A month in review: Hurdles, lessons learned in Wisconsin’s COVID-19 vaccine rollout

MADISON, Wis. — On December 14, TV screens everywhere showed frontline nurses in Wisconsin and around the U.S. getting their first COVID-19 vaccine dose. Emotions ran high after nearly ten months spent fighting a virus that has taken more than 5,600 lives in Wisconsin; the end was in sight.

One month later, the excitement has faded into questions, concerns and partisan finger pointing as–like in many states around the country–administered vaccines fall behind widespread expectations.

Frontline Workers

At a small, independently owned pharmacy in Jefferson–aptly named The Drug store–staff won’t have their vaccine for at least another week. Maybe not even then, if their allotment request to the Department of Health Services isn’t met. (Last week, the state wasn’t able to get enough vaccines to meet vaccinator requests, and said they expect that to happen again.)

When a staff member gets sick from COVID-19 there, the pressure on remaining staff increases as they continue to serve an often-sick clientele. Today, they’re keeping their fingers crossed that the 50 requested doses will arrive.

“I really believe community pharmacies will play one of the biggest roles in getting it rolled out to the public,” owner Josh Lotz said.

Frontline health care workers unaffiliated with large health care systems were weeks behind their counterparts when it came to getting vaccines–and many remain without.

“They are not easily identified or grouped in with a hospital that can say, ‘Oh by the way–run down the hall,'” Ann Lewandowski with the Rural Wisconsin Health Cooperative explained.

Falling Behind

Less than half of the more than half million health care workers and long term care population in the state has had their first dose as part of Phase 1a, the first of three recommended sub-phases under CDC guidelines before vaccines reach the general population.

Wisconsin’s roughly 350 nursing homes have an estimated ten days left before every home has had their first visit as part of the federal pharmacy administration program. But the state’s more than 4,000 assisted living centers haven’t had their first visit at all, and won’t until January 25. John Sauer, CEO of LeadingAge Wisconsin, says he’ll be surprised if every assisted living facility has their first visit at the end of six weeks after that date.

“We were held back by not having adequate inventory of the vaccine,” Sauer explained. The federal program Wisconsin is using to vaccinate long term care facilities requires that a state have enough vaccines on hand to complete each stage; that roadblock has only finally been cleared for assisted living, the stage after nursing homes. For Sauer, being within reach of finishing first visits to nursing homes within thirty days is a success all its own–one to learn from and move forward.

“Where are we going to be in 30 days? 60 days? 90 days?” he asked rhetorically. “This is a critical time.”

On Thursday, one month after COVID-19 vaccines started, Wisconsin fell in the bottom third of states and territories for doses administered by rate of every 100,000 in population when measured on the CDC vaccine dashboard.

The variation between state is in part due to a federal government that left states largely on their own to plan distribution and administration. Resulting in a patchwork of protocols, Michigan announced Monday they are moving into Phase 1b while Minnesota’s vaccine tracker notes that likely won’t happen until early February. And while Illinois as early as January 6 had announced who would belong in Phase 1b, Wisconsin still hasn’t set their guidance yet.

But health officials push back on the notion that state-to-state comparisons have value; instead, they say inadequate allocations of vaccines from the federal government has left Wisconsin no choice in a delayed rollout.

“The ultimate measure of success is how many people have completed their series and what percentage of the opulation has been covered by the vaccine to produce herd immunity,” Julie Willems Van Dijk said Monday, deputy secretary of the Wisconsin Department of Health Services.

Funding, Infrastructure lacking

Sarah Sorum, CEO of the Pharmacy Society of Wisconsin, said allowing communities to move on to a new phase of vaccine administration when they’re ready could be one way to improve rollout. Illinois has a similar model, after the state set 1b guidance on January 6.

“There’s a bottleneck for getting vaccine in arms,” she explained, because Phase 1a might be completed faster in rural areas when compared to larger cities.

“The dilemma then is do you have them wait so we can advance as a state to the next phase…or can we allow communities to flex as they need to?”

The logistical challenge of distributing and administering a new vaccine on the scale needed to provide herd immunity for COVID-19 is “not an insignificant” logistics challenge, Lewandowski said. (She also chairs the state advisory board developing vaccine phase recommendations for Wisconsin, but did not speak on behalf of that role.)

“There was no one who had experience handling the vaccine, and breaking it down, in the state,” she said. “We’ve underfunded vaccines in public health in this country for more than ten, twenty, thirty years…that means when we come into a pandemic, things are going to be slower than any of us would like.”

Until the second Covid-19 relief bill passed Congress in mid-December, funds for vaccine distribution for states were scarce.

Frustration growing

As states like Michigan and Illinois open up the next phase to anyone 65 and older–something the Wisconsin DHS says they’re considering–county health officials say they’re fielding nonstop calls from the public as seniors and those at high health risk ask when they’ll get their own vaccine.

“They are calling, they are unhappy,” Jefferson County health officer Gail Scott said. “They want to know when they’re going to get their vaccine, and why is someone else getting it before them?”

Meanwhile, pharmacies gear up to take on a larger role in coming phases–even if they’re waiting on shots themselves.

“We have a long road with a lot of work ahead,” Lotz said.