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The Health 202: How West Virginia beat other states in administering coronavirus vaccines

with Alexandra Ellerbeck

The Biden administration will start shipping extra coronavirus vaccine doses straight to pharmacies, hoping to speed the process of getting shots into arms.

But in West Virginia — which has administered the vaccines faster than any other state except Alaska — officials lament that the new allocations will not be going directly to the state to distribute. 

“We’re appreciative of any help we’re given, but we would appreciate it more if we would get it delivered to us and in our system,” James Hoyer, the director of the Joint Interagency Task Force for Vaccines in West Virginia, told me over the phone yesterday.

West Virginia has won praise for its quick and efficient handling of the vaccine rollout.

Eleven percent of state residents have gotten their first shot, and 4.1 percent have completed vaccination, according to The Washington Post’s vaccine tracker. As of one week ago, all residents and staff members of the state’s 214 long-term care facilities have been offered the full regime.

Meanwhile, many of states with much better-funded health-care systems have lagged behind. In Massachusetts, 7.2 percent of the residents have received a first shot; 7.7 percent in California.

“People think we’re the poorest or most backward or whatever it may be,” West Virginia Gov. Jim Justice (R) told The Post. “But West Virginia has become the diamond in the rough.”

Justice spoke at a Washington Post Live event on Monday:

West Virginia has emerged as a success in the nation's otherwise chaotic coronavirus vaccine rollout. Gov. Jim Justice says the state took a "real practical approach" to its vaccine distribution by bringing vaccines to the people instead of trying to bring residents to the vaccine. The state is using mom-and-pop pharmacies to distribute shots instead of chain stores. They’ve also put the National Guard to work. "We saved a lot of lives here. It's not rocket science, but you've got to move." (Video: Washington Post Live)
The key for West Virginia, Hoyer said, has been a centralized state-run system.

Once vaccines come to the state health department, they’re shipped to five hospitals, each located in a different geographic region of the state. These hospitals then serve as a hub for distributing the vaccines to community health centers, clinics, pharmacies, doctor officers and other hospitals. The state tracks the movement of all vaccines with a central registration system.

Every Monday, the state task force holds a Zoom call with officials from the state’s 55 counties to discuss supply for the week and any changes that need to be made in distribution.

The state has also drawn on the National Guard to help with logistics and organization. And rather than letting counties make their own rules about who gets the vaccine first, as other states have done, Justice has issued specific and firm guidance on prioritization. 

The state has been so successful that President Biden’s coronavirus coordinator, Jeff Zients, called Justice to ask for advice, my colleague Griff Witte reports.

West Virginia is participating in the new pharmacy program because it doesn’t want to miss out on any vaccine doses.

Under the new initiative, first envisioned under the Trump administration, thousands of retail pharmacies will receive direct shipments of the vaccines. It will involve 6,500 stores initially but could expand to tens of thousands of chain drugstores, independent pharmacies and supermarkets if it works well, Amy Goldstein and Laurie McGinley report.

“The measures announced Tuesday reflect an eagerness by the Biden White House to portray itself as presiding over a more active federal response than its predecessor at a time when the virus is rampant, more worrisome variants have arrived in the United States and demand for the two authorized vaccines far outstrips supply,” they write.

The system could help speed the vaccine rollout, particularly in the states that have moved more slowly. But Hoyer insists that in West Virginia, it’s the state — not pharmacies — that is best equipped to decide where the vaccines should go.

“If you throw all the stuff to a couple of pharmacies, they don’t have the experience we’ve got coordinating,” Hoyer said.

West Virginia was the only state to opt out of a separate federal program to distribute the vaccines in long-term care facilities using major pharmacy chains such as Walgreens and CVS. Instead, the state worked with small local pharmacies that were already used to administering flu vaccines and other medications to nursing home residents.

West Virginia’s uniform statewide process is unique.

In many states, governors have delegated the vaccination process to underfunded county health departments and health providers. Each devised their own sign-up systems and made their own rules for who can get vaccinated and when. That has led to mass confusion in some places, as we detailed in this Health 202.

In these states, shipping vaccines directly to pharmacies could help older Americans obtain vaccines, freeing them from having to navigate websites run by public health departments.

“The idea originated last fall with the Trump administration, and the Centers for Disease Control and Prevention has been working with states and U.S. territories to identify the first participating stores,” Amy and Laurie write. “The doses scheduled to be shipped to certain stores next week will mark the first time the program has moved from theory to fact.”

