The COVID-19 vaccine rollout has picked up speed in Virginia recently. More doses are expected to arrive in the coming weeks and a new statewide registration system is up and running. More pharmacies, including Walgreens, Walmart, Food Lion, Martin’s, Harris Teeter and Kroger are approved to begin providing shots in the coming weeks and community groups are offering to help sign people up.
But hundreds of people continue to languish on wait lists hoping for an appointment. Across Virginia residents have complained about long waits for appointments, challenges navigating websites and the lack of communication from those managing registrations.
The state’s current system of allocating vaccine doses based on population has also received criticism from politicians for failing to account for the needs of the most vulnerable Virginians, including those in rural areas. More recently the state has discussed re-prioritizing the way it allocates vaccines so that it reaches areas hit hardest by the disease.
During a press call last Friday, Dr. Danny Avula, the state’s vaccine coordinator, said the Virginia Department of Health recognized the need to reconsider the way it’s been distributing vaccines, with an added focus put on priority populations. In the coming weeks, he said, he expects the state to put a weighted distribution model in place that prioritizes people 65 and older, specifically Black and Latino residents, and those who live in places where rates of hospitalization and death are high.
Rappahannock resident Donald Porter, who is about to turn 73, said he thinks the system is only working for those who are well-connected.
He said he wants to know who the more than 1,300 Rappahannock residents who’ve received their first vaccine are, because he knows it’s not him or his wife Shirley, or his 84-year-old sister. He suspects that younger people are getting vaccinated ahead of those who are more vulnerable and that people are jumping the line due to connections.
“I think right now it’s who you know that is getting the shot, and until I see something different, that’s my opinion,” he said.
Other residents have similar concerns.
“I have signed up online and via phone. Still no vaccine appointment. I'm fed up. … I bet all the rich folks in Rappahannock are the ones who have gotten [the] vaccine to date,” one resident said in a message to the Rappahannock News.
For Donald, the biggest challenge with the vaccine process has been the lack of information. He said it took him and Shirley until February to register because it took that much time — and assistance from some acquaintances — to figure out how to go about it.
“We think we’ve done everything right,” he said. He and his wife Shirley registered for an appointment earlier this month and still don’t have an appointment. When he tried calling the health department, he said he got an automated answering system and didn’t know where to direct his call.
Shirley, who freely admits she is not very savvy with technology, filled in the registration survey through the Rappahannock-Rapidan Health District (RRHD) website on Feb. 6. She said they got an email confirmation that acknowledged it could take some time to schedule an appointment.
Then they registered on the statewide site once it launched on Feb. 16. Shirley said her understanding was that by registering on that site it would put them on the list for whatever appointments came up first, whether through the health district, CVS or otherwise.
“Bottom line is, if it’s life and death, you register any way you can,” Donald said. “Hopefully, something will come through sooner rather than later.”
Still falling short
April Achter, the population health coordinator for the RRHD, said she knows people are frustrated and that the transition to the centralized system has initially made things more confusing (for one thing, the call center asked people to re-register when they didn’t need to).
“We just don’t have enough vaccine right now for all the folks who want it,” she said.
Under the current distribution system, Achter said, RRHD is using multiple strategies to reach residents: scheduling appointments from the registration list; allocating doses to providers so they can reach their own patients; and doing outreach to churches, seniors and community groups that can help people sign up.
“Moving forward, we absolutely want to make sure that we are approaching vaccine in an equitable manner so that everyone in our community who desires to be vaccinated has the opportunity to do so,” she said.
Dr. Steven von Elten, a provider at Piedmont Family Practice in Warrenton, one of two private providers receiving vaccine doses from the federal allocation, said he worries the state doesn’t have the capability to identify people who are at the highest risk and that its current policy is discriminatory.
“Some people, you need to talk to them, you need to explain the vaccine,” he said, noting that patients have reservations for a variety of reasons. “We have to come to recognize that’s how we’ll be ultimately successful, and at some point we’re going to have to have a change of mindset.”
