Clifford Phillips isn’t one to show a lot of emotion when things get tough. The 86-year-old from Elkins keeps a stiff upper lip. But when West Virginia Gov. Jim Justice announced at the end of December that COVID-19 vaccinations would begin immediately for residents ages 80 and older, Phillips’ daughter said her father’s tough exterior began to crack.
After months of enduring the pandemic, hope was on the horizon. He wanted in.
“I don’t believe he would ever admit that he’s scared, but I think he might be,” said Donna Cain. “He started calling me every day asking if I had heard anything about the vaccine. He wanted to know how he could get it.”
Cain got to work, making phone calls and searching the web to find out how to get her dad vaccinated or at least on a waiting list. But the search took her down a rabbit hole.
“I go to the governor’s website. I go to DHHR’s website. I go to the local health department’s website and they all point you in opposite directions,” Cain said on Jan. 6. “The governor says ‘call your health department.’ But I call the local health department every day and they haven’t been given any information by the state. It’s incredibly frustrating.”
Cain isn’t alone in that frustration. Local health department officials around the state are flummoxed, largely because of a last-minute change to vaccination priorities personally ordered by Justice.
West Virginia’s vaccine rollout has gotten accolades — its vaccination rate currently leads the nation — as the state has targeted low-hanging fruit: health care workers and nursing home residents. But on Dec. 30, Justice made a surprise announcement: shots would be available to members of the general public months ahead of schedule, starting with people over 80. That kicked off a frenzy.
“We’re pivoting again,” Justice said during a press conference, announcing the jump to Phase 2 of the state’s rollout while Phase 1 was just getting started.
“Doses are being delivered as we speak,” he said.
The news was welcomed by many of the state’s elderly residents, who were eager to see the progress. West Virginia is also one of the country’s worst coronavirus hotspots. Nearly every county in the state is now red on the state’s COVID tracking map.
But it came as a surprise to local health departments, which play a crucial role in the distribution of the state’s vaccine. They knew vaccination of the general public was coming — but not so soon. Earliest estimates before Justice’s announcement had been February, and the details of how to allocate and schedule appointments were still being ironed out. The federal system designed to do it still wasn’t working as planned.
An October draft of the state’s official plan submitted to the federal Centers for Disease Control and published on a state website — and later removed — called local health departments “primary stakeholders,” and detailed how they would be included in statewide planning workshops. But in this case, county health officials say, they were left out of the loop.
Given no warning that plans were about to change, many local health departments could offer little reassurance to West Virginians desperate to know where and when they could get vaccinated, a process that could extend well into the next year. The result created disparities in vaccine rollout across the state, as smaller health departments struggled to find the resources to accommodate the sudden shift in plan.
Elderly residents like Clifford Phillips were left alone and without guidance while trying to sign up for the long-awaited vaccine.
“It’s a disease and you’re trying to save yourself from it,” Clifford Phillips said.
The governor’s office did not respond to a request for comment for this story. But at a Monday press conference, Justice took credit for the accelerated rollout. “This is nobody’s thought but mine,” he said.
“Every hour that goes by that somebody that’s 70 or 80 years old doesn’t get this vaccine, somebody’s gonna die… we gave them hope,” he added.
‘We’re being asked to do the impossible’
West Virginia’s vaccine rollout started well. Health officials had a plan that laid out who would get the vaccine and when. Shared during a briefing by the governor on Dec. 11, the plan stated that nursing homes, health care workers, first responders, teachers and government employees would all have priority. Then, the general rollout would begin, starting with the state’s oldest residents.
A task force, made up of state officials and led by Major Gen. James Hoyer of the state National Guard, coordinated “vaccine clinics” with the assistance of local health departments. The U.S. Centers for Disease Control created a central database where first responders could sign up for appointments.
There were several hiccups — like when the CDC’s software sent some early patients to the wrong city to get their shot — but overall things seemed to be going smoothly. Justice has repeatedly crowed that the state’s vaccination rate was leading the nation.
