Mass COVID-19 vaccinations already underway across the state, with the Missouri National Guard activated to help get shots in arms at its first event in Poplar Bluff Friday.
But with demand still outpacing the state's limited supply, some public health officials on the state's Advisory Committee on Equitable COVID Vaccine Distribution expressed concern Thursday that diverting large amounts of doses to mass vaccination events may make equitable distribution more difficult.
Gov. Mike Parson announced Wednesday that Missouri National Guard members will be deployed across the state to help with administering vaccines - through mass vaccination events in nine regions, but also to assist with administrative duties like alleviating data backlogs.
"The purpose of all these vaccine teams is to support our existing vaccinators and provide additional vaccination sources for eligible Missourians that may otherwise have a hard time receiving one," Parson said.
But increasing the number of people administering vaccines doesn't alleviate the shortfall in doses currently facing the state.
For the week of Jan. 18 alone, the state received about 240 requests, totaling roughly 254,000 doses. Missouri is expecting to receive only 76,225 doses for the initial shot of Pfizer and Moderna's vaccines that week, Lynelle Paro, the assistant bureau chief for DHSS' Bureau of Immunizations, outlined during an Advisory Committee on Equitable COVID Vaccine Distribution meeting Thursday.
"So you can see we have a large amount of requests," Paro said, "but unfortunately, we don't have enough vaccine to fulfill all of those requests."
As of last week, some providers still had not received their first vaccine shipment, and some of the state's largest public health departments only recently received their first shipment of 975 doses earlier this month.
Paro said the state anticipates being allocated about 38,025 doses of Pfizer's vaccine and 38,200 of Moderna's a week - a total of roughly 76,225. Allotments of Moderna's vaccine are once again available after the state had directed its share of Moderna's doses to the federal partnership with CVS and Walgreens to vaccinate residents and staff in long-term care facilities, Paro said.
Diverting supply?
Rex Archer, director of health for the Kansas City Health Department and a member of the advisory committee, noted on the call that if there are nine mass vaccination events - one for each Highway Patrol region - each administering 2,500 doses a week, that would be a total of 22,500 doses weekly.
That would be nearly 30 percent of the state's estimated weekly allocations.
What's more, Parson said during a news conference Wednesday that the sites would be capable of administering as many as 2,500 doses per day. Additional sites are expected to be up and running by the end of the month.
"That's going to further constrain flow that we would have been able to manage otherwise," Clay Goddard, director of the Springfield-Greene County Health Department, said on Thursday's advisory committee call.
In Springfield, Goddard said, the health department has been able to administer "a couple of thousand doses" weekly and ensures it gets delivered throughout the area.
Larry Jones, executive director of the Missouri Center for Public Health Excellence and a member of the committee, said that if the state's allotment of vaccine remains the same, "we're making it even harder for equitable distribution."
"It seems like that should be coming out of new distribution that comes in, not off of the continuation at this time," Jones said of doses going toward mass vaccination events. "That's my two cents."
Ahead of Thursday's meeting, Jones said residents with underlying conditions who are now eligible would likely be best suited to receive their initial shot through their primary care providers, who would know the details of their unique situation and be able to better advise them.
"Clinics work well when you're taking care of an entire police department or every teacher and staff member in a school where the majority of them have no problems whatsoever," Jones said. "But they don't work quite as well when you're doing mass clinics and you have people with medical conditions who may have lots of questions."
Archer noted the nine regions vary in terms of population, raising questions about how the state would tailor events to serve each region uniquely.
"As you know, some of the Highway Patrol districts have 10, 15 or more times as many people in them as other ones do," Archer said. "So I'm just wondering how that was going to play out and still be equitable."
The Missouri National Guard teams will work in conjunction with "Regional Implementation Teams" that are made up of local health care and community leaders.
On Thursday's call, Jonathan Garoutte, administrator for DHSS' Section for Environmental Public Health who is helping lead the state's effort on establishing regional implementation teams in the nine regions, said they are "moving rapidly" to identify team leads for the Regional Implementation Teams; however, they are not all finalized yet.
Garoutte described the 2,500 number as "a max target" that doesn't necessarily have to be met by each site.
"We're going to do mass vax events in those regions that make sense for those regions," Garoutte said. "And in fact, if there are opportunities to add a mass vaccination team in areas of higher population, we'll consider that as well."
Reporting backlog
When asked how the state would take into consideration the committee's concerns, and if it would consider delaying mass vaccination events until vaccine supply from the federal government increased, a spokesperson for the Missouri National Guard directed questions to DHSS, who directed questions to the Governor's Office.
A spokeswoman for the Governor's Office had not responded to a request for comment by Friday afternoon.
Teams of Missouri National Guard members will not only assist with mass vaccination events in each of Missouri's nine Highway Patrol regions, but "targeted teams" will also be deployed. Parson said targeted teams in St. Louis and Kansas City will specifically work with clergies to reach vulnerable populations.
Parson noted that after the state expanded the tiers of eligible residents - allowing people 65 years and older, those with certain underlying health conditions and first responders to receive the vaccine - the National Guard was needed to help reach more rural communities and support the vaccination of millions of residents.
An estimated 2.5 million residents fall within the second tier of Phase 1B alone - making up about 40 percent of the state's population.
According to the Centers for Disease Control and Prevention, as of Thursday morning Missouri has been distributed 621,200 doses, with about 265,382 administered - about 42.7 percent of the doses received. That puts Missouri toward the bottom of the country in terms of the percentage of doses administered, according to Bloomberg.
Parson said currently at least 68 vaccinators are reporting data manually, slowing the process down and creating a backlog.
"This backlog causes the total number of vaccines administered to appear much smaller than it actually is," Parson said. "In reality, there are many more vaccines that have been administered but not yet been reported to us."
Jones said most providers' first priority is to get the vaccine out to residents and that it's natural for the data entry to be secondary until the process is better streamlined.
"If they have to make a choice between one or the other, they're going to get it into somebody's arm so that they're starting to be protected," Jones said.
Advisory committee members' concerns were raised ahead of the first mass vaccination event Friday at Hydro Adventures in Poplar Bluff.
According to the Daily American Republic, 1,950 people pre-registered for the event to receive the first dose of the Pfizer vaccine. A second dose will be administered at the same location in three weeks on Feb. 12, the newspaper reported.
Parson said details on future events would be released once they were finalized.
The Missouri Independent is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.