Urban and county health departments are already running deficits and will continue to fight to get vaccines out to people, the National Association of County and City Health Officials said.
“The concerns outweigh the benefits here,” NACCHO CEO Lori Tremmel Freeman told CNN.
“The money and financial support that allows this to happen successfully comes after the vaccine has already been distributed – so our local health departments already have a deficit,” she added.
HHS Secretary Alex Azar framed the changes, which are similar to the approach previously announced by the upcoming Biden administration, as something that had always been part of the plan. A senior official told CNN on Tuesday that the shift follows two Operation Warp Speed meetings that Azar has held over the past 48 hours on how to increase the backlog implementation process.
Opening vaccinations to people 65 and older can help in areas where there have been more doses than people who are eligible or willing to receive them ̵
Local health officials are moving to get health professionals in place for a stream of additional Covid-19 vaccine doses – but many of these departments are understaffed and under-resourced, NACCHO’S Freeman said.
“The release of all the other doses and the removal of that restraint are not necessarily seen as a solution to get the vaccine out faster. We still have existing problems – logistical problems – with how to plan and staff this mass vaccination effort,” she said.
‘There is a balance required’
At both state and county level, supply and demand do not always match the Covid-19 vaccine.
The two vaccines approved for emergency use in the United States – Pfizer / BioNTech and Moderna – are administered as two-dose shots at 21- and 28-day intervals, respectively.
With the Trump administration’s new rollout guidelines, Freeman said, there are concerns about mixed messages to the public about how important it is to receive a second dose of Covid-19 vaccine, and when.
“What message does it send the original guidance we received where you have 21 to 28 days to get your second dose? What if that doesn’t happen?” Freeman said. “There is a balance required between wanting to get as many people immunized as possible and ensuring that we are able to cope with the second dose of vaccine and have adequate supply.”
Another concern at the local level is tracing who received their first and second Covid-19 vaccine.
During Tuesday’s news briefing, Azar said the second dose would still be available to those who need it.
‘We are still in the middle of the pandemic’
At the local level, some health departments may decide not to change their plans.
The city and county of Denver, for example, have administered Covid-19 vaccines under Colorado’s Phase 1a and 1b priorities, meaning that health professionals, first responders, and people age 70 and older are the only groups currently eligible to receive vaccine.
To make changes to the step-by-step approach, such as lowering the eligible age to 65, “I think it would be a state decision,” said Dr. Judith Shlay, deputy director of Denver Public Health, told CNN on Tuesday.
“Our governor should make that decision. I’m not sure we’re doing that at the moment, because we really have a lot to do with what we’re trying to do at the moment,” Shlay said.
Some states have decided to open vaccination to more people.
Idaho will open Covid-19 vaccinations to all residents aged 65 and over, from Feb. 1, Gov. Brad Little announced Tuesday afternoon. “We do not want to create a bubble or a backlog,” Little said. “Once we have taken care of capacity, we will be able to reach the population aged 65 and over.”
Meanwhile, the government of Tate Reeves in Mississippi announced that Mississippians 65 or older or those with pre-existing medical conditions can make arrangements for Covid-19 vaccinations.
But Shlay said the commitment is huge.
“What we need to build is the infrastructure that can then be available consistently for several months at a time. This will probably be nine months or a year to get all this rolled out,” she said.
The American Hospital Association said simplifying the process and pushing out more vaccines could help speed up vaccination.
But “for this initiative to succeed at the speed we need it to be, there must be a robust infrastructure across all states and jurisdictions capable of accommodating a large number of people who receive both their first and second shot in time way, “Rick Pollack, AHA’s president and CEO, said in a statement sent to CNN Tuesday.
‘Our local health departments have not always been front and center’
While Freeman spoke to CNN Tuesday morning, she said she was on her way to a meeting with President-elect Joe Biden’s transition team to discuss the rollout of the Covid-19 vaccine.
She said local health departments have been left out of the federal decision-making process.
“Throughout this pandemic, our local health departments have not always been front and center,” she said.
“It is discouraging to us that this kind of decision would be taken without fully integrating the public health system’s response to such a decision, especially because our health departments are so under-resourced and understaffed and are doing really excellent work in spite of that,” he added. she.
“With each layer of complexity that comes along, the weight on the shoulders of our health departments just becomes unbearable. They want to do a good job – they want to protect and immunize their community and do it effectively, efficiently – but this does not necessarily help them do. that. ”
CNN’s Maggie Fox, Andy Rose, Jamiel Lynch and Nick Neville contributed to this report.