The dozens of open appointment slots in the three Southern states stood in sharp contrast to the availability in states such as Delaware, Connecticut and Pennsylvania.
Last week, as COVID vaccine appointment slots were snapped up within an hour at CVS stores in 20 states, slots remained open all day at CVS pharmacies in Alabama, South Carolina and Louisiana.
The dozens of open appointment slots in the three Southern states stood in sharp contrast to the availability in states such as Delaware, Connecticut and Pennsylvania, where appointments generally were gone by midmorning or earlier. CVS and other retailers typically post appointment slots around 7 a.m. for the next day.
In many counties across the three states — particularly in rural areas — retailers and outpatient clinics are among the few places offering COVID-19 shots. CVS and other large pharmacies, including Walgreens and Walmart, are among the biggest providers of the vaccinations.
South Carolina health officials said they noticed demand was waning at some vaccine sites — and, as a result, lowered the age eligibility for the shots from 65 to 55 starting Monday.
"Reports here and there from around the state, not everywhere, indicate vaccine appointments have not been filling, so this was the time to do this," said Nick Davidson, senior deputy for public health at the South Carolina Department of Health and Environmental Control.
Marvella Ford, a professor in the department of public health sciences at the Medical University of South Carolina in Charleston, wasn't surprised by the vacant appointments.
"We know we have work to do to engage with the community to get the word out about the safety and effectiveness of the vaccine," she said. Many in the state's large Black community are skeptical about the vaccine, she said, and many poor residents in rural areas face hurdles, including lack of transportation to vaccine sites and lack of internet access to book appointments.
"There are a lot of barriers," Ford added, "and we want to shine a light on them so we can figure out a way to overcome them."
Ford is a leader of a Black faculty group that, along with a Hispanic faculty group at the medical school, has been meeting with community organizations across the state to urge Black and Hispanic residents to get vaccinated.
Dr. Scott Harris, Alabama's state health officer, attributed the openings at CVS to the pharmacy chain having recently added several stores offering the vaccine. "I do not believe there is an issue with uptake, but we will continue to monitor this," he said.
As of 4 p.m. Friday, all 33 Louisiana CVS stores that are offering vaccines had dozens of open Saturday appointments for COVID vaccines.
Two-thirds of the 80 participating CVS stores in South Carolina had openings. About half of the 56 CVS stores in Alabama administering vaccines still had availability.
CVS spokesperson Mike DeAngelis could not explain why the three states had more supply than demand. "We are aware that demand for vaccine appointments at our pharmacies is stronger in some states than it is in others," he said. "We are working across multiple fronts to increase awareness of vaccine availability, safety and effectiveness."
CVS is one of several large, national pharmacies offering COVID shots. But it's the only retailer that makes it easy for people to go online and search by state for open appointments over several days. At Walgreens and Walmart, users can search for the shots only by ZIP code.
As a result, consumers in states where vaccines remain extremely limited can easily see where CVS appointments remain aplenty. While some states have enacted residency requirements to block out-of-state visitors from getting vaccines, other states such as South Carolina have not.
Lior Rennert, a biostatistician at the Clemson University School of Public Health who has worked on South Carolina's vaccine rollout, said he was surprised to hear of the open slots since the state ranks in the top 10 nationally in the number of vaccines given out, measured as a percent of population. Yet, he said, politically conservative states like those in the Deep South face more challenges overcoming vaccine hesitancy than more liberal states.
He expects open slots to get filled up as the state expands eligibility.
"If there continue to be a lot of openings in the next week or two, that may indicate either a lack of communication about availability at CVS locations or that there is simply not as great of a demand due to vaccine hesitancy," Rennert said.
As President Joe Biden's pandemic relief package steams through Congress, Democrats have hitched a ride for a top healthcare priority: strengthening the Affordable Care Act with some of the most significant changes to insurance affordability in more than a decade.
The bill would spend $34 billion to help Americans who buy insurance on the marketplaces created by the ACA through 2022, when the benefits would expire. The Senate sent its relief package, one of the largest in congressional history, back to the House where it could come up as early as Tuesday. It is expected to pass and then go to Biden for his signature.
Those who have studied the legislation said it would throw a lifeline to lower- and middle-income Americans who have fallen through the cracks of the government's eligibility requirements for ACA assistance. Stephanie Salazar-Rodriguez of Denver, for instance, is hopeful it will make a difference. Without changes, she expects to spend more than $10,000 on premiums this year after losing her primary job, and her insurance, last month.
If her annual income were $3,000 less, she could pay as little as $3,000 a year after subsidies.
"To me, that's not affluence," Salazar-Rodriguez said. "You're talking about people who are struggling to survive."
The legislation could also provide relief to others who purchase insurance on the exchanges and opt for policies with lower premiums but high deductibles — and often avoid seeking care because they don't have the cash to cover those costs. Most of the nearly 14 million people enrolled in plans sold on the marketplaces would pay less under the new provisions, with the option to use those savings to buy a new plan with a lower deductible.
The Congressional Budget Office also estimated an additional 1.7 million people would enroll in the exchanges under the proposal, about 1.3 million of whom are currently uninsured.
Republicans, who have repeatedly tried to repeal the ACA, hammered Democrats over the years with allegations that many of the marketplace plans are not affordable and prevent people from buying coverage. They argue the new legislation offers unnecessary help to wealthier Americans while doing nothing to lower the cost of insurance.
Now that Democrats have control of the White House and Congress for the first time since the passage of the ACA, they are moving quickly to make changes to the landmark healthcare program.
The COVID relief package also includes other proposals to increase healthcare affordability, particularly for the unemployed. Those receiving unemployment benefits, typically ineligible for subsidies on the exchange, would be temporarily eligible.
In addition, the Senate version of the bill would pick up 100% of the cost of premiums for those on COBRA, the program allowing recently unemployed workers to privately purchase coverage offered by their former job, often at a high cost. The House had included a similar provision but provided only an 85% subsidy. According to CBO, the House COBRA changes would have cost nearly $8 billion with about 2.2 million people expected to enroll — a huge expansion of the subsidy program.
The legislation, which includes a bevy of anti-poverty provisions, also offers an extra financial incentive to about a dozen states that have not expanded Medicaid, the program that covers low-income Americans.
Pandemic Spurs Effort
Advocates and public health experts say it is critical to help people afford health insurance since millions lost their jobs and their job-based health insurance in the pandemic and about 59,000 Americans are contracting COVID-19 every day.
"It just becomes the thing people can't afford when they've lost their job," said Katie Keith, an expert on the Affordable Care Act with Georgetown University's Center on Health Insurance Reforms.
About 15 million uninsured people could buy insurance through the exchanges, most of whom would be eligible for new or larger subsidies under the proposal, according to KFF. (KHN is an editorially independent program of KFF.)
Frederick Isasi, executive director of Families USA, which advocates for healthcare affordability and supported the passage of the ACA, said more than half of those eligible for coverage cannot afford it. "Health insurance is about financial security and health security," he said.
Under the ACA, subsidies are calculated based on the recipient's income, age and their area's average premium costs.
The proposal would ensure no one who buys insurance on the exchanges pays more than 8.5% of income. Currently, subsidies are available only to those making between 100% and 400% of the federal poverty level (for those seeking subsidies in 2021, between $12,760 and $51,040, for an individual).
Some marketplace customers near the federal poverty level who now must pay some of the premiums out-of-pocket could get a subsidy that pays the entire cost of a silver, or midlevel, plan.
The change would also benefit Americans who make more than the subsidy cutoff. About 3.4 million uninsured people fall into this category, according to the KFF analysis.
For example, currently, a 60-year-old who makes $50,000 annually pays no more than $410 per month out-of-pocket for a silver plan on the exchanges, with the government chipping in $548 per month.
