Planning, staffing cited amid Iowa’s vaccination struggles

DES MOINES, Iowa (AP) — Iowa’s lagging ability to broadly deliver coronavirus vaccines to people is due to inadequate preparation, confusing communication and a lack of staff and resources at local agencies, according to public health managers and experts.

For weeks, Iowa has ranked near the bottom of states in vaccinating its citizens, and on Saturday it had the 15th-worst rate, according to U.S. Centers for Disease Control and Prevention data. The state had delivered an initial shot to 10,074 per 100,000 people, ranking it ahead of other states including Nebraska, Missouri and Kansas.

About 72% of the nearly 596,000 doses delivered had been administered as of Saturday, according to CDC data. That means Iowa hasn’t been able to administer about one- fourth of the vaccine it has received.

In Iowa, much of the responsibility of vaccinating people has been left to county officials, but that has been difficult since the state hasn’t had a centralized system to sign up for shots. County public health officials have had to reach and sign up eligible people, an especially tough task in small, rural communities where many older people don’t have internet access.

“The elderly don’t have computers and they can’t get in on those online registrations,” said Wapello County Public Health Director Lynelle Diers, who is coordinating vaccines in the Ottumwa area in southeast Iowa. “It’s better if it’s a phone registration. We actually have one privately owned pharmacy that’s doing very, very well in that system.”

Diers worked with the county emergency management director to contact city and township clerks in rural areas to get a list of eligible citizens who could then be phoned when a local vaccination site is established. It’s a logistical problem that takes people, time and money to work through and all are in short supply for county public health departments, many of which have seen their funding cut for years.

As they divvy up about 500 doses a week, Diers said her staff has focused first on vaccinating firefighters, police, emergency responders and teachers at mass gatherings while also sending some doses to pharmacies and clinics that can vaccinate people age 65 and older.

All the vaccine typically is used within a few days after it arrives.

Diers said state officials initially told small counties that had received more vaccine than they could distribute to store it for second doses. That changed and the state advised counties to recruit people from an adjacent county to get a shot. Then the directive changed again to tell them to transfer unused vaccine to a nearby county.

Iowa Gov. Kim Reynolds last week said some counties had fallen behind in vaccinations when they had to cancel clinics because of severe winter weather. She said they’re being rescheduled and those counties will catch up quickly.

Reynolds also said Iowa has one of the highest concentrations of long-term care facilities in the nation, and that getting residents and workers vaccinated in that first phase of the process administered largely by the federal government had taken longer than expected, frustrating many states.

Reynolds said the state will provide contract nurses to help counties that have been slow in administering vaccines due to staffing shortages and may ask the Iowa National Guard to support mass vaccination efforts.

“If necessary, additional doses for some counties may be reallocated to others while we get caught up and that’s just an effort to make sure that we don’t have vaccines that are going unused, and once they get caught up they will go back to their normal allocation,” she said.

Reynolds announced last week that the state had signed a contract with Microsoft to create a statewide registration and appointment scheduling system for residents to sign up for vaccinations. On Friday, her administration announced it was delaying the awarding of a contract to operate a call center to help set up appointments.

Some questioned why a system for scheduling vaccinations hadn’t been established weeks if not months earlier.

“Why that proposal wasn’t done months ago in of readiness is a big question,” said Iowa House Democratic Leader Todd Prichard. “It’s indicative of why we are where we’re at. Why weren’t we leaning forward to be more proactive? Our administration needs to do better.”

Reynolds also has complained that Iowa wasn’t getting enough vaccine from the federal allocation.

There’s no doubt that inadequate supplies of vaccine and issues nationally have hampered efficient vaccine delivery.

Epidemiologist Michael Osterholm, a professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the federal government had failed to implement a national system to register and schedule vaccinations. A federal software system that was proposed by then President Donald Trump’s administration wasn’t effective.

“We should have had a much more well tested and reliable system for the country to use,” he said.

Keith Mueller, a professor and head of the Department of Health Management and Policy at the University of Iowa, said the national plan of distributing vaccine to 21 pharmacy chains has shortcomings because those businesses aren’t located everywhere.

The Rural Policy Research Institute, which Mueller also directs, found there are 111 rural counties with no pharmacies, and it’s likely that more than 300 counties have no pharmacy available to deliver vaccine.

“What we don’t seem to be able to do across the country is take advantage of any existing networks to get this done quickly and efficiently,” he said.