Some Michiganders finesse COVID-19 vaccine priority list, jump ahead of vulnerable | National

Monto, an octogenarian who lives in Ann Arbor and serves as acting chair of the U.S. Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee, said he hasn’t yet been vaccinated.

With the demand so high and the supply of vaccines so low, Monto said he’s holding out to make sure his wife, who also qualifies for vaccination because of her age, will be able to snag an appointment for a shot in the arm. So far, they’ve had no luck.

Loopholes have enabled younger, healthier less at-risk people to get vaccinated ahead of elderly people, who are most likely to be hospitalized and die if they are infected with the virus, and front-line workers, whose jobs expose them to a virus that has infected more than half a million Michiganders and killed nearly 14,000 so far in the pandemic.

All the jockeying for vaccines takes on even more urgency now that state health officials have announced a more contagious variant of the virus has been detected in Michigan. The B.1.1.7 strain, which originated in the United Kingdom, was identified Saturday in a Washtenaw County woman.

Though the U.K. variant is not known to be more deadly, it is more transmissible. Though the variant is more contagious, scientists believe both the Pfizer and Moderna vaccines still offer protection, and urge people to use precautions such as mask wearing and social distancing until more people are vaccinated.

Those eligible for vaccines in the state now include health care workers, those who live or work in a long-term care centers, people ages 65 and older, teachers, day care providers and law enforcement officers — all of whom fall within phase 1A, 1B, or — for those ages 65-74 — 1C priority groups.

One of those loopholes was exploited through the St. Joseph Mercy Health System. There, a web link created for doctors, nurses and other health care workers to make appointments to get their shots was “in some cases … shared publicly, resulting in unexpected submissions beyond 1A participants,” said spokeswoman Laura Blodgett.

“As we move forward with vaccine administration of our community, we are in a position in which we need to trust that people who identify as being in an age group or essential occupation currently permitted by MDHHS (Michigan Department of Health and Human Services) are being truthful.”

But not everyone is being honest.

“I had a patient just yesterday who was 63 or 64 and reported to me that he had had the COVID vaccine because he had quote-unquote ‘connections,’ ” said Dr. Michael Williams, a primary care doctor in Rochester Hills who also is president of United Physicians, one of southeastern Michigan’s largest independent practice associations with 1,700 physicians.

“I can’t speak for how that was done. Do I think there are people that have already received the vaccine that should have been prioritized behind others? Of course.”

States still need more vaccine

So far, Michigan’s share of the national supply of 31 million doses of Pfizer and Moderna’s COVID-19 vaccines has been 831,150 doses.

Gov. Gretchen Whitmer has tried to secure more. Earlier this month, she joined a coalition of eight governors in appealing to the U.S. Department of Health and Human Services to release doses of the vaccines that the department was said to have been holding in reserve.

HHS Secretary Alex Azar pledged last week to release those doses to states, but a Washington Post report published Friday revealed that federal stockpile of vaccines doesn’t exist; every dose that has been delivered to the federal government has already been used up.

Officials at the U.S. Department of Health and Human Services did not respond to a Free Press request for comment.

Pfizer reported Friday afternoon that it has been holding onto second booster doses for the COVID-19 vaccines it has already distributed at the request of the federal government, according to a report published by Reuters.

“Operation Warp Speed has asked us to start shipping second doses only recently,” a Pfizer spokeswoman told Reuters. “As a result, we have on hand all the second doses of the previous shipments to the U.S.”

All the uncertainty led Whitmer to write a joint letter to Azar with Wisconsin Gov. Tony Evers and Minnesota Gov. Tim Walz, saying: “It has become abundantly clear that … the American people have been misled about these delays.”

“Pfizer just announced … they have millions of doses of the vaccine on hand and are waiting on addresses from the Trump administration so they can deliver the vaccine to states. If you are unable or unwilling to give us that supply, we urge you to grant permission for us to directly purchase vaccines so we may distribute them to the people of Michigan, Wisconsin, and Minnesota as quickly as possible.”

Based on the current supply of vaccines, the state health department’s immunization timeline estimates it won’t be until May when all of the health care workers in the state who want a vaccine will get one.

And it’ll be late June or early July before all the Michiganders age 65 and older, people living in long-term care facilities and essential workers such as teachers, child care workers and law enforcement officers get immunized.

The timeline shows that vaccinations for other essential workers and people ages 16-64 years with underlying health conditions that puts them at high risk for serious COVID-19 complications won’t open up until May.

And immunizations for the general public — people younger than 64 without chronic health conditions that put them at high risk or a job as an essential worker — won’t begin until mid-August.

The state’s timeline for immunizations “is dependent on our vaccine supply and subject to change based on that supply,” said Lynn Sutfin, a spokeswoman for the state health department.

Every week since mid-December, Michigan has gotten 60,450 doses of the Pfizer vaccine, which health officials divvy up among its 133 hospitals and health systems and four dozen local health departments, she said.