A 60-year-old who makes $52,000 annually would receive no subsidy and would be expected to pay the full premium herself, at a cost of about $957 per month for the same plan, KFF found.
For Salazar-Rodriguez, that cutoff carries a heavy cost. She was recently laid off from her job at a community health organization that has struggled during the pandemic, and now she pays $913 per month out of her own pocket for insurance.
In a little less than a year, at age 65, she will qualify for Medicare. For now, her age is a liability. Older, pre-retirement Americans pay some of the highest premiums in the nation.
Having once worked assisting people enrolling in the exchanges, Salazar-Rodriguez went straight to the marketplace for coverage when she lost her job. But she was startled to discover how high her premiums would be — and that, because of her income from her other work as a consultant, she is ineligible for a subsidy or Medicaid.
She opted instead for COBRA coverage, which she said was comparable in cost and had more of the benefits she needs than the unsubsidized plans she found on the exchanges in that price range.
She worries she will have to run up her credit card and find extra work to afford her premiums. The pandemic has made forgoing insurance unthinkable, she said. Many of her loved ones have had COVID-19. Some friends are still suffering symptoms months after falling ill. She lost a brother-in-law in Texas.
"That's why I am paying that nearly $1,000 a month, because I know one hospitalization could bankrupt me if I didn't have it, and I can't take that chance," Salazar-Rodriguez said.
Changes Are Temporary
Though the subsidy fixes are temporary, lasting two years to address the economic impacts of the pandemic, experts and lawmakers expect the new subsidy criteria would eventually become permanent.
The KFF analysis found that subsidies would gradually phase out for those with higher incomes — for instance, a single 60-year-old making about $160,000 would not receive a subsidy because no silver plan would cost more than 8.5% of his income.
Brian Blase, a senior fellow at the Galen Institute, a nonprofit group that researches free-market approaches to health reform, criticized the proposal in a recent analysis, saying it shifts the burden of paying premiums from private payers to taxpayers without addressing the causes of high premiums.
He argued a family of four headed by a 60-year-old earning almost $240,000 could qualify for a nearly $9,000 subsidy.
The Wall Street Journal seized on Blase's example in a recent op-ed. "These are not the folks hit hard by the pandemic," the editorial staff wrote.
Many of the changes in the relief package date back to the passage of the ACA, President Barack Obama's signature domestic policy that overhauled the nation's healthcare system. At the time, those who wrote the law expected Congress would observe how it worked and make adjustments over time. But the law became a lightning rod for GOP opposition.
The proposal is part of the ACA's "unfinished business," said Keith of Georgetown University.
She noted there are other coverage gaps not addressed by this package, such as the so-called family glitch, in which a family's eligibility for marketplace subsidies is based on whether the cost of job-based coverage for one individual rather than the family is affordable.
The current bill "is narrow compared to the wish list Democrats have, but it would do so much with premium affordability in this way right now," Keith said.
California rolled out a statewide covid vaccination website this week aiming to streamline the appointment process after months of criticism, but the site is riddled with its own snags, preventing many from signing up for shots.
The vaccine sign-up website, My Turn, is the state’s answer to a previous hodgepodge of vaccination appointment systems that residents had to log on to through websites belonging to various hospitals, pharmacies, clinics and many of California’s 58 counties.
The site, created by tech giant Salesforce, is being integrated into insurer Blue Shield of California’s $15 million contract with the state to take over its covid vaccination distribution system. My Turn is considered a clearinghouse, allowing most California residents to register for covid vaccinations and then receive an alert when they’re eligible to sign up for a vaccine appointment. The app then directs users on how to sign up for available appointments at certain venues.
The My Turn database, however, does not include information about vaccinations available at most pharmacies, or at Kaiser Permanente and Sutter Health hospitals. People who want to get vaccinated at those locations must contact the companies by phone or through their websites.
Like most aspects of state, local and federal government response to covid, My Turn’s rollout has been glitchy. Technology experts say the kinks are not surprising, given the multiplicity of health care information-sharing systems in the state, and a tendency of government officials to overlook the need for consumer usability when building IT systems.
California Department of Public Health spokesperson Darrel Ng said My Turn “is being continually updated to add features to make it easier and more convenient for Californians to make vaccine appointments. If there are technological snafus, they are corrected quickly.” Salesforce did not respond to a request for comment.
So far, more than 650,000 vaccines have been administered via the My Turn system and 600,000 more are scheduled, Ng said. But widespread failures on the site have unleashed a chain of desperate and sarcastic social media responses.
“Here in the Bay Area, with Silicon Valley and all its wealth & technological brilliance, here is how we vaccinate our populace a year into a pandemic,” William Boos tweeted, showing a screenshot of an error message saying an “authentication token” was missing.
Several Twitter users said they were unable to register for the first shot because no slot for a second shot was being shown as available through the system.
“Seeing spots open on 3/1 on @Walgreens for my category, but no second dose appointments are available. And the MyTurn website shows spots, but has an error message after you choose a time,” tweeted Jennifer Lazo.
Others say the system directed them to vaccination sites with no available slots.
“There are no appointments in San Diego County. Try it yourself. Put in that you are 65+. It’ll say you are eligible and bring you to a site in El Cajon where there are 0 appointments available,” tweeted another user.
One irregularity allowed anyone who had registered in the state to book a vaccine appointment in tiny, rural Kings County. Clinics had to turn away residents who had driven in from neighboring counties, and county officials stopped booking appointments through My Turn entirely until the issue was resolved.
Technological issues with vaccination websites have been an issue nationwide.
In New York, hundreds of seniors lined up one chilly mid-February morning after being told to come for second vaccine appointments between 7 and 8 a.m., only to learn the appointment offer was a computer error. Health officials in Georgia resorted to hand-counting vaccine doses to determine how many available appointments there were.
We asked four health tech experts to explain why My Turn and other systems are not running smoothly. Their responses have been edited for length and clarity:
Arien Malec, senior vice president of research and development at Change Healthcare:
The My Turn website and vaccination dissemination system are products of a reactive, rather than proactive, response that has plagued the medical and tech industries since covid first came on the scene. Everybody is making this up on the fly. My Turn, in particular, is a usability nightmare. The site clearly favors already tech-savvy users and doesn’t appear to have been properly vetted. Tech companies typically spend time and money on testing out software before being released to the general public. My Turn doesn’t seem to pass such muster. There are informal ways of doing usability testing that are relatively cheap. Given all the money that we’re spending on covid vaccination, and given the economic benefit of vaccinating more people, it is cheap at any price.
Hana Schank, director of strategy for the Public Interest Technology program at the New America think tank:
The issues with My Turn and other state-adopted vaccination sites are rooted in government officials’ lack of technological expertise. The people who are making the policy decisions are not equipped to make the tech decisions. Their ultimate goal is less focused on a good consumer experience and more on achieving a tangible result — which, in this case, is getting people vaccinated. Are people signing up? Yes. Are vaccines being distributed? Yes. Done. They think that checks their boxes. A tech issue is never just a tech issue. It’s always a bureaucracy issue, or it’s a silo issue or it’s a lack of expertise. The way the government thinks about success is from another era. Government is really bad at providing a good user experience.
Atul Butte, director of the Bakar Computational Health Sciences Institute at the University of California-San Francisco:
Considering where California was just two months ago, when the vaccines first began getting distributed in the state, My Turn should be viewed as a success. While the user interface may contain glitches, a lot of work goes on behind the scenes, trying to get the various counties and their health data aligned in order to get proper vaccination counts for residents. The website draws on four databases: one for ordering the vaccines and tracking shipments; one for inventorying at all sites; the California Immunization Registry, or CAIR; and finally the vaccine appointment scheduler. Each of those databases has many components. CAIR is spread across regions and its system is old; its user-facing website hasn’t been updated since 2013.
