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The Health 202: Pharmacies were expecting vaccine shipments. Manufacturing and winter weather delayed them.

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Major pharmacy chains around the United States are supposed to be getting direct shipments of vaccine doses — one way the Biden administration is hoping to speed the immunization effort.

But winter weather, manufacturing delays and logistical problems have lately hampered the initiative, forcing some pharmacies to reschedule appointments or scramble to distribute vaccines they weren’t prepared for.

The administration says “very, very few” vaccine doses were distributed through the direct-to-pharmacy program last week.

That’s according to a spokeswoman for the Department of Health and Human Services, who pointed to an announcement by vaccine maker Moderna that some of its shipments were being delayed because of some hiccups in the final stages of production.

Several participating pharmacy chains — including Rite Aid, Walgreens and CVS — said they had experienced delays last week in getting vaccine shipments, particularly those from Moderna.

While CVS pharmacies initially received a quarter-million doses through the program starting Feb. 12, the allotment didn’t transpire the following week, according to senior manager Amy Thibault. Walgreens Senior Vice President Rick Gates said the company's pharmacies have received limited shipments that arrived “later than expected.” 

And Rite Aid CEO Heyward Donigan said the firm's Moderna shipments didn’t arrive last week, forcing it to reschedule immunization appointments for 35,000 patients.

“It’s been unfortunate,” Donigan said in a Post Live interview yesterday. “Between the weather and all of the logistics, we haven’t received the doses we had assumed we would.”

Rite Aid CEO Heyward Donigan says recent winter weather delayed shipments of the vaccine allotment the company was set to receive from the federal government, resulting in the rescheduling of 35,000 vaccine appointments. Donigan says it does appear they will be getting their allocation this coming week. “Between the weather and all of the logistics, we just haven’t received the doses that we had assumed we would. It does look—that was for one week—it does look like we are going to get our allocation for this coming week.” (Video: Washington Post Live)

Rite Aid pharmacies did receive some vaccine shipments — but they were from Pfizer, even though the pharmacy chain hadn’t up to then been distributing Pfizer’s vaccine, given its need for subzero storage. Even so, Donigan said the pharmacies quickly pivoted to administering that vaccine as they await Moderna shipments.

The pharmacies said they were notified last week by the Centers for Disease Control and Prevention about the delays. The agency attributed it to the Moderna holdups and the winter weather across the Midwest and the South. 

The initiative seems to be getting back on track.

The pharmacy executives said they expect to start receiving large shipments again by the end of this week or early next week. The White House has said distribution through the program has increased from 1 million to 2 million doses, which will be going to 7,000 pharmacies across the country.

Donigan said it looks “as though we’re going to be getting our allocation this coming week.”

The initiative — which includes 21 participating pharmacy chains — is central to the Biden administration's goal of getting the vaccines to vulnerable communities, officials have said. The administration announced the direct pharmacy shipments in early February, saying the shipments will make it faster and easier for people to get inoculated. 

Yet the initiative doesn’t replace the main system for allocating the vaccines, which go to states based on their adult population. Along with the direct shipments, pharmacies are also getting vaccine supplies doled out by state public health departments.

The snafus illustrate ongoing challenges in the massive, unprecedented immunization effort.

More than 46 million Americans have received at least one shot, according to The Post’s vaccine tracker, but demand for vaccinations still far outstrips supply nearly everywhere.

“Everyone’s slammed,” Heyward said. 

“There’s millions and millions of people trying to get through to get scheduled,” she added. “The demand is so intense that it’s hard for any one technology or call center to keep up with it at this point.”

Rite Aid CEO Heyward Donigan says volume has been one of the biggest challenges of vaccine distribution: “Everyone’s slammed…there’s just millions and millions of people trying to get through to get scheduled. The demand is so intense that it’s hard for anyone —technology or call center to keep up with it at this point.” (Video: Washington Post Live)

In D.C., a glitch in the coronavirus vaccine registration system caused it to freeze up yesterday amid a flood of submissions on the first day of eligibility for people in certain areas with underlying health conditions.

An unknown number of qualified residents were locked out from registering for an appointment, The Post's Antonio Olivo, Lola Fadulu and Michael Brice-Saddler report. City health officials blamed “a technical review failure,” which sparked more confusion in what has been a frustrating vaccination process in the Washington region.

