SC to reallocate thousands of surplus COVID vaccines from long-term care facilities
A month since state health officials set aside more than 200,000 doses of COVID-19 vaccine for residents and staff of South Carolina long-term care facilities, only about a fifth of those doses have gotten into arms.
The low utilization rate, it appears, is due not to a lack of vaccination clinics being held at such facilities — South Carolina actually ranks ahead of most states in inoculating long-term care residents and staff — but to the number of doses state health officials originally allocated to the program and hesitation, particularly among staff, about getting vaccinated.
Frustrated by the rate of vaccine administration at the nearly 900 facilities the state’s federal pharmacy partners are servicing, Gov. Henry McMaster Friday sent a letter to the state Department of Health and Environmental Control chairman asking the agency to redistribute 37,800 doses of vaccine previously allocated to the long-term care program.
“The LTC Program partners CVS and Walgreens have completed their first pass through our state’s long-term care facilities and have determined that there will be a surplus once every resident and staff member have been offered both doses,” the governor wrote in his letter to DHEC Chairman Mark Elam. “These surplus vaccines should be made available to the general public right away rather than at the completion of the LTC program.”
DHEC said late Friday it had received approval from the U.S. Centers for Disease Control and Prevention to reallocate the requested doses, all of them manufactured by Moderna, and would next week begin parsing them out to vaccine providers across the state for administration to the roughly 1 million South Carolinians eligible for vaccines in phase 1a of the state’s rollout.
The reallocation of doses comes as South Carolina, like all states, struggles to meet the tremendous demand for a potentially life-saving vaccine that holds the promise of ending the coronavirus pandemic.
In developing its phased vaccination plan last year with the goal of averting deaths, the state Department of Health and Environmental Control prioritized frontline medical workers and long-term care facility residents and staff to receive the state’s first doses.
Long-term care facilities encompass skilled nursing facilities, commonly referred to as nursing homes, community residential care facilities, otherwise known as assisted living facilities, and intermediate care facilities for individuals with intellectual disabilities. South Carolina’s 750 long-term care facilities have a combined bed count of about 44,000, DHEC said.
Like many states, South Carolina entered into a federal pharmacy partnership with CVS and Walgreens to inoculate long-term care residents, who account for a disproportionate number of the state’s COVID-19 deaths.
Other than deciding how many vaccine doses to allocate to the program, DHEC has had very little role in the vaccine rollout to long-term care facilities, which is coordinated by the retail pharmacies and overseen by the CDC.
State health officials, citing the extreme vulnerability of long-term care facility residents, immediately dedicated 86,400 first and second vaccine doses to the federal pharmacy program.
They have since set aside an additional 117,000 doses in an “LTC savings bank” for their pharmacy partners to administer at nursing homes, assisted living facilities and other congregate care settings as needed, DHEC spokeswoman Laura Renwick said.
Of the 203,400 Moderna vaccine doses DHEC ultimately set aside for use at long-term care facilities, fewer than 40,000 had been administered, as of Friday, according to agency data. Vaccination data provided by CVS and Walgreens puts the number of doses administered at closer to 48,000.
That’s despite the fact that all 193 of South Carolina’s nursing homes and more than 90% of its nearly 500 assisted living facilities have had at least one vaccination clinic, Renwick said.
Vaccinations at the state’s 66 intermediate care facilities for people with intellectual disabilities aren’t as far along, she said, but about 950 ICF residents and staff are expected to receive first doses in the coming weeks.
DHEC allocated more doses than were needed
The disparity between the utilization rate of vaccine doses allocated to long-term care facilities and the proportion of those facilities that have held vaccination clinics is at least partially due to the way DHEC determined how many doses to set aside for the federal pharmacy program.
South Carolina, unlike most states, immediately allocated all the vaccine doses it believed would be necessary to inoculate residents and staff at every enrolled long-term care facility in the state, assuming each facility was at 100% capacity and had a one-to-one employee to resident staffing ratio, Renwick said.
In addition to dedicating doses to the state’s 750 nursing homes, assisted living facilities and intermediate care facilities, DHEC also allocated shots for residents and staff at another 140 facilities that don’t meet the state’s definition of a long-term care facility, but had nonetheless managed to enroll in the federal pharmacy program.
Non-qualified facilities that enrolled included group homes for adults with intellectual disabilities, affordable housing units for low-income seniors and independent living facilities, among others, Renwick said.
“Because Phase 1a guidance wasn’t finalized at the time and because those in congregate-living settings continue to be at elevated risk for disease transmission throughout the pandemic, the decision was made to leave those facilities enrolled in the federal program,” she said. “Many of these individuals would have been vaccinated in Phase 1a regardless, after the state opted to add those 70 and older to Phase1 guidelines.”
Since many of the state’s long-term care facilities have empty beds and don’t employ an even ratio of employees to residents, DHEC’s estimate overshot the number of doses necessary to vaccinate all residents and staff.
Health care officials also said a significant proportion of long-term care facility staff have declined to get vaccinated, at least on first pass, leaving unused even more doses that had been set aside for the program.
Randy Lee, president and CEO of the South Carolina Health Care Association, which represents skilled nursing homes and a few assisted living facilities, said he didn’t know exactly how many residents and staff had declined the vaccine, but that the number wasn’t insignificant.
While residents overwhelmingly accepted the vaccine, staff members were less forthcoming, Lee said.
“There was a bit of a low level of trust of the vaccine,” he said, explaining that misgivings generally stemmed from concerns about its safety and the speed at which it was developed.
Lee said a survey the association conducted found that some of those who declined the vaccine avoid all immunizations, while others were open to getting vaccinated but wanted to take a wait-and-see approach.
He said a large number of people who declined the vaccine initially — pharmacy teams generally hold three separate clinics at each facility to ensure everyone who wants the vaccine gets two doses spaced four weeks apart — have since received it or plan to when their facility holds a second clinic.
“They were encouraged by the way the vaccine did not affect their coworkers,” Lee said.
Had DHEC not initially dedicated so many doses to long-term care facilities, those doses would already have flowed into the state and could have been used sooner by providers to inoculate other phase 1a individuals, including people 70 and older who have struggled to book timely vaccination appointments due to limited supply.
The agency, however, said it had no regrets about its decision to allocate more doses than ended up being necessary.
“We are happy with our decision to first and foremost save the lives of our long-term care facility residents and staff,” Renwick said. “Those types of facilities have been absolutely devastated across the country during this pandemic and deserve to be among the first vaccinated and guaranteed to have vaccine.”
As states continue to receive an insufficient supply of vaccine from the federal government each week with no guarantee that amount will increase, Renwick said South Carolina was better positioned than other states to get shots in the arms of its most vulnerable residents.
“While other states will need to find the necessary doses to cover their LTC program clinics from their total weekly allotments, we have created a savings bank of COVID-19 vaccine for our LTCF residents and staff,” she said.
DHEC always has planned to move any unused vaccine doses from its long-term care reserve into the statewide pool once all long-term care residents and staff had been given the opportunity to get both shots.
McMaster’s request Friday simply sped up that reallocation process.
This story was originally published January 29, 2021 at 4:27 PM.