Oregon About To Double Vaccine Eligibility List As Providers Struggle To Get A Shot Amid Confusion

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Oregon is about to more than double the number of people eligible for a COVID-19 vaccination even though many who are already in line struggle to get vaccinated.

Gov. Kate Brown said on Tuesday that everyone 65 and older would be eligible for a vaccine starting Jan. 23, along with school staff, including people who work in daycare and preschool. 

Her decision came hours after the U.S. Department of Human Services told states to immediately start vaccinating everyone 65 and older along with those who have pre-existing conditions that put them at risk of dying or developing a severe infection from COVID-19. The department said that it would release its stocks of vaccines, including those that were being held as second doses, to allow states to step up their vaccinations.

States will receive allocations based on their population of seniors. Those that don’t use up supplies will have their shipments of vaccine curtailed, the department said.

It’s not clear whether the department made these upcoming vaccine shipments contingent on states vaccinating seniors and people with pre-existing conditions. Brown said seniors would be eligible but did not mention other people at high risk due to underlying conditions. A statement from her office indicated that they will not be eligible in the near future.

“We are still evaluating how the state would implement the (federal government’s) new recommendations to prioritize individuals with underlying health conditions,” said Brown spokesman Charles Boyle. “My understanding is that the number of Oregonians who could potentially be counted as having an underlying health condition as defined by the (Centers for Disease Control) is approximately 1.6 million people. At this point, there are not nearly enough vaccines available for that large a number of people.”

The state’s vaccination campaign began about three weeks ago. The top 1a group includes 500,000 people, including hospital staff, other health care personnel, long-term care residents, dentists, emergency responders and others. 

Brown’s decision to put seniors next in line in the 1b group adds 700,000 to the list of those eligible, Boyle said. Educators and school staff, who Brown had already put in the 1b category, include about 115,000 people, according to the Oregon Department of Education.

The state has received about 325,000 doses. So far, health care providers have given more than 110,000 Oregonians one injection. Both of the vaccines approved for emergency use by Pfizer and Moderna require two doses for full inoculation, either three or four weeks apart. About 9,500 people in Oregon have received both shots, according to Oregon Health Authority data.

The distribution and vaccination process has been confusing and chaotic, with big hospitals getting many doses of the vaccine, and smaller providers being left to scramble.

Nevertheless, Brown welcomed the offer of stepped up vaccine deliveries.

“While this is an unexpected change in course from the federal government, receiving more vaccines is welcome news for states — and Oregon is ready to devote all resources necessary to ramp up distribution with our health care partners,” Brown said in a statement.

Professionals Scramble To Get Vaccinated

Federal experts warned that the vaccine rollout would be messy, and they were right. In Oregon, the process has lacked clarity, fueling confusion and frustration among those outside a hospital system.

The Oregon Health Authority has used hospitals as the primary vaccine administrators, in part because large systems have freezers that can store the Pfizer vaccine at the necessary temperature. That’s made it easy for employees of large hospital systems to get vaccinated, even including staff who telecommute from home. 

Providers in independent clinics largely have been left to their own devices. 

The Oregon Health Authority has not published instructions on how to get vaccinated. The agency hasn’t even posted a phone number for smaller clinics to call.

“It’s catch as catch can,” said Scott Osburne, general manager of West Portland Physical Therapy Clinic in Southwest Portland.

He’s been trying for days to get vaccination appointments for his staff of more than 20, including 10 physical therapists.

He emailed the Oregon Health Authority and received an auto reply from the “OHA Vaccine Planning Unit.” It informed him that “there is no central telephone number to contact or website registry. OHA is working with local public health, health care partners and 211 to determine the best contacts in each community.”

Osburne also contacted Legacy Health, his primary care provider. They said they’d let him know.

Then this week, he found a potential way in. Multnomah, Washington and Clackamas counties posted a “survey” for unaffiliated practitioners to sign up and Osburne did. He received an email saying public health officials would connect him with a health care system or provide an update on the timing within a week.

“This email is purely aspirational,” Osburne said, adding that it is unclear when he might get an answer. “They might tell us in a week but it might be longer,”  he said.

He said the promise of a vaccine was like hearing that “everyone can get a Cadillac - if you can find it.”

Some of his physical therapists got vaccinated this weekend at a drive-through event organized by Oregon Health & Science University and Service Employees International Union Local 503 after one of their patients advised them to show up. The Oregon Medical Association also texted some of its members, saying the clinic had 50 extra doses of vaccine. Dr. Maureen Mays, an independent primary care physician in Portland, called OHSU and was told that people needed an invitation. OMA called OHSU and removed that obstacle, Mays said.

She got a shot on Saturday at Kaiser Permanente, after having a staff member call hospitals to see where she could slip in. She said one of her staff spent 45 minutes on the phone with Kaiser to find the right contact.

Mays shared the number with her contacts. As a result, Thomas Pollard, a 73-year-old dentist in Portland, got an appointment with Kaiser Permanente in North Portland.

“Hopefully it’s going to really take off here soon,” Pollard said. “They didn’t understand what dentistry’s exposure is.”

Vaccinations In Long-Term Care

Oregon Sen. Michael Dembrow, D-Portland, is not worried about health care professionals getting vaccinated. They have the skills to be able to work that out, he said.

He’s concerned about seniors and people with disabilities who live in residential facilities.