Dr. Chris Longhurst, chief information officer at UC San Diego Health:
Even if you had the perfect technology, and everybody was using My Turn, people are still gonna be upset because they can’t get vaccinated. We’re in the valley of despair right now, because we had the weather issues in Texas that impacted not only transportation with the vaccine, but also the manufacturing of some of the vaccine. And then you’ve got the state’s transition to Blue Shield as the new third-party authority, which is bumpy at best. Then you’ve got technology transitions — My Turn, and My Turn integration with electronic health records, that are also bumpy at best. And then you also have the governor opening up a bunch of new tiers for educators and essential workers. There’s no supply to meet that new demand. So that creates tremendous misalignment and frustration.
During a March 2 news conference on the COVID-19 pandemic, President Joe Biden claimed that former President Donald Trump's administration did not ensure there would be enough vaccines for the American public.
During a March 2 news conference on the COVID-19 pandemic, President Joe Biden claimed that former President Donald Trump's administration did not ensure there would be enough vaccines for the American public.
"When I came into office, the prior administration had contracted for not nearly enough vaccine to cover adults in America," said Biden. "We rectified that."
Biden then announced he was using the Defense Production Act to facilitate a partnership between two competing drug companies: Merck had agreed to help manufacture the recently authorized Johnson & Johnson vaccine.
The move, he said, would accelerate the timeline for the availability of vaccines: "We're now on track to have enough vaccine supply for every adult in America by the end of May," he said, two months earlier than he had previously projected.
It's been a common political message since the Biden administration took office that the initial vaccine rollout under Trump was "chaotic." PolitiFact previously rated a claim by Biden's chief of staff, Ron Klain, that the Trump administration left no vaccine plan behind as Mostly False.
So, we thought it was important to check whether Biden was going too far in alleging that the Trump administration hadn't contracted for enough vaccines to cover the American public. Let's see what the contracts, which are public documents, say.
The Operation Warp Speed Contracts and FDA's Process
As part of Operation Warp Speed, the Trump administration entered into contracts with multiple drugmakers. The contracts were generally signed while potential vaccines were still in clinical trials.
Experts told us this was smart because the Trump administration didn't know which vaccines from which drugmakers would work, how effective they would be or how quickly they could be produced.
"That was the whole approach of Operation Warp Speed," said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. "Not knowing which one would cross the finish line, the Trump administration took a portfolio approach and invested in multiple vaccines."
Here's what the Trump team's contracts called for drugmakers to supply to the U.S. government:
In all, the amounts agreed to under these contracts total about 800 million vaccine doses, or enough for more than 400 million people.
The U.S., based on U.S. Census estimates, has around 328 million people, of whom about 255 million are 18 or older. (Vaccines are not yet authorized for children.)
So, it appears that the Trump administration's contracts with drugmakers did cover enough doses to vaccinate the entire U.S. adult population — and then some. By that measure, Biden's statement is inaccurate.
An important point to remember, though, is that these contract numbers don't necessarily represent deliverable vaccines. The contracts represent early promises. There were still important hurdles to be cleared before these possible vaccine candidates could be a reality.
Kevin Gilligan, a senior consultant with Biologics Consulting, a firm focused on pharmaceuticals, said that once drugmakers develop a vaccine they must test it through clinical trials with humans and amass enough data to show the vaccines are safe and effective and cause minimal side effects.
The data is then presented to the Food and Drug Administration, which decides whether the vaccine should be authorized for emergency use. Granting an emergency use authorization means the vaccine can then be distributed to the public.
Until recently, the Pfizer and Moderna vaccines were the only two that had reached that point, gaining authorization on Dec. 11 and 18 respectively.
The Trump administration announced Dec. 23 that it would buy an additional 200 million doses in total of both companies' vaccines.
A Caveat Worth Noting: The Real Numbers Were Lower
A Biden administration press official told KHN that the president was referring only to orders for the authorized vaccines: "When the Trump administration was in office, there were only two approved vaccines (Pfizer and Moderna) and the Trump administration had not contracted for enough of them to vaccinate all Americans. They only had 400 million doses of these authorized vaccines, which is only enough for 200 million Americans. Upon coming into office, one of our first steps was to ensure that we had enough supply secured for every American. We were prepared from Day One."
On this point, the Biden White House is correct. The U.S. government had in place agreements to buy 400 million doses of the authorized vaccines, which were both two-dose vaccines — not enough for the entire U.S. adult population.
It's also true that five days after Biden became president, he announced his administration had reached agreements with Moderna and Pfizer to buy a combined additional 200 million doses. That purchase was finalized on Feb. 11 and brought the total U.S. supply to 600 million, or enough to vaccinate 300 million people.
In addition, on Feb. 27, Johnson & Johnson's vaccine was authorized for emergency use. Under the Operation Warp Speed contract, J&J is supposed to provide 100 million doses to the U.S. by the end of May, but the company is reportedly behind on production. The Biden administration's move to get J&J to team up with Merck to achieve its production goal will increase vaccine supply.
But, is it fair for Biden to blame the Trump administration for not buying more of the Pfizer and Moderna vaccines once they became authorized for emergency use?
The answer to that isn't clear-cut, said the experts.
"It's not totally fair to say the prior administration didn't purchase enough, since they did move to purchase more doses after the vaccine was authorized," said Jennifer Kates, senior vice president and director of global health and HIV policy at KFF. "I think the question is should they have purchased it earlier?"
The New York Times reported on Dec. 7 that before Pfizer's COVID vaccine was shown to be highly effective in clinical trials, the company had offered the U.S. government the option to buy additional doses, but the Trump administration declined. Former Health and Human Services secretary Alex Azar disputed the news report, saying during a TV interview that Pfizer hadn't agreed to a production amount or delivery time for the additional vaccine, so he couldn't agree to the deal: "I'm certainly not going to sign a deal with Pfizer giving them $10 billion to buy vaccine that they could deliver to us five, 10 years hence. That doesn't make any sense."
James Love, director of Knowledge Ecology International, a nongovernmental organization that obtained copies of COVID government contracts, agreed that once it was clear the Pfizer and Moderna vaccines were likely to receive FDA authorization, the Trump administration could have taken action to make competing drug companies increase their vaccine manufacturing capacity in the way Biden did with Merck and J&J.
"The U.S. could have forced technology transfer between companies, which meant they would have been assured of additional vaccine manufacturing capacity," said Love. "The agreements we have now about scaling manufacturing are coming pretty late actually. It takes several months to get stuff up and running."
But Gilligan noted that the Biden administration had the advantage of hindsight. "Biden inherited the success of vaccine development done under Trump and then expanded on it," said Gilligan. "And the Biden administration has the benefit of looking back at what was done well and what wasn't and making the appropriate corrective changes. Hindsight is 20/20."
Overall, there are questions around whether the Trump administration could have acted more quickly to buy doses or increase vaccine manufacturing capacity. And the Biden administration has certainly taken significant measures to expand supplies.
But it's stretching the truth to say the Trump administration hadn't contracted for enough COVID vaccines to inoculate the U.S. adult population.
Our Ruling
Biden said the Trump administration "had contracted for not nearly enough vaccine to cover adults in America."
While Trump was still in office, his administration had agreements in place to buy 400 million doses of authorized vaccine, or enough to inoculate about 200 million people. That wouldn't cover the U.S. adult population.
However, KHN-PolitiFact reviewed the Trump administration's Operation Warp Speed contracts and found those included enough vaccine doses that, once cleared for use by the FDA, would inoculate about 550 million people — more than double the U.S. adult population.
Biden's statement contains an element of truth but ignores facts that would give a different impression.
