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States redistribute hundreds of thousands of vaccine doses unused by nursing homes

Excess doses allocated for elder-care facilities are now being shared with the public

Eleanor Garrison lives at Arbor Springs Health and Rehab Center in Opelika, Ala. Coronavirus cases have dropped at long-term-care centers like hers in recent weeks, at least in part because of vaccinations. (Julie Bennett/AP)

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The federal government allocated too much vaccine to elder-care facilities, and many states are now redistributing hundreds of thousands of the unused doses to others — a move expected to expand vaccinations to more people, more quickly, according to officials involved in the effort.

In California, Gov. Gavin Newsom (D) said Thursday that he is redirecting 170,000 doses of unused vaccine intended for long-term-care facilities. In Texas, health officials said they would redistribute 126,750 doses. In Illinois, the state is redirecting about 97,000 doses. South Carolina Gov. Henry McMaster (R) announced on Twitter last week that the state was reallocating 37,800 doses to vaccine providers. “These surplus vaccines should be made available to members of the general public right away rather than at the completion of the [long-term-care] program,” McMaster wrote.

In Maine, the state is initially taking about 4,000 doses from nursing homes, assisted-living facilities and other locations. “We’re not letting those doses go to waste,” said Nirav Shah, director of Maine’s Center for Disease Control and Prevention, in a briefing for reporters.

“I’m frustrated,” he said in a subsequent interview. “We have more doses than we needed [for long-term-care facilities]. We’re starting to take them.” Any additional doses will help increase supply, Shah added.

Some non-priority District residents are receiving coronavirus vaccines just before they are set to expire. (Video: Allie Caren/The Washington Post)

The additional doses come at a time when state officials say demand is far outstripping supply as the slow and often-chaotic vaccine rollout enters its second month.

“This latest step by the federal government — to work with states to transfer doses back to the general state supply — should help to alleviate a barrier many have complained about,” said Jennifer Kates, a senior vice president at the Kaiser Family Foundation. “It’s understandable that some recalibration would be needed. But, at two months into the rollout, they hopefully can pivot quickly, given the stakes.”

When the vaccine began rolling out last month, states could sign up to have CVS and Walgreens inoculate residents and staff members in long-term-care facilities. Every state except West Virginia chose the program, overseen by the federal Centers for Disease Control and Prevention. Doses were sent directly to the pharmacy chains, which coordinated with the facilities to schedule vaccinations. The doses were counted as part of the state’s allotment.

But they were allocated by the number of beds, not the actual number of residents, in each facility, leading to the provision of more than needed. Workers in long-term-care homes also turned out to be far less willing than expected to be vaccinated, adding to the surplus. Still more became available when people administering the vaccine found they could get six doses out of each vial of Pfizer’s product, rather than five.

The CDC is working with 32 jurisdictions on a case-by-case basis to “transfer doses back from pharmacy partners when there is an excess,” said spokeswoman Kristen Nordlund. She declined to say how many total doses are being redirected.

“The program is still ongoing, with vaccination wrapping up in skilled-nursing facilities and ongoing in assisted-living facilities … so there is no way at this time to know exactly how many doses are still needed to complete vaccination at the remaining facilities,” she said.

In the initial weeks of the program, the CDC required that jurisdictions allocate “ample vaccine supply” to ensure that residents and staffers could be inoculated without interruption or delays, she said.

“Now that pharmacies have made substantial progress in efforts to vaccinate the long-term-care facility populations … we are working with jurisdictions to ensure they are able to easily use any excess vaccine for other targeted populations,” Nordlund said.

States can defer or cancel subsequent allocations to long-term-care facilities, or the CDC can transfer doses back to the states, she added. Some places are choosing to leave excess vaccine doses with CVS and Walgreens to vaccinate other priority groups.

Advocates for the elderly are monitoring the situation closely to make sure residents and staff are not shortchanged.

“Obviously, after months during the pandemic where older adults and the people who care for them were not prioritized, it was really heartening that CDC recommended that states prioritize older people and the people who care for them,” said Lisa Sanders, spokeswoman for LeadingAge, an association of nonprofit providers of aging services.

“There should be enough for older adults and care workers,” she added. “We’re watching it. At this point, we have not heard of a shortfall.”

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More than 58 million doses had been delivered across the country as of Friday, and more than 36 million had been administered. That includes more than 7 million people who had received both doses of the two-shot regimen from Pfizer or Moderna, according to the CDC. More than 4 million shots have been given in long-term-care facilities, with nearly 800,000 people receiving both doses. An estimated 260 million residents of the United States are eligible to get one of the vaccines.

Fraser Engerman, a spokesman for Walgreens, said it became clear early in the effort that the CDC had overestimated the doses needed. The company makes three visits to each facility, so it pushed extra doses from the first clinic to the second, then from the second to the third. If the doses were thawed, they were rerouted to other locations, he said.

Even so, “we had to reallocate supply,” Engerman said.

Walgreens has administered more than 1.6 million doses at the nearly 26,400 long-term-care locations it contracted to serve, according to its website. Engerman said “thousands” of employees are working to vaccinate elder-care residents and staff, and the company hopes to have 45,000 pharmacists and pharmacy technicians trained by mid-February to help in the broader rollout.

Michael DeAngelis, a spokesman for CVS, said the pharmacy chain had administered nearly 2.5 million vaccines at more than 40,000 facilities. “If we project our vaccine allotment will exceed what’s needed, we’ll work with a state to redirect an appropriate portion of that allocation so it’s repurposed elsewhere,” he said in a statement.

In Illinois, state officials are using surplus doses “that otherwise would be sitting in the freezer three weeks from now” to vaccinate a priority group of 3.2 million people — including 1.3 million front-line essential workers and 1.9 million residents age 65 and older, Ngozi Ezike, director of the state’s public health department, said in a statement.

In Maine, long-term-care occupancy rates were as low as 50 or 60 percent of the bed total when the vaccine arrived, said Shah. Other facilities were completely full. When the scale of the problem was recognized, the state moved to claw back extra doses from those facilities and the two pharmacy companies.

Maine has transferred 4,400 doses, with about half going to the general population. The rest are mostly being redirected to independent pharmacies to speed up vaccinations in assisted-living facilities because CVS, the state’s pharmacy partner, is not moving quickly enough, Shah said, noting that some CVS clinics are not scheduled to take place until May.

Only one state, West Virginia, chose not to participate in the federal partnership with the drugstore chains, and it has succeeded better than most at delivering the vaccine. Using a network of local pharmacies, West Virginia finished providing second doses to everyone in long-term care at the end of January, said Clay Marsh, the state’s coronavirus czar.

For reasons that aren’t entirely clear, West Virginia also has seen about 60 percent of its nursing home staff accept the vaccine, a much higher rate than the national average. Marsh credited the state’s small-town nature and a push to convince everyone that inoculation is critical protection for the individual as well as family and friends. As they have seen more people get vaccinated, some residents are jumping on board, boosting the numbers, he said.

“The more people that take it, the more people that take it,” Marsh said.

Andrew Ba Tran contributed to this report.