Less than a fifth of phase 1a South Carolinians have received their first dose of the COVID-19 vaccine. Although, this figure could be closer to half of the phase if the elderly population, which only became eligible last week, was not included in the calculation.
“As a state, we are moving at an unacceptable rate,” state Rep. Wes Newton said during a committee meeting to study the COVID-19 vaccine rollout on Thursday.
The sentiment is shared among many in the state. Over five weeks since the first Pfizer vaccines arrived in the state, many South Carolinians have been frustrated with the pace of vaccinations.
Marshall Taylor, the Department of Health and Environmental Control’s acting director, agreed that the rollout has been too slow but added that supply of vaccines coming from the federal government is just too small at the moment.
About 17.8% of phase 1a vaccine recipients have received their first doses and about 3.7% have received second doses, based on vaccine allocation reports and phase population estimates on DHEC’s website.
As of Jan. 21, 175,355 first doses — 145,216 of the Pfizer vaccine and 30,139 of the Moderna vaccine — and 36,434 second doses have been administered. DHEC estimates that phase 1a includes around 987,039 people.
The Moderna vaccines were primarily allocated for long-term care facilities (LTCF) in the early weeks: 20,408 administered to residents and 9,731 to staff so far. These vaccines are administered by CVS and Walgreens through a federal partnership.
Here are DHEC’s population estimates for each phase:
- Phase 1a: 987,039 (19.2% of the state’s population)
- Phase 1b: 573,501 (11.1%)
- Phase 1c: 2,897,527 (56.3%)
- Phase 2: 690,645 (13.4%)
Dr. Linda Bell, the state’s top epidemiologist, told the sub-committee that the inclusion of people 70 and older, regardless of health status, created a much larger phase 1a group.
Before the addition of this group and the addition of hospitalized patients aged 65 and older, DHEC had estimated phase 1a to include roughly 353,000 people.
If those 70 and older were not included in the population estimate, roughly 49.7% healthcare workers and LTCF residents and staff — the original phase 1a population —have received their first dose.
This is not a perfect estimation, however. The vaccination allocation reports do not breakdown vaccinations by the age groups and it’s important to note that the 70 and over population also crosses within other phase 1a populations. Some could be healthcare workers themselves and others could be long-term care facility residents.
Supply of the vaccine
Dr. Brannan Traxler, the state’s interim public health director, told the committee that the federal government gives South Carolina around 60,000 to 64,000 first doses each week — roughly equal parts Pfizer and Moderna brands. This allotment will not change for the foreseeable future.
Second doses are also received each week — also roughly equal parts Pfizer and Moderna. These shipments are equal to first doses received (60,000 to 64,000 weekly) and lag three to four weeks behind because second doses are to be administered three to four weeks after first doses.
Second dose inventory was a hot topic during the meeting. State representatives noted that with such little supply of vaccines in South Carolina, many constituents are worried that a second dose could not be guaranteed. Health officials squashed those fears.
If a provider puts a first dose in an individual’s arm, that provider is guaranteed a second dose that follows it, Taylor said.
Health officials said that the LTCFs have received all the Moderna vaccines that they need and for the last two weeks, new shipments of the Moderna vaccine are coming in to the state for non-LTCF phase 1a vaccinations.
The state has received 337,575 total first doses for non-LTCF phase 1a recipients, 273,975 of Pfizer and 63,600 of Moderna. The state allocated 101,700 Moderna first doses to LTCFs.
Guidance changes complicated the rollout
About a week before the first shipment of Pfizer vaccines arrived in South Carolina on the week of Dec. 14, the CDC’s Advisory Committee on Immunization Practices (ACIP) changed its guidelines to include more healthcare populations and the population of phase 1a increased from about 184,000 to about 353,000.
Without this increase in population, phase 1a first dose vaccinations would be nearly complete.
This month, the state opened phase 1a to current hospital patients aged 65 and older who don’t currently have COVID-19, and then to those 70 and older, regardless of health status or pre-existing conditions. These populations increased phase 1a to just under 1 million people.
The 70 and older population — the elderly in general — is one of the most critical populations to vaccinate quickly.
Of the 16,869 total COVID-19 hospitalizations in the state, 45.2% were those aged 71 and older, and another 36.8% were between the ages of 51 and 70. Of the 6,373 COVID-19 deaths reported as of Jan. 19, 68.6% were 71 and older, and 27.1% of deaths were between 51 and 70.
Some rollout changes have helped to speed up vaccinations. Notably, setting a Jan. 15 deadline for phase 1a healthcare workers to schedule their appointments helped. Currently, there are over 256,000 scheduled appointments — this figure does not include third-party providers — and 755 clinics are scheduled with LTCFs.
Originally, the CDC had recommended to move on to phase 1b when 70% of phase 1a had been vaccinated. Now, they recommend states move to the next phase when supply of the vaccine can begin to handle increased demand.
In previous DHEC news briefings, health officials said phase 1a was opened to the 70 and older population because a majority of phase 1a healthcare workers had either already received their first dose or were scheduled to receive them in the coming weeks.
Issues with scheduling appointments
The current mechanism for South Carolinians to schedule appointments is through the CDC’s Vaccine Administration Management System (VAMS) to the enjoyment of no one.
“VAMS has become a cuss word at DHEC,” Taylor said.
Health officials have called VAMS “clunky” over the past few weeks. It requires an email which many do not have. DHEC or providers help people register with VAMS and then VAMS emails an invitation to schedule an appointment to that individual.
Taylor also said that VAMS can spontaneously cancel appointments and the system does not distinguish between first and second doses. The system is also used to order and track vaccine inventory. Providers don’t like VAMS because its data entry is labor intensive and takes away precious time.
DHEC is working on a statewide system that would make scheduling appointments easier and streamlined. It would be a “one-stop-shop” to schedule both doses and would not require an email or a two step process like VAMS. In the future, this new system would integrate with DHEC’s SIMON.
SIMON did not comply with all CDC requirements to manage the COVID-19 vaccine and so VAMS is currently used to schedule appointments. Health officials did not provide a launch date for the new system but said it was expected in the coming weeks. VAMS would still be used for the ordering and tracking of inventory.
In the meantime, the agency is working to open a new call center designed specifically for vaccine information. At the moment, DHEC’s Care Line is taking calls to schedule appointments.
“We recognize that the Care Line is insufficient,” Taylor said.
The line experienced issues once phase 1a was opened to those 70 and older last Wednesday. Towards the end of last week, DHEC doubled their call center staff to about 60 people and worked with the state Emergency Management Division’s call lines to handle overflow calls.
“I’m sorry about people having to wait, people not being able to get through,” Taylor said.
The new call center will start with around 100 workers and will have the ability to grow if needed. It’s expected sooner than the new appointment scheduling system.