© Patrick T. Fallon/AFP/Getty ImagesSyringes wand vials of the Pfizer-BioNTech Covid-19 vaccine are prepared to be administered to front-line health care workers under an emergency use authorization at a drive up vaccination site from Renown Health in Reno, Nevada on December 17, 2020.
In some hospitals, health centers and pharmacies in the United States, there are vials of Covid-19 vaccines that aren't making it into arms.
Out of the more than 22 million doses of vaccine that have been distributed to hospitals and pharmacies so far in the United States, only about 6.7 million people have received their first dose, according to data from the US Centers for Disease Control and Prevention.
There's no one reason for the slow rollout or doses going unused; experts say it was never going to be easy to begin a mass vaccination campaign during a pandemic. It takes time to vaccinate and monitor large numbers of people, and some facilities are staggering staff vaccinations to avoid having too many health care workers out at once.
The supply and demand don't always line up. Some in the highest priority groups -- health care workers and and long-term care facility residents -- don't want the vaccine, or at least, not yet. At the same time, the American Medical Association on Friday said it was "concerned" that some health care workers not employed by hospitals or health care systems face difficulties accessing the vaccine.
To speed up the process, the federal government is urging states to offer the vaccine to people who are older or in higher-risk groups, but some areas are still focusing on the earliest priority groups -- even if that means doses brought out of cold storage go unused.
"We all thought that the real problem was going to be a shortage -- we would be having lines out the door -- and what we're finding is that, from what we hear nationally right now, there's still a lot of vaccine," Dr. Neil Calman, president and CEO of the Institute for Family Health, a nonprofit health organization that includes the Family Health Center of Harlem, told CNN on Friday.
"Every dose that's in somebody's arm is somebody that's not going to get sick with Covid," he said. "It's not doing any good trying to ration it out like this, week by week, because any dose that's sitting in a refrigerator is a life that's not being potentially saved."
Searching for people to vaccinate
The debate has been playing out on the political stage in New York, where New York Gov. Andrew Cuomo pressured hospitals to move faster. Meanwhile, New York City Mayor Bill de Blasio pushed to begin vaccinating more priority groups.
That will start Monday, when New York will open up to first responders, teachers and residents 75 and older, in addition to prioritizing health care workers.
Frustration had already been mounting. On Tuesday evening last week, nurses from the Family Health Center of Harlem in New York traveled through the neighborhood trying to find people who were eligible to receive a Covid-19 vaccine.
The health center had a few extra doses of the Moderna vaccine that had been taken out of cold storage. The doses were supposed to be administered to health care workers -- but some did not show up for their appointments, and the clock was ticking.
"It expires six hours after you take the first dose out of the vial," Calman said.
The nurses could not administer the vaccine to just anyone -- as in the state of New York, they could face penalties for doing so. Under a new executive order in the state, health care providers who knowingly administer the vaccine to people outside of the state's priority groups could face penalties up to $1 million, as well as have their state licenses taken away.
That evening, the nurses "went out in the community, and they went to two open pharmacies and they asked whether any of the pharmacists who were there had wanted the vaccine," Calman said. "They went to a firehouse, which is down the street, to see if any of the people in the firehouse needed vaccine. ... They went to a residential facility."
By the end of that evening, there were still "three to four" doses left and they were discarded, Calman said.
"We should maintain the priority levels -- I think it's very important to have health care workers first, and to be able to bring teachers in now and others," Calman said. "But during that time, the health care provider community should be able to be vaccinating our highest risk patients, and be able to use our professional judgment in terms of who those people are and who we can get vaccine to."
'We expect these issues to be worked out'
Across the country, Legacy Health, a nonprofit health system with six hospitals in Oregon and southwest Washington, confirmed to CNN on Friday that, during its early vaccination efforts last month, 27 doses of the Pfizer/BioNTech Covid-19 vaccine were thrown away because they expired before there was time to get them into arms -- and some initial information provided about the vaccine was unclear.
Brian Terrett, a spokesperson for Legacy Health, told CNN in an email that hospitals under Legacy Health scheduled vaccinations based on the initial information provided that each vial of vaccine contains five doses. It turns out that some vials contain six or seven doses -- and at the time, hospitals had extra doses, but no one scheduled or available to give them to.
So, "the 27 expired doses occurred early in our vaccination effort when we had more vaccines than patients," Terrett said. "Having six or seven doses in a vial has allowed us to vaccinate almost 700 more people than we were allocated. For every expired vaccine, Legacy vaccinated almost 25 more people than we expected."
As reports emerge nationwide of Covid-19 vaccines at some hospitals going unused, the American Hospital Association responded in a statement that it expects "these issues to be worked out."
The association represents and serves US hospitals and health care networks.
"America's hospitals and health systems are working hard to administer COVID-19 vaccines as quickly and safely as possible, doing so as prescribed in their state or local jurisdiction's microplan," Rick Pollack, AHA's president and CEO, said in a statement emailed to CNN on Friday.
"At the same time, we continue to care for a large amount of COVID-19 patients under very stressed circumstances involving PPE shortages, worker shortages and limited ICU bed capacity in certain areas. Mass vaccination is a huge and complex process -- and not unlike any other effort of this kind -- there are always bumps in the road on any large governmental endeavor, particularly at the beginning," Pollack said in part. "We expect these issues to be worked out, and the pace of vaccinations will increase dramatically over the coming weeks."
Slow rollouts in long-term care facilities
Vaccinations for long-term care facility residents and staff are also moving slowly in many places. As of Friday morning, more than 4 million doses had been distributed for use in long-term care facilities, but less than 700,000 eligible individuals had received their first dose.
The federal government partnered with CVS and Walgreens to facilitate vaccination in participating long-term care facilities.
In a statement published Wednesday, CVS said that the number of residents requiring vaccination was 20-30% lower than initial projections and that "initial uptake among staff is low," though part of that may be due to facilities staggering vaccination among staff.
Walgreens, meanwhile, told CNN that any unused doses are reallocated to the next scheduled clinic at a long-term care facility, and any doses that may expire before then "may be used to vaccinate Walgreens team members who are eligible to receive vaccines as part of the Phase 1a plan outlined by the CDC and states."
West Virginia has been leading the United States in vaccine doses administered per capita, and long-term care facilities may be part of the reason. West Virginia was the only state to opt out of the federal program to distribute Covid-19 vaccine to long-term care facility staff and residents; it started vaccinating people in those facilities about a week before the federal program started in other states.
More than 40% of pharmacies in West Virginia are not chain-affiliated, and the state wanted to prioritize existing relationships, the governor said in a press briefing on December 16.
"We have instead partnered with all the pharmacies in West Virginia," Gov. Jim Justice said in December. "We felt like that, from a state perspective, would be limiting our ability to rapidly distribute and administer the vaccine to the population in need if we had gone with the federal program."
West Virginia, too, has started to open up its vaccine priority line beyond health care workers and nursing home residents -- people age 80 and older are now eligible to receive the vaccine.