process, a common goal remains: getting vaccines in people’s arms.

“Obviously, signing up hundreds of thousands of people at once is an incredibly challenging process,” Colorado National Guard Brig. Gen. Scott Sherman told CNN. In his state, the vaccine call center now has just an 11-second average wait time to answer.

“All of us in public health are working towards the same goal. We’re working toward stamping out COVID and keeping our population safe,” Ehresmann told CNN. “Our desire would be to focus on dealing with COVID rather than, you know, how we’re doing when compared to our colleagues in other states.”