Griffin Dalrymple is an energetic 7-year-old who loves going to school in Eureka, Montana. But two years ago, the boy described by his mother, Jayci, as a "ball of fire" was suddenly knocked back by severe bacterial pneumonia that hospitalized him for two weeks.
As her son lay in the intensive care unit with a tube in his tiny lungs, Jayci began imagining worst-case scenarios. She worried that if Griffin ended up needing a lung transplant, he might be refused because he has Down syndrome.
"It was terrifying knowing that they could deny him certain lifesaving services," she said.
Denying organ transplants to people with intellectual and neurodevelopmental disabilities like Down syndrome or autism is common in the United States, even though it is illegal under the Americans with Disabilities Act.
According to one widely cited 2008 study, 44% of organ transplant centers said they would not add a child with some level of neurodevelopmental disability to the organ transplant list. Eighty-five percent might consider the disability as a factor in deciding whether to list the person.
After Griffin recovered, Jayci brought Montana lawmakers' attention to the issue. Largely as a result of her campaigning, the state is considering a bill that would ban physicians from denying an organ transplant based solely on a patient's disability. Last month, the bill — nicknamed "Griffin's Law" — passed the Montana Senate 50-0.
Although Montana has no transplant centers of its own, advocates hope this bill and others like it will draw attention to the issue and pressure physicians to examine why they are making certain decisions. Andrés Gallegos, chairman of the National Council on Disability, said he hopes such legislation will inspire "a change of heart so people understand that they are discriminating."
If the bill passes the state House and is signed by the governor, Montana would become the 17th state to ban such discrimination. Seven other states and the federal government have similar bills pending, although some experts doubt such laws will be enforceable enough to eliminate discrimination.
According to a 2019 report from the NCD, many physicians and organ transplant centers worry that patients with intellectual or neurodevelopmental disabilities are more likely to have co-occurring conditions that would make a transplant dangerous, or that these patients' quality of life is unlikely to improve with a transplant. Others believe that these patients may not be able to comply with post-transplant requirements, such as taking immunosuppressive drugs.
But the report, which scoured research papers and medical reports, found that none of these concerns is universally true. Rather, disabled patients can benefit as much as any other patient, according to the NCD, an independent federal agency.
"If a determination is made to not include a person on the list only because that individual has a disability, that's blatant discrimination," said Gallegos.
Many intellectually disabled patients and their families see this firsthand. When Joe Eitl was born in 1983 with a congenital heart defect, his mother, Peg, was told that Joe would never be a candidate for a new heart because of his Down syndrome. So, when his heart failed in 2019, eight hospitals refused to even consider a transplant for Joe, who lives with his mother in Philadelphia.
Peg Eitl conceded that Joe's case was difficult, given he'd had prior reconstructive heart surgery that would complicate a transplant. She pleaded with transplant centers for more than a year and even considered suing them. Last October, Vanderbilt University agreed to perform the procedure. Joe came home Feb. 10 and is recovering.
"I think my greatest frustration was the value placed on someone with special needs," Peg Eitl said. "It pains me that they're discounted as being less than and not as worthy."
Bioethicist David Magnus of Stanford University, who authored the 2008 study on the extent of transplant discrimination, said people like Peg Eitl shouldn't have to prove that Joe would benefit from a transplant. Because people with disabilities are a protected class in the United States, he said, "the burden is on people who want to discriminate."
But that doesn't appear to be the case in practice. In September, Magnus published a follow-up survey of more than 300 transplant programs. Of these, 71% said they would automatically disqualify an adult with an IQ under 35, which is considered severe intellectual disability, while 12% would disqualify a child at that level. Only about 20% of the institutions had formal guidelines regarding child patients.
Magnus suspects these numbers are low given that some physicians may be unwilling to admit to discrimination. He has not yet studied whether new state laws have affected physicians' likelihood to discriminate against disabled patients.
But Magnus doubts that laws like Montana's bill will be enforceable. Part of determining any patient's eligibility for a transplant, he said, is whether they or a caretaker can comply with post-transplant requirements such as remembering to take immunosuppressant drugs. If a person with a disability can't meet these criteria, that person might not be a good candidate.
"All of these are terribly difficult judgments," Magnus said.
Transplant surgeons need to maximize the limited supply of organs and ensure they survive in the patients who receive them. If they don't, "it's taking an organ from someone who could have benefited from it," said Dr. Marwan Abouljoud, president of the American Society of Transplant Surgeons.
Abouljoud said institutions have differing standards for weighing the importance of an intellectual disability in a transplant decision. Ideally, he said, the committee that determines whether to list someone for a transplant will include social workers and behavioral psychologists, as well as program leadership, who can find ways to help the person comply.
On Feb. 12, the transplant surgeons' society adopted a new statement supporting nondiscrimination and encouraging transplant centers to find ways to support these patients. "We will be urging states to adopt local policies on this," Abouljoud said.
Sam Crane, legal director at the Autistic Self Advocacy Network, which has written model legislation adopted by several states, said that some bills — including Montana's — address the concern about post-transplant care. They ban transplant centers from basing their decision solely on a person's ability to carry out post-transplant requirements and require an investigation into sources of support to help the patient comply.
But Crane said physicians could still come up with a pretext to avoid adding a disabled person to the transplant list if they believe a person without a disability would benefit more from receiving an organ.
"It's very difficult to prove discrimination in that sort of situation," she said.
Although a similar nondiscrimination bill has been introduced in the U.S. House of Representatives, Crane said advocates prefer to focus on state laws. Organizations like the autism group have taken the position that the ADA and other federal laws already prohibit this kind of discrimination, making federal legislation unnecessary. Gallegos added that states can also enact stricter requirements than the federal government and fit them to their specific medical systems.
Under state laws, patients can appeal to local courts for an emergency injunction or restraining order. These hearings can be conducted quickly, allowing a judge to decide whether to compel an institution to add a person to the transplant list.
That speed is what Jayci Dalrymple hopes Griffin's Law will achieve. "When you're needing to stop discrimination, you're racing the clock," she said.
Studies have shown that the Moderna, Pfizer-BioNTech and Johnson & Johnson vaccines, the three vaccines currently available in the U.S. under emergency use authorizations, significantly reduce covid symptoms and are effective in preventing hospitalizations and death from the disease.
As cold weather descended upon Washington, D.C., last fall, I deleted my dating apps.
I had tried a few video-chat dates when the pandemic was new last spring. They were fun and novel at the time, and felt like a “quarantine experience.” By summer, I went on several physically distant dates in the park.
But once the temperature started dropping, meeting outside lost its appeal. First dates are awkward enough without shivering as your breath freezes to your mask, all while trying to uncover the title of someone’s favorite book. So I bailed.
Something happened recently, though, that made me return to the dating app world. A local website published an article about people announcing their vaccination status in dating app profiles. Other news outlets followed. I had to see it with my own eyes.
So, I redownloaded my favorite apps: Hinge, Bumble and Tinder. I disclosed in my bio that I was a journalist working on a story about people announcing their vaccination status in dating profiles. Then, I spent the next three hours madly swiping.
Lo and behold, I found several 20- and 30-somethings proudly displaying their vaccine status. One wrote at the top of his profile, “I got both doses of the Pfizer, Covid vaccine!” Another said, “im covid19 free got vaccinated too.”
I messaged them all. Noel, a nurse who lives in the D.C. area, got back to me. He said he put “COVID vaccinated” in his bio as a statement for what he stands for. (KHN is not identifying Noel by his last name because he’s concerned about being identified by his employer.)
“I take very seriously the responsibility to care for myself in order to keep others safe,” he wrote. Noel, who has received both vaccine doses already, said his status announcement has gotten him only positive responses so far. Some people even seemed reassured by it.
