If Missouri’s providers aren’t using vaccine promptly, their future shipments may decrease

If a provider has doses for more than seven days, those may count against them in future order requests for vaccine

Doses of Pfizer's COVID-19 vaccine are prepped to be administered to healthcare workers on the frontlines at Truman Medical Center in Kansas City on Dec. 14 (Photo courtesy of Truman Medical Centers/University Health).

The same day the state launched a new dashboard detailing the number of COVID-19 vaccine doses distributed throughout Missouri, state officials made it clear that local providers must move more quickly to administer doses and report data — or risk seeing future shipments decrease. 

And that warning comes from the governor himself. 

“The comment that I will very briefly close with — and this comes from the governor — if you have inventory of vaccine at the present time… please be putting that into an eligible Missourian’s arms. Don’t wait,” Robert Knodell, Gov. Mike Parson’s deputy chief of staff, said during a call with vaccinators on Tuesday.

He later added: “Please get that out. Get that into someone. It is so, so very important. It will impact your ability to receive additional vaccines for your community in the future and it will impact the decisions that we make.”

Moving forward, if a provider has doses for more than seven days, those will be considered as part of their “on hand” total and may count against them in future order requests, said Ted Delicath, a principal with the McChrystal Group, a Virginia-based consulting firm hired to advise the state’s response to the pandemic.

The state awarded a lucrative no-bid contract to the McChrystal Group after a nonprofit had covered up to $600,000 in expenses for its work in Missouri.

According to state records, the McChrystal Group has been paid nearly $2 million by the state.

“There’s still a significant number of providers who are not reporting vaccine,” Delicath said, later adding, “That’s a problem for a lot of reasons, chief among which that is probably most important to you: if we cannot see what vaccine you have in your inventory, we are likely not going to send you more.”

Delicath stressed that the new policy was not designed to be punitive, but to facilitate quickly getting doses out to residents. He urged providers having trouble reporting either vaccines received or administered to reach out to the state, “because not reporting is simply not an option.”

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The CDC says vaccinators should report data within 24 hours after a dose is administered, and Missouri’s standing order for Pifzer and Moderna says providers should enter data into the state’s system within 24 to 48 hours.

State officials have cited a backlog in reporting as a factor contributing to the state’s seemingly low number of doses administered. The state faced criticism earlier this week after data from the Centers for Disease Control and Prevention showed Missouri was last in the country in terms of the percentage of residents who had received their initial dose.

During a press conference Thursday, Parson said the CDC’s data is “totally misleading” and pointed residents toward the state’s dashboard for the most up-to-date data.

According to the state’s dashboard, 5.7 percent of Missouri residents have received at least the first dose of a vaccine as of Thursday. The CDC’s data puts that figure at 4.8 percent as of Thursday.

Relying on the state data is difficult because Missouri does not publish on its dashboard the total number of doses it has been allocated from the federal government. According to the CDC’s data, of the 822,850 doses that have been allocated to Missouri, 382,552 have been administered — or about 46.5 percent.

Meanwhile, Missouri’s dashboard lists 457,440 doses as being administered — which would be about 55.6 percent of the total doses allocated if the number of doses allocated to the state has not increased from the CDC’s figure.

“I won’t quibble here about (being) last in the nation. I do think those numbers are slightly misleading,” Delicath told vaccinators on Tuesday’s call. “However, the broader truth is correct, and that is we are at the lower end right now.”

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In an effort to quickly boost the state’s numbers, mass vaccination events will be held at 27 sites across the state — rotating through nine sites each week.

Originally scheduled as a one-day event, the first mass vaccination held in Poplar Bluff last Friday extended to Saturday. It was held across two sites and in total 2,266 doses were administered over the course of 13 hours, according to a presentation during a meeting Thursday of the state’s Advisory Committee on Equitable COVID Vaccine Distribution.

The state also plans to bolster deliveries to a set of sixteen “high-throughput” systems, like large healthcare systems, that have the capacity to vaccinate about 5,000 residents a week. The sites are not yet finalized, and will be rotated in a set of eight sites each week, Delicath said.

“If you receive that 5,000 doses, you are making an explicit agreement with the state and its citizens to serve all eligible Phase 1A through Phase 1B, Tier 2 populations,” Delicath said. “So you cannot turn away folks if you have doses and you will be a representative of the community.”

The state estimates receiving an allocation of about 75,000 doses of vaccine from the federal government each week through February, Delicath outlined on Tuesday’s call.

However, requests from hundreds of providers have totaled two to three times the number of doses available, he said.

Last week, state health department officials said the state received about 240 requests for roughly 254,000 doses. Meanwhile, the state was only expecting to receive 76,225 doses.

“And we are only going to see that disparity — if our supply stays the same — grow as more vaccinators are becoming enrolled and requesting,” Delicath said.

Mass vaccination events are expected to be allocated about 17,550 doses — or about 23 percent of the state’s weekly allocation — and the “high-throughput” systems are expected to receive about 40,000 doses — or about 54 percent of the state’s allocation.

The remaining 18,000 or so doses will be divided between Federally Qualified Health Centers, local public health departments and community providers.

Members of the state’s Advisory Committee on Equitable COVID Vaccine Distribution had raised concerns last week that with thousands of doses being distributed to mass vaccination events, there would be fewer left over for providers — making equitable distribution more difficult.

“We recognize that when market supply is as constrained as it is, we are not going to be in a situation that everyone in the marketplace will be happy,” Adam Crumbliss, the director of DHSS’ Division of Community and Public Health, told vaccinators on Tuesday’s call.