But then Justice decided to move faster, delivering on a promise to roll out the vaccine “at light speed.” West Virginia’s population is one of the oldest in the nation, and the governor wanted to move quicker to protect the state’s oldest residents who are particularly vulnerable to the coronavirus. As of Monday, more than 8,000 elderly West Virginians in the general population had been vaccinated, but the lack of prior planning left local health departments scrambling in the wake of Justice’s announcement.
On Dec. 30, Malcolm Lanham, the population health director at the Mid-Ohio Valley Health Department, picked up his phone. “Get to Charleston right away,” he was told. The governor had just made his announcement, and state officials were scrambling to get vaccines out to counties.
“It came out of nowhere,” Lanham said. “This wasn’t supposed to be done until February.”
Lanham’s department, based in Parkersburg, had been telling residents that it wouldn’t be responsible for distributing the vaccine to the elderly.
But Lanham jumped in his car to go pick up the vaccine, and spent the ride home figuring out how to equitably distribute the 100 doses across the six counties his department covers. Half went to Wood County, to be given out at a Sunday drive-thru clinic at the agency’s main office in Parkersburg. The other five counties — Calhoun, Pleasants, Ritchie, Roane and Wirt — got 10 doses each.
Lanham alerted the local media that they would distribute Parkersburg’s doses on Sunday, Jan. 3. Chaos ensued.
Elderly residents began lining up in the parking lot outside the night before. By the next day 300 cars had reportedly showed up, despite the department having only 50 doses of the vaccine.
“We learn by trying. We definitely will not do another drive in,” a representative of the department wrote on Facebook in response to dozens of comments from people who’d waited for hours to no avail.
Meanwhile back in Charleston, a costly error occurred when some of the doses given out for pickup turned out not to be the coronavirus vaccine. Charleston Area Medical Center had distributed an antibody medication instead, and dozens of Boone County residents ended up with a useless shot.
“The more hand-offs you have, the more likely you’ll experience issues,” said Dr. Clay Marsh, the state’s coronavirus czar, in a press conference on Monday. The state would “constantly improve the process,” as it “decentralized” vaccine distribution in an effort to reach more communities, he said.
The challenge of coordinating vaccine distribution has been matched by the challenge of providing members of the public with accurate and up-to-date information. As plans have changed, communication breakdowns have further contributed to the strain on local health officials and sparked public confusion.
According to a guide on public health communication during the pandemic, published by the CDC in March, “Preparedness should focus on strengthening the systems and structures that support effective and well-coordinated communication.”
The guide goes on to state that engaging community stakeholders in planning processes, “can help establish strong lines of communication and ensure that information is consistent…”
But during vaccine rollout in West Virginia, that hasn’t been the case.
“When the timeline starts getting fuzzy, then people say: ‘When am I getting mine?’ ‘When’s my mom getting hers?’” Lanham said. “Everybody wants to be in Phase 1.” The department’s phone line has been ringing off the hook.
In response to the increasing volume of questions, Lanham’s department set up a four person call center to provide answers and coordinate future “pop-up” vaccination events. But Lanham said it has only made life harder for his already-overworked staff, who have been working weekends since the pandemic began.
“Some days we’re working 10, 12, 15 hours a day to pull off these events. There’s a ripple effect with that: from stress to burnout,” he said.
He called on everyone to be patient, but acknowledged it was a hard thing to ask. The virus continues to rage, killing dozens more West Virginians every day.
“We’re being asked to do the impossible,” Lanham said.
“I’m okay being asked to do the impossible — it’s not the first time — but you gotta have the right resources in place,” he added.
Turning to social media for help
Similar scenes were playing out in Randolph County as Donna Cain struggled to find a vaccination for her father.
State officials had been telling callers to contact their local health department. But officials there didn’t have much to tell them.
“People want answers,” said Bonnie Woodrum, the Randolph-Elkins Health Department’s infectious disease specialist. “But there aren’t any answers!”
The county had already given out its first batch of doses by partnering with a local senior center — which had a big room to facilitate social distancing, and a large parking lot. Appointments filled up within three hours.
“It crashed my phone system twice,” said Laura Ward, the center’s director.
