Limited COVID vaccine supply means getting group 1b vaccinated will take months

When Virginia moved into phase 1b for COVID-19 vaccinations, health officials anticipated getting much more of the vaccine than they are actually getting.

As a result, it is going to take a long time – possibly until March or April – until everyone in 1b is vaccinated, said Danny Avula, vaccine coordinator with the Virginia Department of Health (VDH) during a media briefing Jan. 16. 

Virginia is getting about 100,000 to 110,000 new vaccine doses a week, but the number of people who are eligible for a vaccination is much greater.

Demand exceeds supply

Earlier this week the federal Health and Human Services Department gave clear directions to governors to include in group 1b people 65 and older and those with health risks. HHS indicated states would get an increase in vaccine doses. 

The VDH subsequently learned “our allocations may not be increasing,” Avula said, “so we won’t have enough for all of group 1b.”  (Fairfax County separately advised the public “it may take months” to get through groups 1a and 1b.)

Related story: People in group 1b – 65+ and those with health risks – can schedule a COVID vaccine on Monday

The federal government also said there would be a large reserve of second doses. But “there is no warehouse full of frozen vaccines. It’s all just-in-time production,” said Virginia’s secretary of health and human resources Daniel Carey. 

Group 1b also includes police, firefighters, teachers, childcare workers, foodservice and grocery store workers, and people in agricultural production, among other essential workers. 

Unless there is a significant increase in the supply from the federal government or other vaccines from AstraZeneca and Johnson & Johnson are approved – possibly in February or March – Virginia isn’t likely to receive more than 110,000 doses a week. 

As of Jan. 16, Virginia has received 943,400 vaccine doses from Pfizer and Moderna, and health providers have administered 295,202 vaccines, said Avula. 

Across the state, the daily average of vaccinations has increased to 14,000, and “although we are absolutely moving in the right direction,” there are major challenges in ensuring everyone can get vaccinated,” he said. 

There are separate distribution streams within the state. Nursing homes – included in group 1a along with healthcare workers – have gotten 226,000 vaccine doses directly from the federal government under contracts with CVS and Walgreens. The VDH doesn’t have any control over that. 

Vaccinations for staff and residents of nursing homes, including second doses, should be finished by the end of March, Avula said. 

Related story: Teachers, other school staff can get COVID vaccines beginning Jan. 16

The VDH distributed another 145,000 vaccines to hospitals and health systems, which are used for all staff in contact with patients, including dietary staff and custodians, as well as nurses and doctors. 

The VDH is distributing the rest of its vaccine allocation to local health departments and private healthcare providers.

Vaccine doses unused 

A major challenge in Virginia is the wide gap between the number of vaccine doses distributed to health departments and the actual doses that are getting into people’s arms. A couple of hundred thousand doses have been distributed but apparently not used. 

According to Avula, that discrepancy is due in part to inadequate reporting. He suspects that 100,000 to 200,000 doses have been used but the data hasn’t been recorded. 

That’s important because “our future allocation of vaccine doses in Virginia is going to be dependent on getting clear accurate data,” he said. 

In other cases, local health departments have finished vaccinating people in group 1a but didn’t want to start vaccinating group 1b until they’ve gotten a clear directive from the state. Virginia has now authorized vaccines for 1b and many are starting to schedule vaccinations for people in that group this week. 

While it’s important not to break the rules and to vaccinate the most vulnerable people first, Carey said, it’s also important to use all the doses received. 

Any provider in the state that used more than 40 percent of their allocation will have their subsequent request for more doses approved. Providers who used less than 20 percent will get less in the next round. 

In addition to the 106,000 doses Virginia received last week, it also got 61,000 second doses to be allocated directly to healthcare providers for people who already got a first dose, Avula noted. 

Related story: Everyone in Virginia could get COVID vaccine by this summer

If some people don’t come back for a second dose, healthcare providers are instructed to use those vaccines for other people eligible for a first dose. 

There was concern in Fairfax County that some people who got a first dose were told there wasn’t enough vaccine available for the second shot, Avula said. Those healthcare providers should have gotten second doses directly from the federal government, beyond the vaccines allocated to the VDH. “We don’t know why that didn’t happen, but they should be getting enough now.” Fairfax County is expected to get 7,000 second doses this week.

Vaccines rejected

Meanwhile, large numbers of people eligible to receive a vaccine are turning it down, Avula said. More than 60 percent of the elderly agreed to be vaccinated, but fewer numbers of younger nursing home staff accepted a vaccine. However, many changed their minds after they saw their colleagues suffer no ill effects.  

The vaccines are not mandatory, and employers in Virginia can’t require a vaccine as a condition of employment. According to Carey, “peer pressure is our most powerful tool” to build confidence in the vaccine. 

As long as the state stays in 1b and there is more demand than supply, Avula urges people to understand that some people need the vaccine more than others. If people in 1b can work from home and consistently wear a mask and take other precautions, he suggests they consider letting people more at risk get the vaccine first.