It made me wonder: Should this declaration give people the peace of mind to start increasing the frequency of in-person dates? When considering whether to meet up with someone who is vaccinated versus unvaccinated, vaccinated does sound safer. It even initially gave me a spark of hope. But should it?
I polled a few friends who use dating apps. They told me they had indeed spotted the same trend. One who lives in Los Angeles is even going on a FaceTime date with a guy who had “PS I’m vaccinated” in his Hinge bio. She still opted for a video chat, though. “Can’t they still be carriers even if they’re vaccinated?” she texted me.
The next day, I called Dr. Leana Wen, an emergency room physician, public health expert and visiting professor at George Washington University.
I asked her what those of us who might be swiping on the apps should think if we come across someone who advertises that they have been vaccinated.
First, Wen gave me the reality check I expected, and kind of deserved.
“It’s not a free pass,” she said. “We don’t know whether ‘if’ somebody is vaccinated means they will no longer be a carrier of coronavirus. They may still be able to infect you even if they are safe from coronavirus themselves.”
Studies have shown that the Moderna, Pfizer-BioNTech and Johnson & Johnson vaccines, the three vaccines currently available in the U.S. under emergency use authorizations, significantly reduce covid symptoms and are effective in preventing hospitalizations and death from the disease. But it’s still possible for those who are vaccinated to get sick with covid. And research is pending on how great the risk is that those who are vaccinated can carry the virus and pass it on to others.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a recent White House covid-19 press briefing that early studies from Spain and Israel indicate vaccination seems to lead to lower viral loads in the body, which can mean a fully inoculated person is less likely to pass covid on to someone else. But questions remain about transmissibility.
The Centers for Disease Control and Prevention recommends that those who are vaccinated continue to wear masks and maintain physical distance as the vaccine rollout proceeds. Public health experts also point to the emerging covid variants that are finding a foothold in the U.S. The available vaccines appear to be less effective against the variants, another reason for people to be vigilant.
Wen said if two unvaccinated parties who match on a dating app want to meet up, they should take the precautions we’ve heard about since the beginning of the pandemic: meet outdoors, keep 6 feet apart and ask about your favorite book from behind a face-fitting mask.
If both unvaccinated people eventually want to meet indoors, she added, and they both live alone, they could. But it is not exactly a romantic process. They could quarantine for several days. Then both could get a covid test and, as long as they both have negative results, meet up.
However, if you’re like me and live with roommates, and especially if your new paramour also lives with others, too, then that adds more layers of complications.
“Then you take on the risk of all those individuals that live in the other house,” said Wen. “Let’s say all those other people have relationships with someone else, who then have extended networks too. Now your pandemic pod is not with four roommates, it’s potentially with dozens of individuals.”
“You’re only as safe as the highest-risk person,” she added.
There is one silver lining, though, said Wen. She believes if two people are vaccinated they can safely get together.
“We don’t know this for certain, but here’s what I would say for people who are vaccinated and live alone,” said Wen. “I actually think you could pretty safely see somebody else who is vaccinated.”
Wen issued this advice, she said, with the assumption that both people are trying to mitigate their covid transmission risk by wearing masks in public, washing hands, minimizing social circles and not frequenting indoor spaces. Matches should discuss what safety precautions they’re taking before meeting up.
This recommendation also applies to us unvaccinated daters — we should all be having open conversations with our matches about what covid precautions we’re taking and in what circumstances we would feel comfortable meeting in person.
Think about this open communication the way you would talk to a potential sexual partner about the precautions you’re taking to prevent sexually transmitted infections or pregnancy. If it’s not something the person is willing to discuss, then perhaps they aren’t someone with whom you want to meet up.
But, never fear. As eligibility for the covid vaccine opens up to groups that may include younger people, it’s likely vaccine status will gain more prominence in dating profiles. While vaccines were initially limited to health care workers, long-term care facility residents and those 65 and older, eligibility categories in some states are widening to include other essential workers and people with underlying medical conditions.
It also seems possible that dating app companies may eventually roll out a feature to select or highlight your vaccination status in your profile, rather than having to write it in the bio, said Jennifer Reich, a sociology professor at the University of Colorado-Denver, who studies vaccine attitudes.
“I think we could imagine a range of things around covid. We could imagine fields about working from home, vaccine status, antibody status,” said Reich. “Adding these to your profile could help users figure out how they want to manage risk in their lives and what levels of risk they want to take.”
As for me, now that the dating apps are downloaded on my phone again, maybe I’ll give video dates another shot. At least until it’s summer again or I get my own vaccine — whichever comes first.
Despite lobbying Missouri's governor, and even after three members of the KCFD died of covid-19, firefighters were not included in the first phase of vaccine distribution.
This article was published on Friday, March 5, 2021 in Kaiser Health News. This story also ran on KCUR.
Tim Dupin thought — or at least hoped — that Missouri firefighters, paramedics and other emergency medical services personnel would be among the first to get vaccinated against the coronavirus.
After months of feeling overlooked by elected leaders in the distribution of safety equipment and other resources, surely, Dupin thought, their role on the front line of the medical system would be recognized. They had, throughout the pandemic, responded to calls the way they always had: Without regard to whom or what they would encounter at the scene, interacting with people who could have the coronavirus, despite often having makeshift personal protective equipment and masks that were old, faulty or moldy.
Dupin, a captain with the Kansas City Fire Department and president of the International Association of Fire Fighters Local 42, was dumbfounded when the recommended vaccine schedule was released and he saw firefighters would have to wait behind health care workers to get their shots. Despite lobbying Missouri’s governor, and even after three members of the KCFD died of covid-19, firefighters were not included in the first phase of vaccine distribution.
Missouri, like many other states, had adapted guidelines from the Centers for Disease Control and Prevention, which put firefighters in the second phase. When the state moved into that round in mid-January, state officials encouraged firefighters to sign up. And now, most members of the KCFD have been offered the shots.
But firefighters in multiple states said the vaccine prioritizations and the pandemic overall exposed a startling misunderstanding of — or lack of concern for — their role in the medical system.
“They don’t really understand what we went through and what we do,” said Dupin.
Of the country’s more than 29,705 fire departments, 45% provided basic life support services, while an additional 17% provided advanced life support services, according to a 2018 report from the National Fire Protection Association. Firefighters respond to car crashes, hazardous materials spills, mass trauma incidents, rescues and far more medical calls than fire calls. In 2018, fire departments received more than 36.7 million calls, according to the association’s data. Less than 2 million were for fires, while more than 23.5 million were for medical aid.
“We are the tip of the spear,” said Gary Ludwig, fire chief in Champaign, Illinois, and immediate past president of the International Association of Fire Chiefs. “We are health care providers on a truck.”
Indeed, for the Kansas City Fire Department, 1,170 of its 1,284 members are licensed as either emergency medical technicians or paramedics, and are scheduled on a rotating basis to ride on fire vehicles or ambulances, said Chief Donna Lake. Firetrucks are dispatched with ambulances to all medical calls — and any responders called to the scene can provide medical care. That is common practice across the country, even in communities where ambulance services are not part of the fire department.
Not all states relegated firefighters behind health care workers like Missouri or per the CDC recommendations. In Massachusetts, for example, the state included firefighters, more than half of whom hold paramedic or EMT licenses, in the first-round distribution of the vaccines, ultimately allowing them to offer the shots within their own departments, according to Rich MacKinnon, president of the Professional Fire Fighters of Massachusetts. Firefighters are now working with the state to develop plans to help vaccinate other groups.
Still, since the pandemic began, many firefighters and first responders have felt as if they are an afterthought to government officials, said David Mellen, a firefighter and paramedic in Wyandotte County, Kansas, and chief medical officer for a volunteer fire department in neighboring Leavenworth County, who conducts training and podcasts about firefighting.
