By Kate Masters
(VM) – Thousands of employees at Virginia Commonwealth University were notified this week that the system was delaying their second-dose appointments for COVID-19 vaccine — a move that would have affected VCU Health workers along with some university staff, faculty and students.
Hours later, after the Mercury asked state and university leaders to explain the decision, VCU abruptly reversed course.
“We are immediately making a change and will administer second doses as we originally planned to all those due to receive them,” wrote Dr. Arthur Kellermann, the CEO of VCU Health System and senior vice president of the university’s health sciences department, in a statement Wednesday night. “No second appointments will be cancelled. We will communicate quickly to those individuals to help fix this problem.”
But the initial cancellations, which would have affected about 9,500 employees, speak to the wider confusion surrounding Virginia’s new vaccine allocation strategy — part of the state’s effort to speed up the deployment of shots across the state.
In his initial email to staff, Kellerman said the delayed appointments came after the state asked VCU to reroute “several thousand vaccine doses” the system had dedicated for second vaccinations. Those shots, he wrote, would allow “eligible local residents — including first responders, front-line workers and vulnerable citizens” — to receive their first doses of the vaccine.
“This unprecedented pandemic requires all of us working together and supporting what is best for our entire community,” Kellermann said. “We understand and are supportive of the state’s decision to vaccinate as many high-risk community members as possible with the first dose of the COVID-19 vaccine quickly.”
As Virginia has struggled to boost the speed of inoculations and account for a significant gap between the number of doses received and the number that have actually been administered, health officials have announced a series of changes to the state’s distribution strategy — amounting to what one health system described as an “enormous shift.”
Starting this week, the Virginia Department of Health is routing all new doses through local health departments to distribute throughout their communities, rather than shipping vaccines directly to hospitals. In another change, health districts are receiving vaccines based on their share of the state’s population, rather than the number of doses they request.
But the state is also asking hospital systems and local health districts to release shots they’ve held in reserve for second-dose appointments — which appears to have played a significant role in the confusion at VCU. In a news briefing on Wednesday, Gov. Ralph Northam said his administration asked health systems to reallocate extra doses to other settings so they can be used as first vaccinations for frontline workers and other priority groups.
“My team and I have been working the phones, asking hospital companies to shift excess supply to others who can get more first shots in arms right now, this week,” he said.
Kellermann later wrote that the health system “misunderstood the request to provide as many vaccines doses as possible for public use.”
“We were not asked to provide all our available doses,” he said in a statement, adding that VCU was “delighted” it could still provide vaccine to help meet community needs. It was not immediately clear on Wednesday night how many doses, if any, the hospital would reallocate to the state.”
According to state officials, second dose reserves have played a significant role in the gap between the number of vaccines distributed across Virginia and the number of shots that have actually been administered. As of Jan. 27, that disparity stood at more than half a million doses, according to VDH’s public vaccine distribution dashboard.
Northam’s chief of staff, Clark Mercer, said states across the country are allocated a certain supply of vaccines every week from the federal government — including both first and second doses. Virginia, he said, has consistently been requesting its maximum share of doses every week. That’s in contrast to some other states, which only pull down second doses at the time they’re needed.
Both the Pfizer and Moderna vaccines require a two-dose schedule. For Pfizer, shots are spaced three weeks apart; for Moderna, it’s four weeks.
Mercer said that’s widened the gulf between vaccines distributed and vaccines administered. “The health systems in particular, when they were given their initial allotment, held onto their second doses,” he said. “Which makes sense, so they could make sure everyone got a second dose.”
But other health officials say it also created a timing challenge for the state. Because Virginia was requesting both first and second doses every week, many providers were doing their own calculations on how many doses they’d need to reserve for second shots (Mercer said the problem was sometimes compounded by health workers who declined the vaccine).
Dr. Danny Avula, the state’s vaccine coordinator, said those doses sometimes sat on shelves for two or three weeks, just waiting to be administered.
“So, what we’ve decided to do is encourage hospitals to use those second doses as first doses,” he said. “And then we will manage the inventory. We will do the accounting. So, every second dose that gets moved to a first dose, you basically have to account for twice that in follow-up.”
It boils down to the state promising to replace all second doses that hospitals reallocate for immediate use. Both Avula and Alena Yarmosky, Northam’s spokeswoman, said the administration never intended for second doses to be withheld from Virginians who already received their first.
“Everyone is going to get their second doses,” Yarmosky said. “The only doses we’re touching are the doses that are not going to be used in the next two to three weeks.”
But the change in allocation strategy has sparked uncertainty among multiple health systems across the state. Earlier this week, hospitals in Northern Virginia announced they were canceling community vaccination appointments, citing a dramatic reduction in doses under the state’s new system. Some of those shots are being rescheduled for local school employees, according to NBC 4, but it’s not clear if other prioritized residents will be able to book make-up appointments.
The initial announcement from VCU was also met with dismay by a broad swath of employees who were able to schedule their first doses with the health system. The university opened vaccination appointments to large numbers of staff members in late December, including remote employees who had been working from home since the start of the pandemic. Those appointments eventually included VCU medical students, though the system initially excluded them from prioritization.
One mother emailed the Mercury after Kellermann’s initial announcement and said her daughter’s appointment was postponed a week before she was scheduled to begin clinical rotations in the ICU.
“The med student’s second appointments were cancelled, and the CDC guidance which places them in the first vaccination tier was thrown out the window,” she wrote. “So again, the state and VCU management are putting students at risk.”
Kellermann wrote that VCU “apologize[d] to everyone who has been alarmed about a delay in receiving their second vaccine.”
“Please be assured that we are 100 percent committed to making this right,” he added.
