The final goal of COVID-19 vaccination programs is to make so many people immune that a sick person recovers without infecting anybody else. To reach that goal will require overcoming barriers to cooperation between health departments, hospitals, pharmacies and private providers. All have special strengths in a partnership of vaccinators. State and local health departments have a special mandate to facilitate partnerships to help everyone get the most out of vaccinations.
With doses scarce, following clear prioritization rules will offer the most benefit. The prioritization rules were created with extensive open deliberation that includes impacted communities, business leaders, health officials, ethicists and economists. The framework for prioritization was designed to minimize death and severe disease while preserving the function of society and addressing disparities. We must all ensure that the prioritization rules are understood and followed. Public health departments are working to communicate the priority groups and hold all vaccinators accountable for sticking to the guidelines.
Radical laissez faire thinking questions the role of the public sector. An extreme view holds that free markets and unfettered entrepreneurs are the best way to solve all problems of allocation. That ideology would only work if it really did not matter who got a vaccine. With free markets, goods go to the highest bidder or to the most shrewd or most powerful. However, people who have the most to gain from COVID-19 vaccines right now include the most vulnerable and those least capable of elbowing themselves to the front of the line. In Harford County, the leaders of the hospital and the local pharmacies sincerely want to reach the most vulnerable, and they work with the public health department to get vaccines out to priority groups as fast as they arrive. A collaboration where health departments check on who is getting vaccinated and use this data to help partners close the gaps will help all succeed.
There is a misconception that the state’s local public health departments are falling behind on delivering doses. This is a misunderstanding of the statistics that compare doses allocated to counties versus shots administered. The count of doses allocated includes a reserve stock of second doses that have to be on hand to guarantee that each person who gets a first dose will get a second dose. Throughout January as health departments successfully ramped up delivery of first doses, they were mandated to hold on to these reserve stocks of second doses that would go out 3 to 4 weeks later.
Using up reserve second doses to deliver more first doses would be a reasonable consideration in a world where everybody was sure that new second doses would be produced and delivered. But we do not live in that world. If a local health department reallocated a second dose to offer a first dose they could not be guaranteed a replacement second dose. Growing reserve stocks made the number of doses allocated to counties appear higher than the number of first dose shots administered. This made it look like health departments were idling when the opposite was happening. The way to evaluate the performance of a supply chain is to compare wholesale inflows to retail outflows. In the Harford County Health Department, the weekly outflow of first doses into arms was 90% of the weekly inflow into freezers in the first week of January and no less than 100% ever since. Baltimore County Health Department has been vaccinating 500 people an hour at just one of its sites, and if more doses arrive they could double that and scale up elsewhere.
Besides being able to deliver vaccines as fast as the trucks roll up, local health departments are using data from the vaccine registry to find and close gaps. Public health departments share data on where COVID-19 case rates are highest by ZIP code. They use and publicize data on groups that are not being reached by COVID-19 vaccine. Health officers are meeting with local citizen volunteers to reach people who cannot use the internet. Public health departments work with minority groups who have doubts. Listening sessions to hear from minority groups and answer questions and concerns have already started.
This focus on data and partnerships that close gaps is the special advantage of local health departments. Until we are really able to reach everyone with COVID-19 vaccine and leave nobody behind, a healthy balance of private sector and public sector efforts to get shots in arms is the best way forward.
Dr. David Bishai is the Health Officer of Harford County; he can be reached at email@example.com.