“D.C. residents with underlying conditions who live in Zip codes targeted because of their high rates of infections became eligible to register at 9 a.m. Thursday,” they write. “But many of them couldn’t, receiving an erroneous message indicating the city was still only vaccinating elderly residents and essential workers in certain occupations. … By 10:40 a.m., all 4,350 appointments available Thursday for the newly eligible category of residents had been booked.”

Ahh, oof and ouch

AHH: Many Americans with medical conditions making them more vulnerable to the coronavirus aren't able to get the vaccine yet.

An estimated 81 million adults have conditions the CDC identifies as posing an increased risk for severe covid-19. In December, the CDC designated that group a vaccination priority — after health-care workers, nursing home residents and staff, older adults and some front-line essential workers.

“But those recommendations have plainly become unworkable, as states veer from federal guidelines and chart their own paths, often in seemingly random ways,” Lena H. Sun and Isaac Stanley-Becker report. “The result: Access to a shot can depend on what side of a state line you live on.”

Jonathan Temte, a member of the CDC advisory panel that issued the guidelines, called the result a “free-for-all.” The decisions could become even more torturous when a third vaccine made by Johnson & Johnson — which is expected to gain regulatory approval this weekend — joins the mix, though with only a trickle of supply at first.

“The situation is intensifying anxiety for some of the most medically vulnerable people in the country,” Lena and Isaac write. “ And it is causing them — or their family members — to make extraordinary personal appeals.”

OOF: As some people face delays in getting their second vaccine, a public health debate rages over prioritizing one shot or two.

“The vast majority of recipients of the two-dose Pfizer and Moderna vaccines are able to get their second shot within the recommended period, according to vaccine data reviewed by The Washington Post. Yet some people are still encountering problems navigating local programs and unplanned delays — such as bad weather or supply shortages,” The Post’s Meryl Kornfield reports. “These anxiety-inducing hurdles come as an international debate is unfolding over how to best roll out the limited vaccine supply: prioritizing fully inoculating people who have had their first dose or offering partial protection with single doses to more people.”

New data suggests that the United Kingdom's strategy of prioritizing distributing first doses, even at the risk of delays in second shots, resulted in a decline in infections. Other studies have suggested that a single dose of the vaccine may be enough to immunize people who are fully infected. 

A recent paper published by the University of Minnesota’s Center for Infectious Disease Research and Policy estimated that, amid the spread of new, more contagious variants, there would be 39,000 fewer deaths if second shots were deferred in favor of offering first shots. The paper was co-written by Michael Osterholm, a member of Biden’s coronavirus advisory board during the transition.

“But other health experts in the United States are divided about halting the distribution of second doses, with some expressing concern that a population with limited protection could deal a blow to vaccines’ effectiveness as immune-resistant variants evolve,” Meryl writes.

OUCH: Schools are working to track down students who disappeared during the pandemic.

“School districts across the country that closed buildings in mid-March in response to the coronavirus pandemic handled the transition to remote learning with varying levels of success. During the disruption, schools lost track of students. Many students who were present in the classroom in early March could not be found online. And others who showed up in the spring haven’t been seen since,” The Post’s Moriah Balingit reports.

Several states have seen a drop in public school enrollment and an increase in the number of children being home-schooled or attending private schools. But other children who were supposed to be enrolled in public schools have simply not shown up.

“It is deeply worrisome for educators when they cannot account for where a young person is, or whether they are learning and safe. When school is in session and classes are face to face, teachers are better able to detect whether a schoolchild is being abused or neglected,” Moriah writes.

Many school districts are now going to extraordinary lengths to try to find those kids, hiring family liaisons or attendance officers to help track down students and ensure that they have the tools necessary to participate in online classes. Others, such as Detroit and Miami, have kept kids on the rosters even after they have failed to show up for more than a month, Moriah writes.

More in coronavirus news

Coronavirus vaccine websites violate disability laws.

A Kaiser Health News investigation found that many vaccine registration and information websites violate disability laws, which require communications in an accessible format.

“WebAIM, a nonprofit web accessibility organization, checked covid vaccine websites gathered by KHN from all 50 states and the District of Columbia. On Jan. 27, it found accessibility issues on nearly all of 94 webpages, which included general vaccine information, lists of vaccine providers and registration forms,” Kaiser Health News’s Lauren Weber and Hannah Recht report. “In at least seven states, blind residents said they were unable to register for the vaccine through their state or local governments without help.”

Local officials who use the CDC's Vaccine Administration Management System also report ongoing accessibility issues.

A new Kaiser Family Foundation report finds growing enthusiasm for coronavirus vaccines.