All of the doses of the Moderna vaccine delivered to the state so far — 241,500 doses — have been put in a bank for use in long-term care facilities such as nursing homes.

But next week, Michigan is slated to get nearly 2,000 extra doses of the Pfizer vaccine and was granted permission from the federal government to pull 60,000 doses of the Moderna vaccine initially allocated to long-term care facilities for use in hospitals and at local health departments, Sutfin said.

“We were notified on Wednesday that we could allocate doses of Moderna from the LTC ‘bank’ to providers in Michigan and defer doses from a later week’s allocation for this program,” she said.

“This means an additional 60,000 doses will be sent to providers” at hospitals and health departments,” Sutfin said. The people living and working in long-term care facilities are getting COVID-19 shots through a federal partnership with CVS and Walgreens.

“These are vaccine doses that have not been requested from the ‘bank’ by CVS and Walgreens and won’t be needed this week based on the clinics they have scheduled. We will be replacing those doses in future allocations.

“This is being done to accelerate vaccine delivery as we work to reach our goal of vaccinating 70% of Michiganders over age 16 as quickly as possible.”

Primary care doctors left out of vaccine plan

Prioritizing who should be first to get vaccinated, finding the most vulnerable and ensuring others don’t skip ahead of those most in need is a logistical challenge when there are so few doses and so many people who want them.

U-M’s Monto said it’s a mistake that many health systems are randomly inviting patients 65 and older to come in for vaccine appointments. He said a tiered approach by age would be a more responsible approach, knowing that the older a patient is, the more likely that person is to die from COVID-19.

Family medicine and primary care physicians say they have long-standing relationships with patients and are in a unique position to help ensure that the people who most need vaccines get them — if state health officials would only include them in the process.

So far, they’ve all but been left out of the vaccination efforts, said Julie Novak, CEO of the Michigan State Medical Society.

“Primary care physicians … are responsible for the majority of the regularly provided vaccinations in Michigan,” Novak said. “In fact, while the state of Michigan makes a push (to) get all patients caught up on all needed vaccinations, the COVID-19 vaccine has not been made available to the physicians and their staff who know these patients and have the expertise, equipment and processes in place to administer these vaccines.

“These physicians and their staffs have been left out of the initial distribution plan. In order to protect front-line health care workers and increase access to the COVID-19 vaccination for everyone in a timely manner, this needs to change.”

When Dr. Robert Jackson thinks about who is most vulnerable in this coronavirus pandemic, he thinks of a patient he calls Ms. S, who is 92 and blind.

He knows she should have a COVID-19 vaccine, but to get one, “her grandchildren have to figure out how to get her a vaccine and how to get her there.”

He thinks about the elderly couple he calls Mr. and Mrs. M, who live five blocks away from his office in Allen Park. Their last flu shots, he said, “were given by me in their house because they can’t get out.

“So you see a number of these vulnerable seniors who should be getting the vaccine that probably won’t ever in the present circumstance, and that worries me,” said Jackson, who is a family medicine doctor with Western Wayne Physicians.

Many of his older patients don’t have access to online patient portals and don’t have smartphones or internet access to sign up through hospital systems that are immunizing those 65 and older.

That’s another problem with the way this vaccine program has been rolled out, said Jackson, who also is medical director and president of Accountable Healthcare Alliance, a consortium of primary care doctors and specialists.

“They’re trying to build out new infrastructure for vaccine delivery when there’s already some infrastructure,” Jackson said. “Close to two-thirds of vaccines in the state are given by primary care physicians, and we’re on the back bench. We’re not even playing the game, so to speak.”

He has to tell patients who call his office that he can’t get them the COVID-19 vaccines. Instead, he urges them to try to sign up online through their local hospitals and hope to be randomly selected among hundreds of thousands of patients to schedule an appointment or wait for an opening to pop up with the local health department, which could be months away.

Williams, of United Physicians, said it’s a flaw in the the system that he hopes will change as more supply of vaccines is made available.

“I think everyone’s frustrated,” Williams said, “including my 81-year-old father who lives in Temperance and has not been able to really find many answers as to where he can go get a vaccine. He’s probably very common to many, many senior citizens who are wanting to get the vaccine but they’ve just not been able to find it.

“The doctors know which of their patients are most in need,” Williams said. “A lot of the independent doctors and private practice and primary care doctors run flu clinics in the fall to mass vaccinate their patients, especially those at higher risk. And they have operational strategies that can really be used to deliver the COVID vaccine to the appropriate people.

“That’s a little bit of an overlook right now. We hope to maybe see that delivery of vaccine distribution to include primary care doctors to make sure that we’re getting the right people first. … We can make sure that we are prioritizing people based on their medical need. … I don’t think the health departments, or the hospitals for that matter, have enough access to information on all patients to decide who should be higher priority than others.”

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