“That’s one area -- and maybe the greatest area -- where we’re falling short,” Dembrow said.

Three pharmacy companies -- Walgreens, CVS Health and Consonus Pharmacy -- are responsible for vaccinating people in nursing homes and other residential living facilities in Oregon. So far, they have either held vaccine clinics or will do so within a week in all of Oregon’s 130 nursing facilities, home to 8,500 people, according to the Department of Human Services.

But another 30,000 people who live in assisted living facilities, residential care and adult foster homes are also eligible now for a vaccine, along with 20,000 staff members.

As of Monday, the pharmacies reported they had injected 14,000 doses since the campaign started 15 days earlier. Just under half went to residents, they said.

Though many older people in residential care are at high-risk for COVID-19, not all older Oregonians are being cared for in formal care settings.

“It’s not accurate to say that older adults who have health conditions are only in facilities,” said Joyce DeMonnin, spokesperson for AARP Oregon, which has just over 500,000 members in the state. “The vast majority are being cared for at home.”

AARP, an association for people 50 and older, wrote to Brown this week, urging her to include seniors in a top priority vaccine list. The group welcomed her decision to add those 65 and older to the 1b eligibility list.

“Everyone is so relieved,” DeMonnin said. “There will be a lot of logistical details to work out but this is a great first step.”

Next Steps Unclear

Oregon’s hospital association said its members are ready to deliver.

“Oregon’s hospitals have been enthusiastic partners in bringing the COVID-19 vaccine to our residents, and we are happy that more vaccine is being sent to Oregon,” said Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems. 

Hospitals have led the vaccination effort in Oregon -- and most other states. But with injections lagging, states like California, New York, Delaware, Pennsylvania, Florida, Texas and Louisiana have started working with pharmacies to get people vaccinated.

The National Association of Chain Drug Stores said Wednesday that if federal authorities approved, its members could solve the vaccination problem.

“Retail pharmacies have the ability to administer 100 million vaccine doses in just one month,” Steven Anderson, president and CEO of the association, said in a conference call with reporters.

The only problem, he said, is the supply.

It’s not clear how many doses federal authorities plan to send to Oregon -- -- and when -- and whether the state would be able to keep up.

Oregon has used 35% of the 325,000 doses it has received. That compares with 36% in Washington state and 26% in California, according to the Bloomberg tracker. Nationwide, the average is about 33%, the CDC shows.

If shipments pour in, administrators will have to step up the pace of vaccinations. Critics say the health authority needs to come up with a plan -- and clearly communicate with the public. 

“I don’t dismiss the logistical challenges of this, but they don’t seem to be communicating that there is a plan they’re working on,” said Osburne, manager of the physical therapists’ practice.

He suggested the state hold massive vaccination clinics round-the-clock in convention centers, parking lots or empty school buildings. 

Until now, the largest hospitals in the Portland area have focused on vaccinating their employees. Providence has injected nearly 19,000 people, mainly employees and affiliated professionals, a spokesman said, and OHSU has given more than 17,600 injections to employees and students in its medical, nursing and dental schools. It also vaccinated about 2,200 people at its vaccination events last weekend in Portland and Hillsboro. Kaiser Permanente has administered more than 11,000 doses, and is now focusing on vaccinating nonemployees in the top priority group. Legacy Health has administered about 13,000 doses.

But now hospitals appear to be planning big events. Kaiser Permanente said will hold a clinic next week at the Oregon Convention Center and will hold an “event” this weekend at one of its medical office buildings. Legacy Health said it has opened “two large super site vaccine clinics” at Legacy Emanuel Medical Center in North Portland and at Legacy Meridian Park Medical Center in Tualatin for vaccinating nonemployees. It has committed to vaccinating 1,000 people a day. OHSU will stage another invitation-only vaccination event this weekend wiith SEIU Local 503. It also plans to hold open vaccination sites in the Portland metro area next week, “with the understanding that demand will exceed vaccine allocation.”

Spokespeople for the hospitals released no details.

Just how the state and health care providers will set about alerting and vaccinating the hundreds of thousands of people in the 65-and-over group is unclear.

Brown said state officials will spell out plans on Friday.

She asked those who are newly eligible for a vaccine to sit tight.

“If you are an Oregonian who is newly eligible for vaccination, I am asking for your patience,” Brown said. “Please, do not call your doctor’s office or health care provider with questions about when you can be vaccinated.”

There is one option for those in the 1a group however: Sign up through the new county web page.

Though many applauded the wider eligibility list, some worry that at-risk groups will be left out. 

“In the metro region, we're still very much working our way through phase 1A - first responders, people in long-term care facilities, frontline providers,” said Dr. Sharon Meieran, a Multnomah County commissioner and an emergency room physician. “And this group doesn't even include additional vulnerable populations, such as people who are incarcerated and people experiencing homelessness. With a sudden influx of vaccine supply and a much wider net of eligibility, I'm very concerned that the state will not get the vaccine efficiently or effectively to the people who need it most.”

The state’s vaccine advisory committee, which held its second meeting on Thursday, was created to ensure the state distributed vaccines equitably by recommending priority groups. The health authority has already determined the top tier, and Brown has decided that educators and seniors will be next. That leaves the group to consider others who might not be vaccinated for months.

You can reach Lynne Terry at [email protected] or on Twitter @LynnePDX.




 

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