Mellen and other firefighters said they have been consistently let down by government officials who failed to deliver on critical protective equipment, forcing departments — career and volunteer — to bid against one another, hospitals, doctors’ offices and other entities for items such as masks, gowns and gloves.
The limited number of vendors almost always focused on fulfilling larger hospital orders, Mellen said. Forced to turn to federal officials, then state leaders — all of whom, he said, had little to offer — firefighters were left with often unusable or impractical equipment.
“When I hear those sirens coming down the road, that brings me a level of comfort. I know that I have help coming,” Mellen said. “They may not be there right away, but I know they’re coming. If I heard those sirens turn and go the opposite direction? Well, that’s exactly what happened.”
The lack of support has fueled stress and anxiety in the ranks of first responders, who have also been dealing with widespread pay stagnation and a financial squeeze on departments throughout the country. And now they’re seeing their colleagues felled by the coronavirus.
As of Feb. 19, 110 firefighters and 53 EMS workers nationwide have died of covid, according to the National Fallen Firefighters Foundation. It is not known how many contracted the virus on the job. Dupin said contact tracing showed that all three KCFD members who died contracted covid while working.
Some in the field expressed concern about what the future holds amid reports of fewer recruits nationwide the past several years and anecdotal evidence of increasing numbers of retirements and other departures. The concern is compounded by pandemic-driven shortfalls in local and state finances, and what that could mean for future funding.
“The back door is bigger than the front door,” said Craig Haigh, fire chief and emergency management director for Hanover Park, Illinois, near Chicago.
Haigh said that while some departments, like his, have maintained attractive wage and benefit packages, firefighters have borne a lot of the strain the pandemic has put on the health system.
It has been exhausting, Haigh said. So much so that he, like others, has begun to think about walking away from the job he said he was “born to do.”
Now, Haigh, 53, is reconsidering his future. “‘I’ll work until I’m 65’ has changed to ‘Maybe it’s time for me to let someone else make these decisions,’” he said. “I’m not the only one who falls into that category of ‘We’re just worn out.’”
In the most recent election, Roseville voters had chosen three school board members who campaigned primarily on a message of reopening classrooms full time.
Brandon Dell’Orto listened to the comments and complaints as the school board meeting dragged on hour after hour. Many parents were angry. Their kids were sad, bored, borderline depressed, fed up with a school model that didn’t allow them to be on campus every day. The parents wanted schools open. They demanded it.
Dell’Orto, a history teacher and teachers union leader in the Roseville Joint Union High School District near Sacramento, knew it wasn’t so simple. Many of the district’s classrooms couldn’t meet new state guidelines for resuming safe on-campus instruction. Further, 4 in 5 teachers in his union, the Roseville Secondary Education Association, opposed a full return to the physical classroom. They feared for their safety and that of some students, and many preferred to wait to be vaccinated before once again teaching in person.
Dell’Orto also knew that the protocols and opinions were unlikely to affect the ultimate decision. In the most recent election, Roseville voters had chosen three school board members who campaigned primarily on a message of reopening classrooms full time. It was clear, Dell’Orto said, that the new members were going to do exactly that.
California has 1,037 public school districts, each empowered to make its own decision about reopening schools during the covid-19 pandemic. Politics and public health are at war in many districts, including this one. So, while classrooms had been closed nearly a year in neighboring Sacramento County, the Roseville schools were going the other way.
The night of the meeting, Jan. 26, the school board rushed out an online survey to parents. Within three days, 94% of those households had responded, and the results were clear: They overwhelmingly wanted the schools to reopen five days a week for in-person instruction. On Jan. 31, the board approved such a reopening, effective immediately.
“We are not going to move backwards,” Lisa Mendenhall, parent of a student at Oakmont High School, had declared at the board meeting.
For years, Dell’Orto said, Roseville’s teachers have enjoyed a good relationship with the district, its families and the school board. But when it came to discussing the continuation of a hybrid model versus a full return to campus, the teachers union, which had proposed the hybrid, was largely ignored. During the 5 ½-hour meeting on Jan. 26, Dell’Orto said he was allotted 90 seconds to weigh in.
“We really try to be a pragmatic, productive partner,” he told California Healthline. “Lately, though, everything has gone to ‘Pick a side.’”
“This is why the country is in this situation,” Dell’Orto told the board. “Because people don’t want to follow guidelines.”
The board approved a back-to-school order even though three of the six high schools in the district had been unable to meet guidelines for keeping the recommended distance between students. In a previous attempt at reopening, following winter vacation, one of the schools, Roseville High, had to quickly shut down after a covid outbreak forced hundreds of students and staff members into quarantine.
Jess Borjon, the district’s interim superintendent, told California Healthline that administrators were “confident that we can arrive at the minimum distance” of 4 feet between desks allowed under new California Department of Public Health guidelines issued in mid-January. The Roseville High outbreak, he said, “was a reminder of how diligent we have to be to stay open.”
Roseville, with a population of about 141,500, is a mostly suburban city northeast of Sacramento. Unlike Sacramento, though, it’s in largely rural Placer County, which sprawls all the way to Lake Tahoe and has voted for the Republican candidate in five straight presidential elections.
Placer County, with nearly 400,000 people, has tended to resist health and safety protocols during the pandemic, with many businesses and churches defying orders to close.
Last summer, the county supervisors, unhappy with their public health officer’s reluctance to arbitrarily terminate covid emergency declarations, stripped her of that authority, then lifted the emergency themselves. The officer, Dr. Aimee Sisson, promptly resigned and was hired to the same position in nearby Yolo County, whose supervisors have closely followed her guidance and kept schools closed.
In fall’s Roseville school board election, one returning member and two new candidates were elected on the promise that they would reopen schools. Newly elected Heidi Hall is listed as a Placer “county coordinator” of the statewide petition to recall California Gov. Gavin Newsom.
Hall blamed the Democratic governor for the confusing and shifting state guidelines for reopening schools. At the Jan. 26 meeting, she declared that California’s distancing recommendations were “not making a difference in these positivity rates” and that it was “irresponsible to listen to this guideline coming down that is not based in any science.”
In fact, the CDPH guidelines on reopening schools closely follow protocols produced recently by the Centers for Disease Control and Prevention. That set of guidelines stirred vigorous debate among experts, some of whom said it would be impossible to reopen schools while following them. President Joe Biden has repeatedly said he wants most U.S. schools open by the end of April. While children rarely get seriously ill from covid, their ability to transmit the disease remains a subject of intense interest, and the CDC recently found that teachers and staffers may act as vectors of covid in schools where distancing recommendations aren’t followed and masks are not worn.
None of it mattered in Roseville. The three newly elected board members voted against a motion that would have opened elementary schools (where children are easier to manage) and kept the high schools in the hybrid model, with some students coming to campus on selected days. That would have allowed its six high schools, with a combined enrollment of more than 10,000, to more closely follow the CDPH guidelines. Their votes defeated that motion, 3-2. They later voted to return to full on-campus learning. (None of the three responded to questions posed by KHN.)
The health department’s memo calls for a distance of 6 feet between students’ desks unless, after a “good-faith effort,” such a distance is determined to be impossible. In that case, 4 feet is allowed as the absolute minimum. Three of the Roseville district’s schools were not able to meet the 4-foot requirement, either. They opened anyway.
Doug Ginn, who teaches science at Oakmont, noted that the heating system in his lab “only brings in 10% fresh air” for classes that often have 40 students or more. Ginn’s solution on a recent day was to open the front and back windows and turn on a fan to keep fresh air moving through. It was 35 degrees outside when school began, he said.
