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Virginia implements new strategies for equitable and timely vaccine distribution following initial challenges

Roadblocks in vaccine distribution have led state leaders to redesign registration protocol, increase distribution to underserved populations and demand increased supply

In order to combat the challenges of vaccinating in remote areas of Virginia, such as the Tidewater region, the Virginia Department of Health is partnering with pharmacies such as CVS, Walgreens, Harris Teeter, Kroger and Walmart, among others.
In order to combat the challenges of vaccinating in remote areas of Virginia, such as the Tidewater region, the Virginia Department of Health is partnering with pharmacies such as CVS, Walgreens, Harris Teeter, Kroger and Walmart, among others.

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COVID-19 vaccination in the state of Virginia has proven to be a logistical and organizational challenge, but officials on the forefront are leading initiatives to streamline the process and construct solutions. The roadblocks have included inefficient online registration, difficulties distributing vaccines to geographically isolated locations, and issues with equitable distribution and inadequate vaccine supply.

The release of the PrepMod pre-registration system, the integration of local pharmacies into the grid of vaccination sites and legislation dedicated to increasing infrastructure and vaccine access through data mobilization are being put into effect and modified to help avoid scenarios resulting in inequitable vaccine distribution. 

With regard to the new pre-registration system which was introduced to simplify the process, Gov. Ralph Northam notes efforts to increase efficiency and accessibility by utilizing technology. 

“Virginia is delivering,” Northam said. “[On Feb. 16], we launched the website and preregistration tool. The response has been very strong.” 

Currently, the site averages 150 pre-registrations per minute, totaling 240,000 registrations since its launch. 

The new system also integrates a call center focused on pre-registering individuals over the age of 75 as well as those who speak Spanish. The call center also offers call-back services for over 100 other languages. 

Yet the preregistration system has not been without problems. Since the system is replacing local health departments’ former databases, the transfer of pre-registration data has been slow and individuals are still waiting to see their data transferred to the new database.

Dr. Danny Avula, director of the Richmond City and Henrico County health departments, recommends that individuals continually check the website to see if their information is added but also potentially re-register, as any duplicate data will be deleted. 

Additionally, PrepMod generates appointment sign-up links which can be shared with other individuals who may not be eligible yet to receive the vaccine. This led to the issue here in Charlottesville — as well as in three to four other districts, by Avula’s estimate — where a larger-than-expected number of individuals, many who signed up via shared links, showed up at designated vaccine sites. However, only 1,500 vaccinations were allotted to be administered at a BRHD Kmart clinic held on Feb. 17, so several eligible individuals were turned away as a result. Those turned away did not meet the qualifications of either being over 65, an essential healthcare worker, or over 16 with a preexisting condition listed on the Virginia Health Department website. 

To prevent future issues like this one, the BRHD held an After Action Review of the clinic to “avoid repeating [these] mistakes,” according to a statement released on Feb. 17.

BRHD also appealed to Northam to fix the link-sharing issue. For the time being, both Northam and Avula are appealing to individuals to simply not share the links in attempts to avoid further inequitable vaccine distribution.

“Otherwise, if you sign up off a shared link that was not intended for you, you should expect to have your appointment canceled and be turned away,” Avula said. Clinics are steadily implementing ID checks to ensure the correct person shows up to each appointment, and those not meeting group 1a and 1b qualifications are turned away.

Another substantial challenge to the vaccination effort in Virginia has been the geographic distribution of vaccine sites. In order to combat the challenges of vaccinating in remote areas of Virginia, such as the Tidewater region, the Virginia Department of Health is partnering with pharmacies such as CVS, Walgreens, Harris Teeter, Kroger and Walmart, among others. 

Avula hopes these partnerships will expand access in more remote areas. 

“In those selections, [we tried] to prioritize geographic spread, making sure that was access in parts of the state … which is why there was a big focus on Walmart in particular, and then the independent pharmacy network of places like Southwest Virginia,” Avula said. 

As well as prioritizing access for geographically separated parts of the state, the Virginia Department of Health has been prioritizing overall equity in vaccine distribution. Janice Underwood — chief diversity, equity and inclusion officer for the Commonwealth — notes that “certain communities have had to carry the burden of COVID-19 more than others.” 

In Virginia, the communities being referenced include Black, Latinx and Indigenous populations, who have a statistically higher chance of contracting the virus due to certain socioeconomic factors.

In order to ensure these communities have access to the vaccine as quickly as possible, Underwood emphasizes a data-driven approach to the distribution of the vaccine. As of now, the rate of marginalized communities receiving vaccines in Virginia are approximately 7.3 percent for Black citizens and 6.3 percent for Latinx citizens, compared to 12.4 percent White individuals who have received vaccines. 

“The health equity working group … is looking at data and using a data-driven approach to discover who is most vulnerable to COVID-19 and create an equity methodology to determine where our vaccination sites should be,” Underwood said.

Part of this data comes directly from vaccination sites, where new legislation in the state of Virginia signed by Northam on Feb. 17 dictates that demographic information must be collected on the vaccine recipient. 

This same piece of legislation also includes a provision allowing healthcare workers previously unlicensed to administer vaccines, such as dentists and medical students, to volunteer to administer the vaccine at various sites. 

Allowing for more medical professionals to vaccinate primes Virginia for an influx in vaccine doses, which Northam is pushing heavily for. In concert with Maryland Gov. Larry Hogan and Washington, D.C. Mayor Muriel Bowser, Northam has pushed President Joe Biden to increase the weekly allocation of doses to states. So far, Virginia is only obtaining one-third the weekly allocation it needs to achieve the goal of herd immunity in accordance with the Biden administration’s goal of fully vaccinating all Americans by July.  Virginia ranks 10th out of 50 states on its vaccine distribution rates as of Wednesday.

Eric Swensen, public information officer at U.Va. Health, agrees with Avula and Northam on the major issue being of supply.

“The major challenge — which is a challenge faced nationally — is a need for a greater supply of vaccine doses,” Swensen said.

Northam is optimistic, however, given the recent FDA authorization of the single-dose Johnson and Johnson vaccine and the premonition that AstraZeneca’s will be approved soon. He continually emphasizes that Virginia’s infrastructure is ready for an influx of doses. 

There is no distinct timeline yet as to when the general public, which will include many University students who fail to meet earlier vaccine qualifications, might receive doses. Due to high demand and low supply, groups 1a and 1b — the latter which includes people over the age of 65, individuals over the age of 16 with preexisting conditions and frontline essential workers — are the only ones eligible at the moment. Group 1c is up next, which includes other essential workers. Explicit timelines for the vaccination of each group as well as group designations past group 1c have yet to be set on the VDH website. 

There have not been updates on any other groups yet. 

In the meantime, though, as Virginia waits to achieve herd immunity, Northam continues to emphasize the guidelines which have been in place since the beginning of the pandemic.

“People need to continue to follow these measures of wearing their masks, of social distancing and keeping their hands washed and that is when we can finally put this pandemic in the rear-view mirror,” Northam said.