Making sense of vaccine distribution in Sierra County

In a Thanksgiving address to the nation, President-elect Joseph R. Biden declared that America is “at war with the virus.” As is the case with military combat, the “fog of war” has made it difficult for both frontline health care workers and anxious vaccine seekers to understand how the struggle to get as many shots distributed as quickly as possible is proceeding in their states and communities.

Over the past two weeks the Sun gathered every shred of information available about the workings of the vaccine distribution system in Sierra County. Access begins, as every sentient New Mexican knows, with registering one’s wish to be vaccinated with the New Mexico Department of Health online registry. The four-step process is reprinted below from the NMDOH registry with additional information and clarifications provided by the Sun. These guidelines unfortunately represents nearly the totality of public knowledge.

This report pieces together additional details about the on-the-ground operation in Sierra County from anecdotal evidence and scattered sources of information. Although our assessment is not bullet proof, it appears that system is working, albeit too slowly for everyone’s liking, and that it is fairly efficient and fair in distributing the vaccine that has been made available to Sierra County providers. The biggest hitches are limited supplies of vaccine and inadequate communication of the nitty-gritty details about the organization of Sierra County’s registration “queue.”

The Sun’s assessment is backed up by the only available hard data on local vaccine distribution, which can be found on the New Mexico Department of Health’s COVID-19 Vaccine Dashboard.

As of Feb. 1, Sierra County had partially or fully vaccinated 1,722 individuals. In other words, 15.5 of every 100 county residents have been vaccinated at least once.

One can surmise, since there is no breakdown of that data available, that the majority of these individuals were in the top-priority 1A cohort of health care workers, residents of long-term care facilities and congregate-setting workers. Vaccine distribution here is now likely focused largely on the cohort in Phase IB, whose members are eligible for vaccination on the basis of age (75 or older) or their underlying health conditions. (An itemization of the chronic medical conditions that qualify New Mexicans 16 and older for inclusion in the 1B cohort can be found at the end of this article.)

Sierra County’s performance ranks eighth out of the state’s 33 counties. As of yesterday, Union County ranked first, with 39.5 of every 100 residents having been vaccinated, and Mora County ranked last, with 3.8 of every 100 residents having been vaccinated.

The overall performance of New Mexico’s distribution systems has propelled the state into second place nationally in terms of the percentage of available vaccines that have been distributed. As of today, New Mexico had received 317,900 doses and administered 86.58 percent, or 275,224, of them, according to Becker’s Hospital Review.

Reassuring! Except to unvaccinated New Mexicans, who have no idea when they can expect to receive their desired shots.

With as many as 800,000 state residents currently eligible for vaccination and the weekly supply of vaccine to the state numbering only between 25,000 and 35,000 doses, state health officials acknowledged to the Albuquerque Journal in a story published on Jan. 26 that it may take months to completely vaccinate the willing recipients among the 150,000 New Mexicans who are 75 or older, the 466,000 who have chronic medical conditions and the 138,000 who are health care workers.

SIERRA COUNTY’S THREE VACCINE PROVIDERS

In an attempt to answer how fast the queue is moving in Sierra County, the Sun spoke with personnel at the four health care providers listed on NMDOH’s vaccine dashboard as local distributors.

These conversations uncovered some new information. The Sun learned that NMDOH has apparently listed Ben Archer Health Center in Truth or Consequences as a vaccine provider in error. “I don’t know where you got that information,” said a center employee who answered the phone. “We don’t have vaccine here.”

Sierra Vista Hospital and the Sierra County Public Health Department both confirmed that they hold vaccine clinics twice a week for eligible county residents who have received notification from the state that they may schedule an appointment online. The hospital’s pharmacist declined to say which days, out of fear that the clinics, which are conducted outside the hospital in the north-end parking lot, would be overwhelmed by walk-ins.

The clinics at the public health department are held, when supplies are available, on Tuesdays and Fridays at 201 E. Fourth Street in T or C. Based on personal experience and observation—having an eligible chronic condition, this reporter received her first dose of Pfizer vaccine there on Jan. 15—the clinic’s intake personnel are willing and often able to accommodate special situations (about which more later).

The pharmacist at T or C’s Walmart declined to come to the phone, directing the Sun to speak with “corporate.” We were able to make online contact Rebecca Thomason, senior manager of corporate communications, at Walmart headquarters in Bentonville, Ark. Thomason confirmed that “[r]eceiving a vaccine at any of our stores is by appointment only and availability is based on state allocations.”

Thomason provided a ray of hope that it might be the possible for eligible vaccine recipients to schedule an appointment at Walmart without waiting for notification from NMDOH. She announced that this week Walmart and Sam’s Club stores currently distributing vaccines—including the T or C Walmart—are “expected to launch online schedulers . . . , so eligible populations can sign up directly from our website.”

Thomason gave no specifics, but the Sun will monitor the situation and update this story when it is possible to provide details about the Walmart scheduler.