“I’ve already lost two students [who returned to remote learning] because they don’t feel safe,” said Ginn. “We do everything we can, but for classes like labs where being there in person is so critical, there are only so many ways to modify a crowded room.”
As the district scrambled to redesign classrooms to meet safety mandates, students were already back on campus. Jennifer Leighton, principal at Granite Bay High School, told families in an email shared with The Sacramento Bee that “any form of distancing will not happen — sorry — classes have been large and could likely grow since 300 more than we’ve had are planning to return.”
Borjon said the suggested distancing guidelines weren’t practicable if all the students were on campus for all their classes.
“The spacing issue in full classrooms is a real concern for us, and is at the forefront of our thinking,” the superintendent told KHN. “We share the concerns of teachers, students, parents and staff regarding classroom safety.”
But most parents remain viscerally opposed to the hybrid model. “It does not work. It’s a failure,” said Mark Anderson, whose son attends Oakmont. Added Jennifer Scott, parent of a Granite Bay student, “It makes no sense, as this pandemic is coming to a tail end, that we would go backwards.”
With Roseville schools open, teachers have had to adjust. The schools continue to offer a Zoom option for students to remotely monitor instruction if they don’t feel safe returning to their campuses. So far, though, school officials said they are gaining students on campus with each passing week, which further strains their ability to even approach the state guidelines for a covid-safe environment.
“We’re professionals. We were asked to try to make this work, and so we’re trying to make it work,” said Ginn, whose science classes had to be moved to larger areas, including the library. “It’s not in a teacher to just say no. These are our students you’re talking about.”
Kaiser's CEO, Greg Adams, acknowledged the frustrations of his company's California patients in a Jan. 30 email, explaining that the health system had received only a small fraction of the vaccine supply it needed.
This article was published on Thursday, March 4, 2021 in Kaiser Health News.
As managed-care giant Kaiser Permanente assumes a prominent role in California’s new covid-19 vaccination strategy, it is drawing mixed reviews from members across the country for the way it has run its own vaccine program over the past two months.
Conversations with 10 Kaiser enrollees in five states — Colorado, Washington, Virginia, Maryland and California — revealed a common frustration: difficulty snagging an appointment. Many also described receiving sporadic and sometimes confusing information from the company, though some said Kaiser has been doing better recently.
All of those who spoke to California Healthline were over age 65. Many were long-standing Kaiser members and, aside from the vaccine rollout, had mostly positive opinions of the health system. Some ended up going elsewhere for their shots; others said they would wait for Kaiser because its services were familiar to them and they felt more comfortable going there than to another site. (KHN is an editorially independent program of KFF, which is not affiliated with Kaiser Permanente.)
Kaiser’s CEO, Greg Adams, acknowledged the frustrations of his company’s California patients in a Jan. 30 email, explaining that the health system had received only a small fraction of the vaccine supply it needed.
Members did not blame Kaiser for the lack of vaccines, noting that insufficient supply has been the bane of providers across the country. But Kaiser could have been quicker to administer the vaccines it did receive and should have communicated more clearly about the shortage, they said.
Nino Maida, a San Francisco resident who’s been a Kaiser member for 14 years, said he couldn’t figure out why he was unable to get an appointment. “The frustration lasted about a month, until I got a clear indication from Kaiser that any waiting was due to a lack of vaccine,” said Maida, 74. “I thought they were being very inefficient instead of just poor at communicating.”
A Kaiser spokesperson defended the company’s communication strategy, saying that a page on its website (kp.org/covidvaccine) provides detailed answers about vaccine eligibility and appointments, and that a link prominently displayed on Kaiser’s homepage directs people there. The organization sends regular emails to members with information about their eligibility and instructions on how to set up an appointment, and call center operators also can answer members’ questions, he said.
Clearly, Kaiser Permanente isn’t the only organization encountering vaccination roadblocks. Sutter Health, the large Northern California health system, for example, may have to cancel 95,000 vaccination appointments because it doesn’t have enough vaccine on hand, company spokesperson Amy Thoma Tan said Wednesday.
But Kaiser, which is both an insurer and medical provider, has drawn particular scrutiny because of its size and because it has been chosen to play a significant part in state efforts to speed covid vaccinations.
The company, which covers 12.4 million people in the U.S., including 9.3 million Californians, was also fined nearly $500,000 for workplace safety violations early in the pandemic.
A memorandum of understanding with the state, released last week, stipulates that Kaiser will be part of a vaccination provider network assembled and overseen by Blue Shield of California, which signed a contract on Feb. 1 to administer the statewide inoculation plan. Kaiser will also serve as an adviser to Blue Shield to help the state meet its goal of expanding vaccine access to the most vulnerable communities, the memorandum says.
Under the agreement, Kaiser will receive no state funds. It will operate two mass vaccination sites — one at San Francisco’s Moscone Center, the other at California State Polytechnic University-Pomona, in Los Angeles County — and “may consider the establishment of future mass vaccination sites” that would target rural Californians and those with historically lower vaccination rates. Importantly, Kaiser will vaccinate members and nonmembers, as it has already been doing on a smaller scale.
The memorandum acknowledges the supply constraints Kaiser has faced, saying the state “shall ensure that Blue Shield understands that Kaiser is dependent on sufficient supply of the vaccine.”
Kaiser did not start vaccinating people age 65 and older — in line with state guidelines — until well after other providers had begun doing so. And some longtime Kaiser members were disappointed by the lag.
“It is not good PR to have week after week of news showing the four largest health care providers in Northern California, and Kaiser is the only one still working on staff and people over 75 years old,” said Elizabeth Wieland, 66, of Elk Grove, California, a member for 30 years.
When Kaiser sent an email to patients on Feb. 13 encouraging them to “get vaccinated somewhere outside Kaiser Permanente” if possible, it felt as if they were “throwing in the towel,” Wieland said. “It’s ‘fend for yourself.’ Not what I would have expected, but that seems to be the new normal.”
On Feb. 20, Adams sent an update to members informing them the supply outlook had improved, because “the state has increased Kaiser Permanente’s weekly vaccine allocation to better match the number of members we serve.” As a result, the CEO said, Kaiser was able to start scheduling appointments for people 65 and up.
Kaiser is also vaccinating people 65 and up in Washington state, Virginia and Georgia, a spokesperson said.
Member complaints were not only about the slow rollout. Members said that Kaiser sometimes posted key vaccination information in hard-to-find places, and that they often heard things by word of mouth before they heard it from the company. Some said that, once they managed to sign up for a vaccination, they were promised email updates that never arrived. Still others said that, after getting on Kaiser’s vaccination waiting list, they were suddenly bumped further back in the line with no explanation.
Janet Vorwerk, a retired Kaiser operating room nurse who lives in a suburb of Denver, said that when she got on Kaiser’s waiting list in January, she was No. 20,991 in line. On Feb. 15, she dropped all the way down to 9,989, then inexplicably bounced up to 11,258 two days later, which she said was “so disheartening.” As of last Friday, she was No. 10,269.
“I don’t understand how the numbers are getting jacked around, up and down,” said Vorwerk, 66. Still, she blames the circumstances more than she blames Kaiser. “I understand where they’re coming from,” she said. “You can’t pull a vaccine out of your backside. But at the same time, it would be good to have a better idea of when it might happen.”
Some members said Kaiser’s performance has improved recently.
For Tom Spradley, an 84-year old resident of Citrus Heights, California, initial frustration with Kaiser gave way to a happy ending. He said he called Kaiser for an appointment about a month ago and was on hold for two hours before giving up. He then started checking Kaiser’s vaccine page every day for updates, but said none came for several days.
Finally, he was able to get an appointment for himself and his wife at a Kaiser site in Sacramento, about 20 minutes away. The appointment, he said, was a model of efficiency. They got their first shots and were scheduled for second doses March 12.