They’ve now set up a second round of appointments — and a dedicated phone line — but it’s still not enough to meet demand. “I have a sense that we’re probably not halfway there,” Ward added.
The Randolph-Elkins Health Department, like those in many neighboring counties, has a barebones staff. Over the last decade, the state has cut funding for public health, forcing local health officials to layoff employees.
“We’re extremely underfunded,” Woodrum said. She and her coworkers have been working every day since March.
“We have to depend on volunteers,” she added. Some answer phones, others help give shots.
They’re also dealing with the logistical nightmare of storing and quickly distributing the perishable vaccine. Developed in record time, the vaccines are based on a novel technique and must be stored at subzero temperatures. Once it’s distributed to local officials, the countdown begins. The Moderna vaccine can be stored in the refrigerator for 30 days. The Pfizer vaccine lasts only five.
The CDC has created a system that’s supposed to help officials manage these challenges. Local officials can upload a list of eligible names to the Vaccine Administration Management System, known as VAMS, which can automatically coordinate appointments, send out follow-up reminders, and keep track of who’s gotten vaccinated.
But the system’s rollout in West Virginia has been riddled with bugs.
Back in Parkersburg, Lanham said that the system sent people from South Charleston on an hour-long road trip to his city, thinking they were scheduled to get the vaccine. But the appointments had been incorrectly publicized by the system. The people were turned away at the door.
In response, many local health departments — particularly those in rural areas where email access and phone service can be spotty — have opted to instead manage appointments on their own.
In Randolph County, the senior center started a second round of vaccinations on Friday. There, 86-year-old Clifford Phillips finally got his.
But getting him on the list was anything but easy.
While Cain made repeated calls to the health department on her father’s behalf, her brother took a different approach.
Douglas Phillips, a New York City doctor, began contacting West Virginia officials on Twitter. On Monday, he got a response. The state’s chief health officer, Dr. Ayne Amjad, wanted to help, and they exchanged a series of direct messages.
“So, for a physician with parents who are over 80 and live in WV, how do they go about being vaccinated? There is literally no information available. None. When they call the Health Dept., they get a message ‘all vaccines are already promised.’ Awaiting an answer,” Phillips wrote.
Amjad directed him to the state’s vaccination hotline — a number that his sister had already tried and had proved to be of little help.
Phillips then sent her a screenshot of the Randolph County Health Department’s website, which remains down. The website normally has a page dedicated to “vaccine information,” but it’s been broken for months and the overworked department hasn’t been able to fix it.
“I went to the county health department. This is what you get,” Phillips wrote. “This is too unbelievable to make up.”
This got Amjad’s attention. She asked for the names and phone numbers of Phillips’ parents. While his dad lives at home, his mom, 84, is currently in a rehabilitation center recovering from a recent fall. In late December, the couple would have celebrated their 63rd wedding anniversary, but because of COVID-19, they had to spend the day apart.
As of Jan. 6, despite being a resident at the rehabilitation center, Phillips’ mother hadn’t been vaccinated either.
“I got a hold of the health department and will put their name and number on the list,” Amjad responded.
Thanks to the efforts of their children, both parents received their vaccinations this week. But Phillips said that the experience has left him frustrated — and concerned for the other elderly residents of his home town.
“If not for me and my sister who still lives in Elkins advocating for [my dad]… I mean, nothing would be happening,” said Phillips, who acknowledged the absurdity that it took social media and a top state health officer to get his parents on a vaccination list.
Cain acknowledged the same. It makes her sad, she said, for the people who don’t have the same support. Now that her parents are vaccinated, she’s turning her attention to helping other elderly residents living in her community.
“Advocate for someone else’s parents,” Cain said. “Help them figure out how to get the vaccine. Do what you can. If we all pitch in, we can beat this.”
Although Amjad did not respond to a request for comment, in the Twitter exchange with Phillips she wrote that this is just the beginning of the distribution process. The goal, she said, was to get vaccines to people as soon as they became available, rather than waiting to perfect the system.
“I know it’s not ideal. We are trying to make it better,” Amjad wrote. “It will get better with time.”