More than half of Americans (55 percent) either say that they have already received one dose of the coronavirus vaccine or that they will get it as soon as they can, up from just over a third of Americans in December, according to the report.

Roughly a quarter of Americans want to “wait and see” before they get a shot, with Black and Hispanic adults and those under 30 years old being the most likely to want to hold off on a vaccine.

Check out The Post's look at how West Virginia became the leader in coronavirus vaccinations:
Going into the pandemic, West Virginia knew it was facing trouble, with one of the oldest and sickest populations in the U.S. But it's found vaccine success. (Video: Lee Powell/The Washington Post)

Elsewhere in health care

Senators have reintroduced a bipartisan bill to protect personal health data stored on wearable devices.

The measure, from Sens. Bill Cassidy (R-La.) and Jacky Rosen (D-Nev.), would protect the data under HIPAA, the law protecting individuals' medical records. Health data recorded on personal devices — such as a smartwatch — isn't currently protected under HIPAA.

The Smartwatch Act would prevent entities that collect consumer health information from transferring, selling, sharing or allowing access to consumer health information or any individually identifiable consumer health information collected on personal health trackers. Violations of the new act would be enforced by the Department of Health and Human Services in the same manner the department enforces HIPAA.

“Smartwatches and wearable tech can collect an amazing amount of data about your health with or without your knowledge,” Cassidy said in a statement. “The Smartwatch Act prevents big tech from collecting or selling data without the user’s consent. Americans should always know their health information is secure.”

Anti-tobacco advocates are calling on the Food and Drug Administration to ban menthol-flavored tobacco products.

“Congress gave menthol a pass when it banned flavored cigarettes in 2009, but advocates are highlighting the products' disproportionate use among Black smokers, at a time when policymakers are especially attuned to racial inequities in health,” Axios’s Marisa Fernandez reports.

A new report from the Campaign for Tobacco-Free Kids claims that the tobacco industry has targeted children in Black communities with marketing for menthol cigarettes. The FDA is set to make a decision on whether to ban the flavored cigarettes by late April in response to a lawsuit by the African American Tobacco Control Leadership Council and Action on Smoking and Health.

Patient groups urge Becerra to maintain Medicare’s protected class benefit.

More than 100 patient advocacy organizations sent a letter to Biden’s health and human services secretary nominee, Xavier Becerra, urging him to protect a Medicare policy that ensures coverage of a wide range of drugs used to treat complex medical conditions.

Medicare Part D plans are generally required to provide coverage for at least two drugs in each therapeutic class. But the Centers for Medicare and Medicaid recognized that this may be insufficient for certain drug categories, including many of those used to treat mental health conditions, epilepsy, Parkinson’s disease, lupus, HIV/AIDS, cancer and organ transplants. For six protected classes of drugs, Medicare requires plans to cover most of the drugs in the category.

In President Donald Trump’s final days in office, however, his administration announced a proposal that would give participating plans more flexibility in limiting coverage for drugs in the protected categories. The patient advocacy groups are calling on the Biden administration to reverse this policy proposal.

Senators clashed during a hearing to confirm a transgender nominee.

Sen. Rand Paul (R-Ky.) raised questions about allowing children to undergo difficult-to-reverse gender change treatments during a confirmation hearing for Rachel Levine, a transgender woman and President Biden’s nominee to serve as assistant health secretary. The senator also asked whether Levine would support gender reassignment surgery and hormone therapy for minors, The Post’s Dan Diamond reports. If confirmed, Levine, Pennsylvania’s top health official, would be the highest-ranking openly transgender official in the history of the federal government.

“For most of our history, we have believed that minors don’t have full rights and that parents need to be involved,” Paul said at the Senate Health, Education, Labor and Pensions Committee hearing. “We should be outraged that someone’s talking to a 3-year-old about changing their sex.”

Levine responded by saying that transgender medicine is a “complex and nuanced field with robust research” and promising to discuss the issue further with Paul if confirmed.

Paul’s comments drew rebukes from his Democratic colleagues. Sen. Patty Murray (D-Wash.) said that they expressed “ideological and harmful misrepresentations.”

The clash largely eclipsed the candidacy of Vivek H. Murthy, Biden’s choice for surgeon general, who appeared in tandem at the confirmation hearing alongside Levine. Murthy previously served in the same role under the Obama administration after he was narrowly confirmed in 2014. Republicans have been critical of his position that gun violence is a public health problem and his role as a close Biden adviser, Dan reports.

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