“After a week of bad information on getting a shot, I think they have really come through, and I was really impressed by the job they did,” Spradley said.
[Correction: This article was updated at 3 p.m. ET on March 4, 2021, to correct the amount Kaiser Permanente was fined for workplace safety violations early in the pandemic.]
There have been tens of thousands of covid-19 cases and hundreds of deaths reported among U.S. farmworkers and meat plant workers.
This article was published on Thursday, March 4, 2021 in Kaiser Health News. This story is part of a reporting partnership that includes NPR, Illinois Public Media and KHN.
With more than 20 million acres of corn and soybeans, Illinois is among the top U.S. producers of those crops. To make it all happen, the state relies on thousands of farmworkers — some of whom travel to the state for seasonal work and others, like 35-year-old Saraí, who call Illinois home.
Being an agricultural worker “is the most beautiful thing,” Saraí said in an interview in Spanish.
She moved to the U.S. from Mexico to find work that would allow her to better support her family. KHN agreed to identify Saraí by only her first name because she’s undocumented. Since the onset of the pandemic, she’s spent most of her time shepherding her three kids through their virtual school classes.
There have been tens of thousands of covid-19 cases and hundreds of deaths reported among U.S. farmworkers and meat plant workers. Because no official tracking system is in place, these numbers — based largely on media reports — are likely an undercount.
And yet, agricultural workers like Saraí struggle to access the most basic tool to fight the spread of the coronavirus: testing. Saraí, for example, has been tested only once since the start of the pandemic. The nearest testing site is the next town over, and without a car or a public transportation option, she had to borrow a friend’s vehicle to get there. She hasn’t gotten covid, but Saraí knows many others who’ve gotten sick. She said the pandemic has made the past year a sad and difficult one.
“Many farmworkers are both working and living in sometimes isolated rural regions of the country,” said Diana Tellefson Torres, executive director of the California-based United Farm Workers Foundation.
Besides living far from testing sites, these workers often lack reliable information in their native language and have a general mistrust of the health care system. And missing work to get a test, or to isolate or quarantine, could be financially devastating.
While the rollout of the coronavirus vaccines provides some hope for a better future, the virus is still spreading across the U.S., and efforts to expand access to testing and build trust with farmworkers are still needed, Tellefson Torres said.
She said these efforts will also be critical for ensuring that these hard-to-reach, vulnerable populations are vaccinated when the time comes.
Leverage Long-Standing Community Connections
Early on in the pandemic, Gilberto Rosas, an anthropologist at the University of Illinois at Urbana-Champaign, was struck by how easy it was for him — a work-from-home professor — to get a test, compared with workers in nearby towns who were more vulnerable to catching the virus and developing a severe case of covid.
The university has its own mass testing program for students and employees. The Urbana-Champaign campus is just 15 miles south of Rantoul, where virus outbreaks at a meat processing plant and a hotel housing migrant farmworkers were among the worst in Champaign County last year.
“We can walk down two flights of stairs, go out the back door and we can get testing,” Rosas said. “Whereas these people who are at the forefront — who work in the fields, who work in the plants — they lack that kind of access.”
Rosas is part of a team at the University of Illinois that had set out to study what was causing the virus to spread in the agricultural community. They also decided to do something to address testing access.
“We want to both unearth inequalities, but also mitigate them,” Rosas said.
The researchers teamed up with medical professionals from clinics in the area to organize pop-up coronavirus testing events in Rantoul.
The events are advertised in English and Spanish. The group has tried to leverage long-standing community connections to bolster turnout, reaching out to churches and organizations that cater to the area’s immigrant and agricultural workforce.
Even with that outreach, they’ve been frustrated by low attendance. At an event held before Christmas outside a community center, for example, only 15 people came for a test. Four of those 15 tested positive — a very high rate.
Structural Barriers: Financial and Immigration Worries
Sofia Bolanos Robinette suspects the reason more people don’t turn out for coronavirus testing, even at convenient times and locations, is that a positive result can be financially devastating.
Bolanos Robinette has worked with farmworkers for the past 10 years, most recently as an advocate for students in the Illinois Migrant Education Program. She recently joined Rosas and the other University of Illinois anthropologists to study issues like barriers to testing.
She recalls helping last summer with a coronavirus testing effort aimed at farmworkers who travel to the region for seasonal work. The clinic tried to make it as easy as possible for the workers to attend by setting up a station during off-hours right outside the migrant housing area.
“But some of them said they didn’t even want to take the test, because, in the case they get back [a positive result], they will have to stop working,” Bolanos Robinette said. “And then that means, for them, they will not get any money for at least two weeks.”
That’s a big deal, she said, especially for farmworkers, who earn the bulk of their yearly income doing this seasonal work.
For low-wage farmworkers, “every penny counts,” said Tellefson Torres of the UFW Foundation. In the most recent National Agricultural Workers Survey, one-third of farmworkers reported family incomes below the poverty line.
And they don’t have the same safety net that documented workers in the U.S. have.
“When you have to worry about putting food on your own table for your family, sometimes that is the focus, because there isn’t another option,” Tellefson Torres said.
For undocumented workers, she said, there are even more disincentives to get tested. They may worry it could jeopardize their efforts to obtain a visa — a common misperception. And after years of the Trump administration being more aggressive with immigration enforcement, Tellefson Torres said, there’s a huge lack of trust and a real fear of deportation.
Despite lower-than-ideal turnout at the pop-up events, University of Illinois anthropologist Ellen Moodie said attempts to host “a few small-scale testing events, irregularly scheduled and located in different sites” have made a difference for handfuls of people who might not otherwise have known they had the virus.
However, Moodie said, the U.S. needs a comprehensive strategy to address the virus and protect vulnerable workers. Many public health experts have been calling for such a strategy since the start of the pandemic.
So far, President Joe Biden has made that a priority of his administration. In a document published in January, Biden outlined a covid strategy focused on boosting the production and distribution of vaccines. His plan includes efforts to address supply shortfalls for testing materials, implement stronger worker safety guidelines, expand emergency paid leave and otherwise strengthen the social service safety net.
Vaccine Implications: Mistrust Breeds Skepticism
Building trust with farmworkers remains critical, Tellefson Torres said, not just to get more to show up for testing — but also to get them to show up for vaccination as soon as they are eligible.
At a recent virtual town hall hosted by the UFW Foundation, Tellefson Torres said she has heard from many farmworkers across the U.S. who are eager to get a vaccine. But others have reservations.
The biggest concern she’s heard has been about the potential cost, especially for the many workers who lack health insurance. Tellefson Torres said her organization is working to get the word out that covid vaccination is free for everyone.
Others, she said, worry about vaccine safety, asking questions like: “What is this vaccine? What does it contain? … What are you putting in my body?”
Vaccine safety is something Saraí — the farmworker in Illinois — worries about too. After finding some information online, she grew concerned about the possibility of adverse reactions, so, at least for now, she isn’t planning to be vaccinated.
However, Saraí said, if someone she trusts shows her evidence the vaccines are safe, she could change her mind.
In Illinois, food and agriculture workers are now eligible for the vaccines. Public health administrator Julie Pryde said the Champaign-Urbana Public Health District — which serves Champaign County, including Rantoul — plans to work with a federally supported migrant clinic to host mobile vaccination events targeting migrant and seasonal farmworkers.
Tellefson Torres said partnerships like that will be critical to ensure that agricultural workers, who have faced so many challenges throughout the pandemic, have equitable access to the vaccines — their best hope of staying healthy.
“The norms that we have seen prior to the pandemic — of not prioritizing worker health or just basic safety-net needs — need to be addressed both by state, local, federal governments and employers,” she said. “We’re literally talking about a life-and-death situation here.”