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COVID vaccine shortages felt most in rural areas

Since the first COVID-19 vaccine became available in December, Texas healthcare providers have vaccinated approximately 2 million residents. With 29 million people living in Texas, state officials are working to get more doses more quickly from the federal government. Courtesy photo

Rural areas are being left behind when it comes to distribution of the COVID-19 vaccine through the state’s hub system, a fact that Texas Department of State Health Services officials hope to change.

Now in its eighth week, the hub distribution system, which expanded to 82 hubs by the week of Jan. 25 from 28 when it began, has slowed to a stop — at least for the next week. No new hubs will be added the first week of February, said Imelda Garcia, chair of the DSHS Expert Vaccine Allocation Panel, which makes these decision. She is also associate commissioner for Laboratory and Infectious Disease Services for the DSHS. She made the comment during a Thursday, Jan. 28, COVID-19 news media update held online.

“There’s still a lot of need out there, and not enough vaccine,” she said. 

The state set up a hub system based on the recommendation of the Expert Vaccine Allocation Panel. Garcia explained that department’s goal is to identify providers that could deliver a high number of vaccines. The state would provide a minimum amount of doses per week to the hubs, which means those providers could at least count on receiving certain doses and eligible residents knew those locations would have some vaccines.

The EVAP looked at providers in the urban/suburban settings that could administer up to 2,000 doses a day and providers in the rural areas that could administer 200-400 doses a day. 

Garcia said the EVAP and DSHS are aware of the need for vaccines in rural counties and have established hubs in many. 

For the Highland Lakes, the two closest hubs are Baylor Scott & White Medical Center-Marble Falls and Hill Country Memorial Hospital in Fredericksburg. DSHS distributed 1,200 doses of the Moderna vaccine to Hill Country Memorial and 975 doses of the Pfizer vaccine to Baylor Scott & White Medical Center-Marble Falls the week of Monday, Jan. 25. The Pfizer vaccine requires extremely cold temperatures for storage, which limits its distribution to hospitals and facilities that have the proper equipment. 

While the state is emphasizing the hub system, Garcia pointed out the EVAP is still identifying non-hub providers to get some doses of vaccines each week, usually in much lower numbers. In the Highland Lakes, those would go to H-E-B pharmacies, Atkin’s Pharmacy, and physicians.

As for determining which hubs and providers get vaccines and how much, Garcia said the process starts the week prior to distribution. On Thursday or Friday of each week, the state makes allocation requests to the federal government. Over the weekend, DSHS staff pore over data and information collected from providers and hubs, analyzing it and then providing it to the EVAP on Monday morning.

The EVAP meets each Monday, usually starting at 7:15 a.m. for approximately three hours. Staff go over the COVID-19 data to then formulate a draft recommendation for vaccine distribution. Next stop for review and approval is DSHS Commissioner Dr. John Hellerstedt.

The issue, Garcia pointed out, is the Centers for Disease Control and Prevention usually doesn’t inform states how many doses of vaccine they will be getting until Tuesday. Once that information arrives, DSHS staff and a smaller contingent of the EVAP refine the state distribution plan and implement it.

The vaccines arrive about mid-week, and the process starts all over again.

Along with distributing vaccines across the geographic scope of Texas, Garcia said the DSHS and EVAP also work hard to make sure vaccines are distributed equitably across all demographics, including those populations who typically have little access to healthcare.

As for expanding vaccine eligibility beyond phases 1A and 1B individuals, Garcia said the panel is in constant discussion over that issue as well as trying to determine who would be in the next phase, whether it’s Phase 1C or Phase 2. Phase 1A includes front line and healthcare workers. Phase 1B includes those 65 and older and those 16 and older with health issues.

Currently, Garcia said there has been no determination of when more phases will be added for vaccine eligibility and who might be in the next phase. The main focus remains on vaccinating those in Phase 1A and Phase 1B. As of Thursday, Jan. 28, Garcia said about one in six Texans 65 and older had been vaccinated, with one in 13 Texans 16 and older vaccinated.

That’s been a tremendous undertaking and accomplishment, she pointed out, but added there’s much more to be done. 

If there’s one thing Texans could practice during vaccine rollout, Garcia said, it is patience.