TAKEWAYS FROM THE VACCINATED

The Sun also interviewed 10 county residents who have received one or both doses of vaccine and several residents who qualified for vaccinations, but who had yet to be notified to schedule an appointment with a local provider. None of the vaccinated had serious complaints about their encounters with the system. A snowbird who received his first dose in early January was particularly complimentary, proclaiming: “I got my vaccine before the Queen and the Pope.”

The vaccinated individuals, with one exception, range in age from 68 to 87 and live in locations across the county: Elephant Butte, Cuchillo, Kingston, Lake Valley and Truth or Consequences. All were members of the 1B cohort. The Sun will not divulge their names to protect their privacy.

Nor will we identify the exception mentioned above: a T or C resident in her early 50s who announced on her Facebook page that she had been vaccinated in mid-January by a local provider. This individual declined to be interviewed, claiming: “It’s not worth including my experience as I have since learned that [the provider] changed their game [plan].” Jumping the queue—if that is indeed what happened in this case—does not seem to be a widespread local phenomenon, at least as far as the Sun has been able to discern.

The interviewees offered valuable advice for fellow IB members. (These tips will be relevant to the 1C essential workers as soon as the state announces that it has opened scheduling for that cohort.)

Hang on to the confirmation code you received when you register as if it were gold, as it is the identification the system will use to help you through every step of the process.

If you haven’t yet completed your profile on the state registry, do so immediately, especially if you hope to be deemed eligible on the basis on your health and not on your age.

Monitor your email and text messages throughout the day for delivery of an “event code,” which will allow you to attempt to schedule an appointment online at the registration website. One interviewee received this notification at 7 in the evening.

Use the event code immediately upon receipt, as available appointments are quickly filled.

If your event code doesn’t work, NMDOH advises you to be patient; you will be sent an event code again when local providers are again scheduling.

If your scheduled appointment is cancelled, usually due to lack of doses, the notification should provide a date and time when the appointment has been rescheduled. If it doesn’t, call the provider and ask for assistance in rescheduling. That’s what I did when I received a text message that my appointment for a second dose was no longer operative. The person with whom I spoke promised to look into the problem—and did! She called me back several hours later to confirm that I had been rescheduled.

TAKING ADVANTAGE OF “LEFTOVER” DOSES

The issue of limited supplies is one hitch in New Mexico’s distribution system, but the state can do nothing to speed up the queue until the federal government ramps up national vaccine production and acquisition. The other major hitch, which is the cause of anxiety and frustration, especially among the eligible 1B cohort, is the inadequacy of NMDOH’s post-registration communications.

“We are all in the dark,” a Hillsboro retiree said, about when one can expect to be vaccinated. Local providers are similarly uninformed about supply. An employee at one of the providers said, “We don’t know how much vaccine we’re getting until the day of the clinic when the supplies arrive.”

NMDOH should clearly explain how the 1B queue is organized and how the order in which cohort members are notified to schedule appointments is determined. NMDOH’s vaccine allocation plan states only that, “within a given phase, invitations for New Mexicans to schedule vaccine appointments will be made at random.”

State health officials should also be much more proactive in publicizing the frequent failure of event codes. “Frantic” doesn’t begin to describe the feelings of the stymied. One of Sun’s interviewees, who found he couldn’t make the event code work five minutes after he received it, took matters in his own hands. He called the county health provider, explained the situation and was scheduled over the phone.

Local providers say they make every effort to use all the doses they have been given for each of their vaccine clinics. When people don’t show up for their appointments, for example, their doses are suddenly available for others. Procedures governing how surplus doses are to be distributed should be widely publicized to the public to ensure that access to them is as equitable as possible.

Sierra Vista Hospital explained that providers with unclaimed doses can go into the state registry and identify eligible county residents to see if they can immediately come into the clinic. One of the Sun interviewees, who lives in Kingston, confirmed that he was called by the hospital and asked if he could make an appointment an hour later. He first had to complete a same-day medical questionnaire on the state’s online registry, leaving him with only 30 minutes in which to make the 45-minute trip.

He asked the Sun not to divulge how he managed to get to the clinic in time. When a health care worker came to his car window to check him in, the first thing he was asked was if he had completed the same-day medical questionnaire, prompting him to question—but only just a little—the system’s efficiency. This was the only complaint raised by the Sun’s 10 interviewees.

During my late-afternoon appointment to get my first dose at the county health department, I overheard the visiting nurse announce to the intake personnel that three doses were still unclaimed. Calls were immediately made to try to find eligible persons who could drop everything and come in to be vaccinated. A woman who had driven her elderly sister to the clinic from Caballo hit the jackpot. Eligible to be vaccinated because of a chronic medical condition but lacking both an event code and an appointment, she received one of the leftover doses.

The state gives providers leeway to schedule their own appointments if three of their successive clinics have not been totally filled. The Sun is aware of three eligible individuals who were able to schedule appointments directly with a provider without an event code.

Members of the IB cohort may wish to contact local providers to inquire whether that provider maintains an independent waiting list and if and how you can be listed.

Proactivity just might help advance your place in the queue.