His office, which was initially allocated 100 doses a week, has been reviewing patient records to identify which individuals are over the age of 65 and have comorbidities, such as diabetes or heart disease, and are therefore most at risk for severe COVID-19 disease. Of the practice’s 31,700 patients, he said more than 6,120 are 65 and over. The office is calling those patients directly and arranging vaccine appointments by phone.
“We’re just trying to identify as much as possible patients who are at risk and not necessarily on a computer and tech-savvy,” said von Elten. The problem with only having people sign up online, he added, is that his patients who need the vaccine the most often don’t have ready access.
Providers aren’t required to provide data on race and ethnicity when reporting vaccine metrics to the state, but according to available data on the Virginia Department of Health’s website as of Feb. 23, more than 747,000 White Virginians have received at least one dose of vaccine compared to 126,955 Black residents and 59,161 Latino residents. Data for 589,478 people was not provided.
Black residents, meanwhile, account for 42% of all COVID-19 cases and 38% of total deaths, and the CDC reports higher rates of COVID-19 cases, hospitalizations and deaths for Black and Latino populations, noting that race and ethnicity are risk markers for other underlying conditions that affect health, including socioeconomic status, access to health care, and exposure to the virus related to occupation
Earlier this month, Virginia Congressman Donald McEachin, a Democrat from the 4th district,sent a letter to state health officials stating his concern that rural communities and communities of color would be hardest hit by what he called “a lack of coordinated distribution and administration efforts.”
People most in need — including frontline workers and the elderly — can be hard to reach. They may face language barriers or live in low-income households and may not have the technology or transportation at their disposal to make an appointment. Even standing in line can be too challenging for the most vulnerable Virginians.
There are also concerns about vaccine hesitancy, particularly among communities of color that have experienced a history of medical abuse.
Donald, an African-American man, says that’s not what’s holding him back.
“Not all of us are afraid to take the shot,” he said. “Just give me the opportunity, that’s all I ask.”
Signs of movement
On Tuesday Castleton residents Laura Matthews, 68, and her husband Colin, 67, landed appointments to get their vaccines on March 2 at the Germanna clinic in Culpeper, bringing a wave of relief after more than a month of waiting.
Laura said she completed the RRHD survey back in mid-January and didn’t receive a confirmation email until three weeks after she inquired. Colin, who has underlying conditions, was growing increasingly impatient, so she started pursuing other avenues that people had told her about and regularly checked the CVS website after it started offering appointments on Feb. 9. She was looking as far away as Roanoke but everything was full and she started to think it could be months before they’d get an appointment.
And then the call came. Laura said the woman on the phone answered her husband’s questions before he could even ask them.
“If they’re registered, I now have faith that they will get a call,” she said.
Mimi Forbes, director of the Rappahannock County Food Pantry said 35 of her volunteers received their first vaccine at Germanna on Feb. 10 and 11 and found the process very organized and efficient.
In addition to the pharmacies and local providers, Dr. Avula said vaccines will also start going to clinics that are federally funded and serve un- and under-insured populations in Virginia through the Federally Qualified Health Centers program.
The RRHD hasn’t been allocated additional doses beyond the 2,075 it’s getting currently, but Achter said they are prepared to accept more.
“If we get more vaccine we will simply increase our access points in the district and any time you increase your access points you increase your equity,” she said. They’re also planning to work with partner providers and hospitals to target specific communities that they may not have been able to reach, such as churches, migrant camps, those that have trouble with transportation, and areas that don't have access to a doctor or a pharmacy, Achter added.
How are people getting vaccinated?
The main way to register is through the centralized online system at vaccinate.virginia.gov, which asks residents to fill in a survey that places them on a waiting list. RRHD has been calling people individually from the list to schedule appointments due to glitches in the scheduling system, PrepMod, that allowed anyone with a link it emailed out to make an appointment.
RRHD runs a vaccine clinic four days a week at the Germanna Community College in Culpeper and pulls names from the waiting list for appointments, as does Fauquier Health, which is also receiving federal allocations of the vaccine for Rappahannock residents. Piedmont Family Practice is scheduling appointments directly with its patients only at this time.
By Sara Schonhardt — For Foothills Forum