Health Officials Struggling With Vaccine Supply to Meet DemandFeb 26, 2021 01:58PM ● By David Dykes
By Liv Osby
The Medical University of South Carolina has a team of 550 volunteers ready to vaccinate residents against coronavirus in the Lowcountry - on stand-by.
Lexington Medical Center has a 42-foot mobile medical unit that it could deploy to vaccinate people in rural areas, but it’s parked.
And Prisma Health is cutting its vaccination locations.
Like other providers around the state, a limited supply of vaccine is hampering their vaccination efforts.
MUSC Health got a third of what it expected the week of Feb. 8, said Dr. Danielle Scheurer, chief quality and safety officer and director of the Covid-19 vaccination program.
“We definitely have nowhere near the supply to meet the demand,” she told Charleston Business Magazine.
“We have a sizeable wait list,” she said. “And for the first time (the week of Feb. 15), we are having to freeze all schedules for new first-dose appointments and essentially are only able to honor second-dose appointments based on supply we got this week.”
Dr. Saria Saccocio, ambulatory chief medical officer at Prisma and co-chair of its Covid-19 Vaccine Task Force, said the shipments of vaccine are highly variable.
“Rather than receiving vaccine supplies twice a week, the timing of the vaccine supplies we receive continues to vary considerably from day to day, in addition to receiving reduced quantities than we requested,” she said. “This makes planning extremely difficult, especially considering that we are trying to meet the needs of those with appointments.”
“Do we wish we had much more vaccine? Absolutely,” said Roger Sipe, senior vice president of operations at Lexington Medical, noting that the hospital has been getting 975 doses weekly but has the ability to vaccinate 4,500.
“We’ve got the horsepower in the form of resources and capacity … and as supply increased, we could scale out to multiple locations,” he said. “But once we saw writing on the wall about doses, it just didn’t make sense.”
Meanwhile, AnMed Health in Anderson announced Feb. 16 that it had gotten less than half the vaccine needed for its appointments and was forced to reschedule some of them and limit its clinic at the Civic Center to one day that week.
“Due to a very limited vaccine supply,” the hospital said in a statement, “AnMed Health is not scheduling any new appointments at this time.”
And Bon Secours St. Francis Health System said in a statement that appointment availability varies on supply at the time of scheduling, and that it’s in “constant communication” with the state to align vaccines with demand. It has operated one vaccination site at its St. Francis Downtown campus, scheduling clinics nearly every day.
Across the state and the nation, demand for vaccine significantly outweighs supply, so providers are limiting the roll-out of their vaccination plans, said Stephen White, immunizations director for the state Department of Health and Environmental Control.
“We are seeing that providers are ready to vaccinate at a high pace. But we’re given what the federal allocation gives us and we provide that out the best we can as equitably as we can,” he said. “We do hope we see higher allocations coming each week.”
States don't know with certainty what their allocation for the next week will be because neither the U.S. Centers for Disease Control and Prevention nor the manufacturers know for sure, White said. Pfizer and Moderna can estimate production but if there’s any question about the quality of a batch of vaccine, that affects the output and how much vaccine is available, he said.
And for the past two and a half weeks, supply delivery has been affected by severe weather in other parts of the country, he said.
For example, the state got 35,100 first doses of Pfizer vaccine the week of Jan. 18, which dropped to 31,200 during the weeks of Feb. 1 and Feb. 15, DHEC reports. It subsequently got about 49,140 doses.
At the same time, White said, the number of providers is growing, which means the limited supply of vaccine is being distributed across a larger group. The state has approved 1,166 locations, but 357 have been activated and have gotten vaccine so far, DHEC reports.
“It’s a challenge in onboarding additional providers because we can’t get enough vaccine,” White said.
As of Feb. 23, South Carolina had received 1,084,750 doses and given 774,028 vaccinations, according to DHEC’s website.
DHEC acknowledges that planning clinics is a challenge when the supply is so limited, can change from week to week, or be delayed by weather.
