Governors’ bureaucracy questioned as vaccine doses pile up

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“The more rules we create, the more penalties we put in, the fewer vaccines will be delivered,” former FDA commissioner Scott Gottlieb told CNBC on Monday. ” It’s essential. “

In New York City, Gov. Andrew Cuomo has spent weeks insisting that only healthcare workers can get vaccinated, though many have refused and have only started easing restrictions in recent days. In California, Gov. Gavin Newsom convened vast panels of experts to weigh complicated distribution rules, mirroring the effort in bureaucratic confusion.

The federal government sent 1.2 million doses to New York City, but less than half a million people received an injection, according to the CDC’s Vaccine Tracker. California has shipped nearly 2.5 million doses to local health departments and health care systems, but just over 783,400 vaccinations have been administered. President-elect Joe Biden has set himself the formidable goal of injecting 100 million doses in his first 100 days in office.

“Pharmacists are trying to do the right thing and they know how important it is not to let vaccines go to waste,” said Mitchel Rothholz, head of immunization policy for the American Pharmacists Association. “But on the same hand, when we have discussions going on in California and New York, they need to know that their backs are covered if they pass judgment.”

The slow and cumbersome response from states comes after the federal government has offered little support to governors, both in terms of political guidance and reinforcement on the ground. State leaders were left alone to make major decisions regarding distribution, while facing worsening issues such as a labor shortage and funding problems that will persist until what Congress approved nearly $ 9 billion to help vaccine distribution be distributed.

Other states have relaxed their rules or tried different strategies to guard against wasted shots. New Jersey and the District of Columbia, for example, explicitly allow pharmacies and other providers to give out any unused vaccine to the public on a first come, first served basis.

And in West Virginia, where officials have abandoned the federal distribution framework for immunizing residents and staff of nursing homes and assisted living facilities in favor of their own network of largely independent pharmacies, all over 80 years old. have already had their first injection – and residents of nursing homes are starting. on their second. The state has also started vaccinating schools and colleges. Despite being a sparsely populated rural state – defying direct comparisons to larger, more urban states – West Virginia administered nearly 90,000 of the 126,000 injections it received.

While officials in New York and California have drawn the most heat for their limiting rules, few states have escaped criticism for their bulky deployments.

Virginia, for example, is struggling to keep up with distribution, in part because vendors don’t know how to check if someone is eligible, the Richmond Times-Dispatch reported. Observers of Maryland’s slow deployment – where two counties have hardly used their allotted doses and even Baltimore City is still sitting on most of its shots – have also speculated that the overthinking about priorities is part of the problem.

But unlike New York and California, Florida has relaxed its rules for giving the vaccine to anyone over 65 – and now faces a flood of older people who, stuck from getting vaccinated in their home state, flock to the vacation destination. The free-for-all that followed created long lines and a lot of confusion, although it highlighted the barriers for older people in the rest of the country to get vaccinated.

Regional contrasts only add to the pressure on leaders of poorly performing campaigns to step up their efforts.

“We should follow CDC protocols, and if the state has doses that are going to expire, give them to anyone before they become unnecessary,” said Jordan Cunningham, a Republican member of the Assembly of the State of California, on the strategy of its own state. ” Simple enough. “

Cuomo, a Democrat, began to respond to increasing pressure.

New York first responders, teachers and adults over 75 began receiving their first doses of Covid-19 vaccines on Monday, days after Cuomo canceled its dose reservation policy for health workers . The governor further announced the creation of a new public health body to expedite vaccine delivery to New York City as part of his state-of-state priorities for 2021.

“We would rather have people sign up and wait for the vaccine, rather than having the vaccine waiting for people,” Cuomo said during Monday’s speech, delivered virtually from the State Capitol.

Although he has received praise for his early handling of the Covid-19 pandemic, Cuomo has faced increasing pressure from state lawmakers and local leaders over his grip on vaccine distribution. New York City Mayor Bill de Blasio, who has repeatedly urged Cuomo to expand vaccinations beyond the original priority group, has threatened to abandon state rules and start vaccinating essential workers.

“The state has to give in here,” the Democratic mayor said Friday, before Cuomo updated the state’s vaccination policy. “They have created a situation that creates fear and confusion and where doctors cannot act, even when they know someone is vulnerable. “

New York County officials, meanwhile, have warned that the state’s “use or lose” policy, as well as the sanctions announced for providers who knowingly misallocate doses in the wrong way, only add to the problem. the confusion. They also pushed for the vaccination to be open to first responders and older residents. These concerns have not escaped state legislators.

“The rollout of the vaccine, as we know it, has been extremely disappointing,” New York Senate Majority Leader Andrea Stewart-Cousins, a Democrat, told reporters on Monday.

In California, where officials have set up a 60-member task force and advisory committee to try to make distribution fair, Newsom on Monday fended off criticism that those efforts were slowing the process.

“We are not losing sight of the issue of fairness, we are not losing sight of the imperative to give priority to the most vulnerable and the most essential,” the Democratic governor told reporters.

California officials have spent the last week trying to organize ways to distribute the doses – an issue that came to the fore when a broken freezer compressor at a northern California hospital forced staff to use the doses. Thaw 830 doses as quickly as possible, injecting community members outside of state guidelines to keep the vaccine from going awry.

Newsom has acknowledged that its current strategy “will not get us where we need to go” as quickly as needed. But he maintained his goal of vaccinating an additional 1 million people by this weekend, for a total of more than 1.4 million vaccinations statewide. To achieve this, it offered mass vaccination sites, the option for vaccinators to upgrade to other levels if they have run out of vaccinations in the current phase, and expanded the health workers allowed to administer the vaccine.

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