On a recent Saturday morning, Peggy Hoon got behind the wheel of her 2011 Toyota RAV4 and made the 300-mile round trip to Charlotte from her Raleigh home.
After weeks of waiting on hold or hearing about COVID-19 vaccination events only after they'd filled up, the 65-year-old Wake County resident finally got a shot. She considers herself lucky and worries about equity issues that leave other seniors unable to find doses of the precious vaccine.
State officials say the primary barrier to rolling out the vaccines has been a lack of supply. But the N.C. Watchdog Reporting Network found that in some cases, health workers are giving doses to people who do not yet qualify, according to guidelines from the N.C. Department of Health and Human Services.
And that means people like Hoon, among those at the highest risk of serious injury or death from the disease, are left waiting.
"That's taking a vaccine away from somebody that it might really make a difference if they got COVID rather than the person (getting it through) the back door," Hoon said.
Per DHHS guidelines, only Group 1 – health care workers and long-term care residents and staff – and Group 2 – those age 65 and older – qualify for the vaccine. When a young person jumps the line ahead of an older person with higher risk factors, the result could quite literally be deadly. Those aged 65 and older represent just 14% of all COVID-19 cases in the nation, but 81% of all deaths, according to data from the Centers for Disease Control and Prevention.
The reporting network found that speed and equity are in conflict with each other, an issue exacerbated by the quickly expiring nature of the vaccine and the near impossibility of policing every vaccine clinic.
In short, the vaccine distribution system operates largely on the honor system, and a few have taken advantage, risking the health of other North Carolinians.
Millions In Need; Still Limited Doses
In Ashe County, at least a dozen people under 65 were vaccinated. Staff at AppHealthCare, the three-county health department that includes Ashe, took out doses of vaccine to give outside of the office.
The N.C. Watchdog Reporting Network confirmed dozens of doses of vaccine were taken from the health department against protocol. A department spokeswoman refused on multiple occasions to confirm details of who took the vaccine doses and where they went.
Initially, a spokeswoman for the health department dismissed the out-of-office vaccinations as just an effort to discard leftover doses at the end of the day.
"Our staff did utilize up to 10 doses on separate occasions when a vial of 10 was unused and was about to expire," AppHealth spokeswoman Melissa Bracey told the network in an email last Wednesday.
But she followed up a day later, after the network posed questions about the situation to DHHS, to say the local health department was now investigating.
A week later, Bracey said in an email the department's investigation found a total of 40 doses of vaccine had been given outside of the agency's protocols, and 13 doses outside groups 1 and 2, but did not elaborate on how.
Clinics around the state and country have been directed to not let any vaccine go to waste, even if it means giving a dose to a younger person.
There have been other examples of skirting state regulations:
- In New Hanover, county commissioners all received a vaccine after a commission meeting on Jan. 13, despite the state still being in Group 1
- In Chapel Hill, two UNC basketball coaches were able to get the vaccine
- In Charlotte, Atrium Health scheduled appointments for non-health care workers
- In Durham, some sheriff's deputies were vaccinated, the Durham County Department of Public Health confirmed. A spokeswoman said they scheduled appointments under previous vaccine priority guidelines and were allowed to keep their appointments after the guidance changed
- In Union County and Dare County, teachers and school staff were vaccinated because clinics were scheduled prior to the change in vaccination prioritization
In almost all cases, spokespeople for those who administered vaccinations had what they considered valid reasons for not following state guidelines to the letter of the law.
A New Hanover County spokesperson said commissioners had received the vaccine because there were extra doses, and later said they were vaccinated due to their position as elected leaders.
"Commissioners are leaders in this community, elected by our constituents to govern New Hanover County, and we were each vaccinated in our public duty capacity and not as private citizens," said New Hanover County Chairwoman Julia Olson-Boseman. "I certainly want to keep each person on the board as safe as possible, as they are asked to meet in person as a group and go out in the community to do the job the people elected us to do."
State and local health officials say those cases are the exception, not the rule. The main reason seniors looking for a vaccine can't find a place in line, they say, is simply due to vaccine scarcity.
"We have millions of people who need it, but only thousands of shots," Gov. Roy Cooper said at a recent press briefing.
Groups 1 and 2 combine for some 1.7 million people. To date, the state has been allocated only 1.4 million first doses, and not all of those have even arrived in the state yet. People 65 and older account for more than two-thirds of all first doses administered, a figure that does not include the long-term-care vaccination program.
The need for cold storage requires doses to be used quickly, and many of the vials actually contain an additional dose beyond what is scheduled. The CDC and state health officials have strongly urged clinics to waste absolutely no doses, but that leaves clinics not exactly sure how many doses they will be able to provide.
"Some providers have put in place waiting systems, sometimes requiring people to wait outside in line," said Julie Swann, the department head of industrial and systems engineering at N.C. State University, who has been analyzing the public health impacts of COVID-19. "And the people who are perhaps best suited for that, may be younger populations who can stand out if it's cold or rainy."
Leftover Doses
Analyzing DHHS data shows there have been more than 60,000 leftover doses administered in North Carolina. But even those shouldn't go out of the priority order, according to DHHS guidelines.
"Going out of a priority order should be a very unusual circumstance. It should not be the thing that is happening each and every time," said DHHS Secretary Dr. Mandy Cohen. "But we do not want vaccine wasted, so we recognize that there are some places where we want to just make sure that we get vaccine into arms and are not wasting it."
Health systems in the Triangle say they have implemented backup plans to distribute extra doses equitably.
Dr. David Wohl, a UNC infectious disease expert who is overseeing vaccine distribution at the Friday Center, described what they call "power hour" at about 4 p.m. when clinic staff estimate how many end-of-day doses they will have, and how those could best be distributed.
Gaps In Reporting, Monitoring
In some ways, clinic staff rely on people to be truthful about their group number. Staffs have been overworked for a year, and it's not their responsibility to police groupings. Wohl said his staff tries to verify eligibility, but acknowledged they rely at least somewhat on patients self-identifying.
"But I would say to you, the vast majority of people we're seeing here, they're not cutting the line," Wohl said. "These are people coming in with walkers, in wheelchairs, you know, canes. We're reaching the right people."
In the long-term care program, there is less of the public disclosure that could reveal violations of protocol. The federal government contracts directly with Walgreens and CVS to distribute vaccines in long-term-care facilities. Spokespeople for both pharmacy chains said individuals are required to "attest" to their eligibility. In most cases, individuals are asked for an identification card to confirm identity, though that doesn't necessarily prove eligibility for people younger than 65.
Similarly, state DHHS leaders have said they are not monitoring the thousands of individual vaccine recipients entered into the state's computer system.
In December, Atrium Health in Charlotte scheduled employees to be vaccinated who worked in non-health care roles. In response to public outcry, the hospital said the state had approved those employees receiving the vaccine.
But DHHS said that wasn't true.
After news of the hospital's scheduling employees out of turn broke, though, state officials contacted Atrium and dozens of appointments for non-health care workers were canceled.
This story was jointly reported and edited by Laura Lee and Frank Taylor of Carolina Public Press; Tyler Dukes, Adam Wagner and Jordan Schrader, of The News & Observer; Nick Ochsner of WBTV; Michael Praats of WECT; Ali Ingersoll and Travis Fain of WRAL; and Jason deBruyn of WUNC.
