Why West Virginia's Winning The Race To Get COVID-19 Vaccine Into Arms | KGOU
KGOU

Why West Virginia's Winning The Race To Get COVID-19 Vaccine Into Arms

Jan 7, 2021
Originally published on January 10, 2021 9:06 am

Nearly two weeks before most states started vaccinating anyone in nursing homes, pharmacist Gretchen Garofoli went to a long-term care facility in Morgantown, W.Va., on Dec. 15 and administered one of the first COVID-19 vaccinations in the state.

"Psychologically, yes, it was a beacon of hope," she says.

So far, West Virginia is outpacing the rest of the country. Having delivered vaccine to health workers and completed a first round of shots at all its long-term care facilities, the state is now administering second doses and moving on to other populations, including people age 80 and over, and teachers who are 50 and older.

Meanwhile, many other states are still struggling with the complex logistics of distributing the lifesaving medicines.

"A lot of people are looking to us as a state, because after the first week we had, I believe, something like 90% of doses allocated to our state in arms — which was really unheard of elsewhere," says Garofoli, who is also a clinical associate professor of pharmacy at West Virginia University.

She and other health officials say there is likely a number of reasons behind their early success.

For one thing, West Virginia has been charting its own path to vaccine distribution. All 49 other states signed on with a federal program partnering with CVS and Walgreens to vaccinate long-term care and assisted living facilities. But those chain stores are less common in West Virginia, so the state instead took charge of delivering its vaccine supply to 250 pharmacies — most of them small, independent stores.

The federal plan to rely on big chains to get the shots to long-term care facilities wasn't going to work for her state, Garofoli says.

"We have a lot of independent pharmacies or smaller pharmacies that are in the more rural communities, so in order to get the vaccine out to some of those areas, we needed to follow something a little bit different," she says.

Many long-term care sites in the state already use local pharmacies for other vaccines and medicines as well as twice-weekly coronavirus testing of residents and staff. The state decided to piggyback off those existing relationships. Because those pharmacies already had data on many patients, it was easier to begin scheduling appointments in early December, securing consent forms and matching doses to eligible patients — logistics that are confounding efforts in many other states.

This scheme gave the state an early jump on most other states, says Krista Capehart, director of regulation for the state's Board of Pharmacy and chief architect of West Virginia's distribution plan. When vaccines finally arrived, pharmacists were ready, and knew the number of doses they'd need.

"When it got here, we already had pharmacies matched with long-term care facilities, so we were already ready to have vaccinators and pharmacists ready to go into those facilities and start providing first doses," Capehart says.

Delays in advance paperwork and the logistics of distributing these particular vaccines have tripped up the pace of immunization in some other states, says Claire Hannan, executive director of the Association of Immunization Managers.

State and local officials in other places may not have been able to coordinate as smoothly, she says. "They're trying to get CVS and Walgreens to come to their facilities, and CVS and Walgreens are moving at the pace they're moving."

In contrast, Hannan says, West Virginia is more directly in control of the flow of vaccines to long-term care facilities. It's a smaller operation that can adapt and switch gears, while other states must navigate the bureaucracy of huge national chains. "They're not as flexible, they're not as nimble as public health to make adjustments" to move people and vaccine supplies around, she says.

There also have been some missteps in West Virginia. Most notably Boone County health officials injected 42 people with an antibody cocktail instead of vaccine, though were no adverse consequences reported as a result of that error.

CVS and Walgreens dispute the assertion that their rollout is falling behind.

"We remain on schedule, and the number of vaccines we administer will continue to rise as more facilities are activated by the states," CVS CEO Larry J. Merlo said in an update posted Wednesday on the company's website.

Both chains say their immunization schedule is on track, and that they will complete initial doses for all long-term care facilities by Jan 25 — about a month after West Virginia hit its milestone.

States eager to speed up the process should take note of the gubernatorial leadership in states such as West Virginia and Connecticut that are doing relatively well, says Mark Parkinson, CEO of the American Health Care Association, a long-term care trade group and a former governor of Kansas.

"What I would be doing if I was governor is I would be on speed dial with the CEOs of CVS and Walgreens every single day," he says.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

LULU GARCIA-NAVARRO, HOST:

We're about three weeks into the biggest vaccination effort in history. And here in America, it's happening slower than initially promised, except in West Virginia, which has become the first state to complete the initial vaccination in all of its long-term care facilities. Now it's delivering boosters and initial doses to others, including teachers age 50 and over. NPR's Yuki Noguchi explains why it's on a faster track.

YUKI NOGUCHI, BYLINE: Gretchen Garofoli is a pharmacist in Morgantown, W.V., and administered one of her state's first COVID-19 vaccines.

GRETCHEN GAROFOLI: So we got the vaccines on Tuesday, December 15. And we got the vaccines at the pharmacy around noon. And we were out in the nursing home by 2 p.m. administering our first doses.

NOGUCHI: That was nearly two weeks ahead of when most other states started sending pharmacists into long-term care facilities to vaccinate residents and staff.

GAROFOLI: A lot of people are looking to us as a state because after the first week we had, I believe, around 90% of doses that were allocated to our state into arms, which was really unheard of elsewhere.

NOGUCHI: West Virginia is charting its own path to vaccination. Every other state signed on to a federal program to contract with CVS and Walgreens to vaccinate elder care facilities. Instead, West Virginia delivered its vaccine supply to 250 pharmacies, many of them small, independent stores. Garofoli is also a pharmacy professor at West Virginia University. She says the federal plan to rely on big chains wasn't going to work for her state.

GAROFOLI: We have a lot of independent pharmacies or smaller pharmacies that are in those more rural communities. So in order to get the vaccine out to some of those areas, we needed to follow something a little bit different.

NOGUCHI: So the state set up its own distribution system. Krista Capehart was a key architect of that plan. She says many long-term care sites already use local pharmacies for twice weekly COVID testing of residents and staff. By piggybacking on those existing relationships, the state was able to start scheduling appointments and securing consent forms two weeks ahead of others.

KRISTA CAPEHART: When it got here, we already had pharmacies matched with long-term care facilities, so we were already ready to have vaccinators and pharmacists go into those facilities and start providing first doses.

NOGUCHI: The vaccination process isn't easy. The approved vaccines require special storage and handling. Plus, patients must make appointments and sign paperwork. Those factors are tripping up delivery in some states. And patience is wearing thin.

Claire Hannan is executive director of the Association of Immunization Managers, representing state and local public health officials.

CLAIRE HANNAN: They're trying to get CVS and Walgreens to come to their facilities. And CVS and Walgreens are moving at the pace they're moving.

NOGUCHI: By contrast, she says, West Virginia controls its own vaccine supply. It's a smaller operation that can adapt and switch gears, while other states must navigate the bureaucracy of huge national chains.

HANNAN: They're not as flexible. They're not as nimble as public health to make adjustments. You know, add 500 people. Move a hundred people. You know, go to more facilities at one time.

NOGUCHI: CVS and Walgreens insist they are on track. Both say they will complete initial vaccinations in all long-term care facilities by January 25, about a month after West Virginia hit its milestone.

Mark Parkinson is CEO of the American Health Care Association, a long-term care trade group.

MARK PARKINSON: What I would be doing if I was governor is I would be on speed dial with the CEOs of CVS and Walgreens every single day.

NOGUCHI: Parkinson is, in fact, a former governor of Kansas. He credits West Virginia Governor Jim Justice for mobilizing resources early. The challenge is handling the more complex phases of vaccine rollout to the general public. Yuki Noguchi, NPR News. Transcript provided by NPR, Copyright NPR.