But the agency says it regularly provides guidance to help providers manage limited vaccine inventory and avoid lines or cancelations, such as only scheduling by appointment until vaccine is more widely available.
While the state’s allocation was initially based on population, it’s now based on the percentage of doses each state has successfully administered and the number of residents 65 and older, according to DHEC.
First doses are allocated by the federal government on Thursdays and begin to arrive in the state on Mondays, while second doses are allocated on Sundays and begin to arrive on Wednesdays, according to DHEC. Providers can look up their allocations once they’re determined and track shipments to see when they should arrive.
Sheurer said MUSC had been averaging between 15,000-20,000 doses a week for a few weeks, but got just 3,000 the week of Feb. 15.
And because they learn on Fridays how many doses they’ll be getting on Mondays, it’s tough to efficiently schedule appointments more than a couple of days in advance – an effort that requires an extraordinary amount of time and energy.
“I would never normally approach operations that way. It’s not a good use of the team,” she said. “But there’s so much uncertainty, it’s the lesser of two evils. The greater is trying to predict, falling short and either rescheduling or canceling patients.”
It’s also hard on patients, she said, many of whom are dependent on family and friends to get to the vaccine site with just 48 hours notice.
“We … are ready to roll,” she said. “We’re only missing the vaccine.”
Sipe agrees that it’s difficult to scale and plan clinics under the current circumstances, and that the public is frustrated they aren’t being vaccinated sooner.
Adding to the dilemma, he said, is an incredible increase in demand because of the expansion of those eligible for vaccination just as the supply was diminishing. Managing a vaccine that has to be stored at minus 90 degrees Fahrenheit with a limited shelf life is complex as well.
“Trying to manage all those pieces makes it really difficult,” he said. “It took a week or two to figure out a good work flow.”
So Lexington Medical is using just the main campus in West Columbia for vaccinations at this point and waits to schedule appointments “until the supply is in the door” to avoid having to cancel them, he said.
Saccocio said that because of the increase in demand coupled with the “extremely low” supply of vaccine, Prisma modified its appointment scheduling processes and halved its vaccination sites from 12 to six locations.
“While these changes are primarily due to limited vaccine supplies, this also allows us to serve patients more efficiently, manage vaccination administration more effectively and streamline site logistics,” she said in a statement. “The vaccine supply is not something that we can control.”
Saccocio said Prisma had given 187,000 doses by mid-February, and that it has begun pilot testing eight mobile vaccination units in rural and underserved areas of the Upstate and the Midlands, targeting vulnerable residents in high-need areas.
“We are ready to continue expanding our vaccine distribution to serve all of our communities just as quickly as we receive vaccine doses to do so,” she said. “We understand that current manufacturers are ramping-up their production and there are other vaccine manufacturers seeking approval from the FDA.
“More vaccine is coming, but it is not here just yet.”
Noting that recently retired staffers have volunteered to help the vaccination effort, Sipe added that Lexington Medical is also preparing up to expand. And if it gets a vaccine with a more stable shelf life, like the Johnson & Johnson version, it can add its physician network and rural health clinics to the list of providers.
“We want to be optimistic,” he said. “A month, two months from now, we will have multiple locations in the community. It’s all about supply.”
Scheurer said MUSC is trying “everything we know how to do” to avoid canceling appointments.
“We have far more people eager to receive it than we can come close to scheduling,” she said. “We’ve created a wait list essentially and they’ll be at the front of the line when there’s new supply.”
White added that some providers may be coming up short on second doses because they used some of them as first doses in an effort to vaccinate as many people as they could.
“That leaves them in a position where they need additional second doses that we don’t have,” he said. “We are trying to clarify that the second dose is intended for second dose only … but we are not getting sufficient vaccine for either first or second doses the past two weeks.”
In the meantime, officials are asking the public to be patient and continue to use precautions as they work through limited supply.
“We are hopeful that the amount provided to states can steadily and reliably increase soon,” said White, “but we haven’t received a time frame for expected increases in allotments at this time.”