In PA, getting shots into millions of arms is a logistical and equity nightmareMarch 24, 2021 Category: Featured, Long, Purpose
Pennsylvania is trying to build its last mile vaccination pipeline to deliver on President Joseph Biden’s promise to make all adults eligible for the vaccination by May 1. Essentially, this means lists will become a thing of the past and anyone who wants a vaccine will be able to get it.
While over one million of the state’s 10.2 million residents are fully vaccinated, there are over 500,000 people in Philadelphia suburban areas alone awaiting their shot.
The federal government, which manages vaccine supply distribution, started delivering the COVID vaccines to the states on December 14. As of March 22, Pennsylvania has received 6.3 million doses and administered 4.6 million vaccines for a usage rate of 74% — giving it a state ranking of 41th, far below 9th place New Jersey.
And when it comes to the percentage of seniors who are fully vaccinated, the group most at high risk of contracting and dying from COVID, the state is 49th.
To get shots into more arms faster, the state has implemented a plan that drops hundreds of smaller vaccination sites like local pharmacies in favor of hospitals and medical centers — places that can jab in volume. Gov. Tom Wolf also plans to open 27 mass vaccination facilities across the Commonwealth — much to the chagrin of Philadelphia’s suburban collar counties’ public officials.
On March 18 the Southeast Pennsylvania counties — Montgomery, Bucks, Chester, Delaware — issued a joint statement on the two regional PEMA sites proposed to serve all four populous counties:
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“We are extremely disappointed to hear that PA DoH is not considering our request to allocate the Johnson and Johnson vaccine directly to Bucks, Chester, Delaware, and Montgomery counties. We have reiterated our concerns about establishing a regional PEMA site for many reasons, and we remain deeply concerned that equitable distribution will be compromised at such a site.”
These collar counties want to continue managing distribution of the COVID-19 vaccine according to their emergency preparedness plans. By early March however, the four counties together — which account for almost 25% of the state’s population — had only received 17.4% of the vaccine distributed since Feb. 22, or about 159,000 first doses for more than 2.55 million people.
A report from the Philadelphia Inquirer showed that the suburbs had indeed received fewer vaccine doses per 100,000 residents than less populous rural counties.
For the suburban Philadelphia counties, officials claimed, the problem wasn’t their distribution system but the state’s unfair allotment of dosages.
According to George Choe, president and CEO of the Philip Jaisohn Memorial Foundation, Wolf’s move may get more people vaccinated but it won’t be Asian American seniors with a weak command of English and even less technological savvy — formidable barriers that make a mass vaccination sites too intimidating and difficult to use.
Add to this the recent episodes of hate violence directed at Asian Americans and, Choe said, mass sites are now too frightening to consider for many seniors.
Since 1975, the Jaisohn Foundation has provided medical and social services to the Asian American community with locations in the Olney section of the city, and in Lansdale.
Choe is not alone in his concerns about vaccination rates of suburbanites most at risk and what it means for equity.
Vanessa Briggs, CEO of Brandywine Health Foundation is concerned that building vaccination sites without the concomitant education and targeted outreach will not increase the numbers of minorities, elderly and immigrants who are served, especially in communities like Coatesville, Chester County’s only city, which where 43% of the population is Black, 23% is Latinx, and has a poverty rate of 26%. This is compared with Chester County’s overall, which is 6.2% Black, 7.6% Latinx, and has a poverty rate of 5.9%.
“The shortage of supply and the increased demand has been a problem,” Briggs said. “The Chester County Health Department does have an equity plan but the execution of the plan coupled with limited supply has been prohibitive. I haven’t seen a real targeted approach.”
Coatesville’s City Manager James Logan said, “Yes, we as a city are very concerned about the long, dragged out delays to get our residents vaccinated. We also understand that the county and other stakeholders are advocating for more supplies. However, for weeks we have watched other communities roll out vaccinations through outdoor centers, mobile units, walk-ups, and yet Chester County can’t seem to come up with an effective plan.”
“There are great distribution models and best-practices out there to replicate,” he said, “and if the problem stems from not having enough vaccinations, can we at least plan an effective roll-out sequence so we are ready when we do have enough to administer?
"When you look at Coatesville's diverse population and the only vaccination center providing shots in the city is funded by Chester County, the optics are pretty discouraging."
“Is it an equity issue? That’s hard to say, but when you look at Coatesville’s diverse population and the only vaccination center providing shots in the city is funded by Chester County — the optics are pretty discouraging,” Logan added. “Coatesville has offered up several locations to provide vaccinations, yet the county has only committed to one.”
Another suburban concern is a lack of transportation in communities built around private car ownership. At a press conference in a mass injection site in Lancaster, Wolf assured that “as vaccine supply continues to increase, we want to remind the public that free and subsidized transportation options are already available throughout the Commonwealth and Pennsylvanians can make use of these programs to access vaccine sites.”
“A few churches and residents have taken it upon themselves to bring the vaccine to the community and help those needing assistance to register or drive them to get their first shot,” Logan said. “This effort must be a united one, and how decisions are made requires more communication and engagement to the communities being served.”
The Kaiser Family Foundation (KFF) reported early in March of a consistent pattern of African American and Latinx people being undervaccinated when compared to their COVID burden in terms of cases and fatalities.
KFF’s dashboards showed that Pennsylvania’s white population is being vaccinating a rate proportionate with their population numbers, while Black and Latinx rates are lagging. White residents are 80% of the state and 84% of those vaccinated. Black residents are 11% of the population and 3% of the vaccinated. Latinxs are 8% of the population and 2% of the vaccinated. And Asian Americans, while 4% of population registered 0% vaccinated.
Targeted outreach does benefit the hardest to reach.
“I think we are seen by government representatives at all levels as pivotal to the successful vaccination of Latinos living in southern Chester County,” said LeeAnn Riloff, director of development of LCH Health and Community Services (formerly La Comunidad Hispana). LCH is located in Kennett Square, which is 48% Latinx.
“We have given about 4,000 doses at this time, many to people who would have had no access to the vaccine without us,” Riloff added.
Currently the state is in phase 1A of its vaccine rollout and is also targeting teachers, childcare workers and frontline workers. The state is set to get up to 22 million doses per week by the end of March, compared to about 5 million a week in mid-January, Wolf said.