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Where have all the vaccine doses gone? Incomplete data leaves that an open question

Where have all the vaccine doses gone? Incomplete data leaves that an open question


Virginia’s hospitals appear to be sitting on a stockpile of vaccines, but health officials are not yet sure how many of the 119,000 unaccounted-for first doses are stored in deep freezers or are already at work boosting someone’s immune system.

Hospitals also are storing 176,000 second doses of COVID-19 vaccine that Virginia health officials want them to begin using as first doses in order to shield more vulnerable people from the risks of becoming seriously ill and dying from the virus.

Dr. Danny Avula, who is leading Virginia’s COVID-19 vaccine response, said during a media call Friday that his staff is still attempting to figure out how many unused doses exist.

“By the middle of next week, we should have more clarity on how many first doses are still out there,” he said.

The Virginia Department of Health on Wednesday added information to its online vaccine dashboard to provide more clarity as to where the state’s 1.1 million doses have gone, and where they have been used.

While Virginia had been in the middle of the pack for doses given per capita, it ranked among the worst states in the nation by a measurement used for many vaccine trackers: percentage of doses used.

“That has significantly improved over the last week. For 24 hours we were at the bottom of that list,” Avula said. “The last time I checked earlier today, we were at 21, and I think that number will continue to improve.”

Virginia’s poor showing had to do with a multitude of reasons, but the main contributors were a slow rollout coupled with poor management of doses and troublesome data entry. And all of it has been shrouded in a lack of public accountability.

The department days ago began to provide more information about where the doses have gone and where they have been used, but the reporting is not uniform, granular or exportable in data sheets as is much of the state’s COVID information.

For the data that were made available, it appears that about half of all doses were shipped to Virginia’s health systems. They were the first to receive doses in mid-December as they had the ultra-cold storage needed to store Pfizer’s vaccine, and their staffs were among the top priority of groups to be vaccinated.

Some health systems, such as Carilion Clinic, vaccinated all staff who wanted it, and then partnered with local health departments to inoculate health care workers who weren’t affiliated with their systems. When eligibility was expanded to other essential workers and older residents, Carilion partnered with the health department for mass clinics.

Statistically, more doses have gone to people living in the Roanoke Valley than the health department reports having been shipped here.

But in other health districts with large health systems — Sentara in Norfolk, the University of Virginia Medical Center in the Thomas Jefferson Health District and the Virginia Commonwealth University Medical Center in Richmond — fewer than half of doses sent to those areas have been reported as being used.

Some of the discrepancy could be due to what is called redistributing. Avula said health systems that had more doses than staff were asked to either do as Carilion did, or send them to medical providers, pharmacies and other vaccinators to use. And while those doses are now showing up as having been given by those vaccinators, the doses might not have been subtracted from the hospitals’ totals.

Avula said the initial slow rollout can now work to Virginia’s advantage, as the unused doses can be sent to health districts that have developed mass clinics with the capacity to vaccinate more people than they have doses for.

Virginia will get 18,000 doses on top of its 105,000-dose weekly allotment this week under a shift in allocations by the Biden administration, he said. And Virginia will borrow doses from second-dose shipments to begin the series for 40,000 more people.

The plan for the next three to four weeks is to borrow second doses. Avula said Virginia will better manage and track vaccines so that it can divert some second doses that arrived in Virginia weeks before they were meant to be given. Pfizer doses are given 21 days apart, and Moderna’s second dose is given after 28 days. Under this plan, Virginia will need to manage supplies so that it can replace the borrowed doses when they are scheduled to be given, plus have enough vaccine to give second doses to everyone who received the borrowed doses.

Avula isn’t concerned about running out in doing this for a few weeks until vaccine supply increases.

“We are in this position because the initial rollout over the first few weeks didn’t happen immediately,” he said.

Many of the unused second doses appear to be with the hospitals.

The Virginia Hospital and Healthcare Association reported last week that its members had given 317,837 doses of the Pfizer and Moderna COVID-19 vaccines since mid-December, a figure that is a 35% increase over the number reported the previous week.

The state reported that the hospitals have on hand 119,000 first doses, and received all but 14,000 of them more than a week ago. The hospitals also have 176,000 of the state’s 242,000 unused second doses. The hospital association did not offer an explanation for the unused doses.

Gov. Ralph Northam on Wednesday said the department’s vaccine dashboard is being relaunched with an eye toward transparency, though it lacks granular detail.

While one web page reports how many doses were received by health districts, it doesn’t specify which vaccinators received them.

Virginia last week said it began shipping doses to health districts based on their share of the state’s population. That practice was not observed during the first month of the vaccination campaign.

The Norfolk and Thomas Jefferson districts have received more than twice the number of doses to population, while the Roanoke and Alleghany districts received about half as much as they should have based on population — but did twice as well in vaccinating people.

It isn’t clear why some health districts received more than others. Hospital locations could account for some of the disparity. Nor is it clear from the data why some districts with academic medical centers, such as Roanoke, were more efficient at using doses than Norfolk.

The Southwest Virginia Health Region was the most efficient in using doses. As of Thursday, 88% of the doses coming into the region had been used. Health districts in the region — from Roanoke and Lynchburg and then sweeping westward through the New River Valley across the Grayson Highlands and into Lee County — had delivered 131,211 of their 159,475 doses.

Their performance is 33 percentage points higher than the next most efficient health district.

The Northwest region, which runs from Lexington to Winchester and east to Charlottesville, had used 55% of the 198,733 doses it had received as of Thursday.

The Central region, which centers on Richmond and sweeps into Southside, had used 53% of its 166,955 doses.

Northern Virginia, the smallest geographic region but home to more than a quarter of Virginia’s population, had used about half of its 292,000 doses.

The Eastern Virginia Health Region performed the poorest, having used less than 48% of its 196,200 doses.

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