Zients has tamped down expectations for how much this would help Americans frustrated by the difficulty of getting vaccine appointments.

“Many pharmacies across the country will not have vaccines or will have very limited supply,” he said Tuesday, without predicting a time frame for widening the use of stores.

Ahh, oof and ouch

AHH: British officials say their decision to delay second vaccine doses has been vindicated.

A study of the Oxford-AstraZeneca coronavirus vaccine found a single dose of the vaccine was 76 percent effective against symptomatic virus infection, for up to three months, Karla Adam, William Booth and Carolyn Y. Johnson report. The new research also found the vaccine may keep people from spreading the virus.

British officials hailed the report on the homegrown vaccine, saying it gave evidence in favor of their controversial decision to delay second doses — from four weeks to 12 weeks — while trying to get first shots to as many people as possible.

British Health Secretary Matt Hancock said the research results were “absolutely superb.”

“It categorically supports the strategy we’ve been taking on having a 12-week gap between the doses,” Hancock told Sky News.

“Independent scientists who were not involved in the Oxford study called the data intriguing but incomplete,” our colleagues write. “They warned that results were preliminary, that the sample size was too small to make bold claims, and that there could be alternative explanations for the findings, such as that the group receiving a single dose included more women, younger people and health workers.”

OOF: Congressional Democrats are setting the stage for a party-line approval of Biden's coronavirus relief bill.

House Democrats voted yesterday to advance the $1.9 trillion package, heeding the president’s calls for swift action on his first big agenda item — but without the bipartisan unity he promised, Erica Werner and Jeff Stein report.

“The 218-to-212 nearly party-line vote approved a budget bill that would unlock special rules in the Senate allowing Biden’s relief package to pass with a simple majority, instead of the 60 votes usually needed,” they write. “With the budget resolutions in place, Democrats would be able to get to work in earnest on writing Biden’s proposed relief bill into law — and ultimately pass it without any Republican votes if necessary, though they continued to insist that is not their preference.”

“Biden has courted Senate Republicans, and repeatedly expressed the desire to get their support,” Erica and Jeff write. “But he and his advisers have made increasingly clear that any such agreement must be on Biden’s terms, and that he will not compromise on the $1.9 trillion price tag or major components of his relief legislation, which comes at a moment of economic need for the nation and with Democrats in control of both chambers of Congress and the White House.”

OUCH: San Francisco officials are suing their own school district to restart in-person classes.

The lawsuit alleges that district officials have failed to abide by a state law mandating that districts develop a plan “to offer classroom-based instruction whenever possible.” The school district has offered only virtual learning since last March.

“The move … marks an escalation in a fight between Mayor London Breed (D) and the San Francisco Unified School District over when and how the city’s more than 54,000 public-school students will return to in-person instruction,” Marisa Iati reports.

“Those students, roughly 85 percent of whom are racial minorities, have been learning virtually since March as the district negotiates the terms of reopening with its teachers union,” Marisa writes. “The district previously planned to welcome back young children and students with disabilities in late January, but the timeline was extended after labor negotiations failed.”

City Attorney Dennis Herrera (D) on Wednesday accused school officials of failing to develop a detailed reopening arrangement after more than 10 months of virtual learning, turning students into “Zoom-Bies.” “Unfortunately, so far, they are earning an F,” he told reporters. “Having a plan to make a plan doesn’t cut it and is no plan at all.”

Meanwhile, the school board has been renaming more than 40 schools named after presidents and other historical figures that board members argue are associated with racism. Breed has criticized those moves, calling them an empty show of support for racial justice that fails to address the inequities created by virtual learning.

Seventy-five organizations are asking Congress to increase insurance subsidies in a coronavirus relief package.

The letter, led by the Democratic-aligned group Protect Our Care and provided first to The Health 202, asks Biden and congressional leaders to include a bill from Rep. Lauren Underwood (D-Ill.) which would expand the premium tax credits for private plans purchased on individual marketplaces. Biden has included such a proposal in the relief plan he's asking Congress to pass.

“Including the Health Care Affordability Act in the next covid-19 relief package would extend an affordable option to tens of millions of Americans who remain uninsured, and provide significant financial relief to millions of Americans who currently pay too much for health care,” the letter says.

Signers include the SEIU, the American Federation of Teachers, the National Partnership for Women and Families, and Families USA.

Sugar rush