Confusion over when Covid-19 vaccine distribution could begin in Pennsylvania nursing homes caused at least a weeklong delay in getting the life-saving shots to seniors, a review of emails obtained from Governor Tom Wolf’s office shows.
The delay is significant because Pennsylvania was one of the worst performing states in handling the “fall surge” of Covid-19 as it related to lives lost in long term care facilities (LTCFs).
Nearly all states received their first allocation of vaccine shipments on Dec. 14. The federal government also provided a program called the Federal Pharmacy Partnership, which aimed to help states get shots to seniors by using the pharmacy expertise and expansive geographic reach of for-profit companies like CVS and Walgreens.
Some states, like Florida, aggressively distributed vaccines to LTCFs within days, using both their own plan and the FPP. Other states began vaccinating seniors in LTCFs through the FPP on Dec. 21. Others, Pennsylvania included, began vaccinating seniors through the FPP on Dec. 28.
A series of emails between state and federal officials show that the decision to wait till Dec. 28 was a matter of controversy, and both blamed the other for the shots not having been distributed at least a week earlier through the FPP.
On Wednesday Dec. 16, staffers for the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) asked the Wolf administration for details about their vaccine distribution plan.
“In a similar vein to [question] #3, it appears that all the vaccines thus far have been directed to healthcare workers, and none to LTC facilities,” the email from Sara Maskornick, a staffer on the HELP Committee read. “Could you provide more specifics on the timeline and process for vaccine[s] being distributed to LTCs? I reviewed the state distribution plan and understand that SNFs are at the top of the ‘sub-prioritization’ list, but it doesn’t look like any SNFs have received the vaccine yet.”
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Jack Groarke, Gov. Wolf’s deputy chief of staff for federal affairs, responded by putting the onus back on the feds, saying that vaccinations of elderly in skilled nursing facilities, a subset of LTCFs, would be handled by the FPP.
By Friday, a lawyer for the U.S. Senate Committee on Aging, Caitlin Warner, pressed Groarke for a deeper answer.
“The decision to begin on the vaccinations on the 28th [of Dec.] was made by the federal government,” Groarke responded three days later, on the afternoon of Monday, Dec. 21. “PA DOH advocated for the program to begin sooner.”
That response prompted even more curiosity from Maskornick, as well as an assertion by her that the decision to make the 28th the distribution date was made by the Pennsylvania Department of Health
“Could we please get additional clarification on how this date of December 28 was decided?” Maskornick wrote. “[Centers for Disease Control], Walgreens and CVS have all told us, independently, that this date was selected by PADOH. Were there constraints identified that led DOH to determine it could not start vaccination before the 28th? If so, could you elucidate?”
After this portion of the email exchange, the conversation appears to have shifted away from email and to conference calls.
A report from USA Today at the time noted that the FPP “will launch Dec. 21 for jurisdictions that opted to use the Pfizer-BioNtech vaccine.” The emails obtained by Broad + Liberty show this is the vaccine the state chose for the program.
Because the vaccine Pennsylvania had chosen was available for FPP distribution on Dec. 21, all available evidence points to the state missing a key week for vaccine delivery to LTCFs through the program, in addition to not having any delivery strategy apart from the FPP.
All available evidence points to [Pennsylvania] missing a key week for vaccine delivery to LTCFs through the program, in addition to not having any delivery strategy apart from the FPP.
If evidence to the contrary exists, it remains hidden in large part because requests for comment to the Wolf administration, the Pennsylvania DOH, the Senate HELP Committee, and the CDC were not returned.
By December 21 — the same day Groarke told Warner and Moskornick that the decision to distribute vaccines to seniors on the 28th was not in the state’s hands — the Pennsylvania Health Care Association was already complaining that long-term care residents weren’t being vaccinated quickly enough.
“[I]t is now clear that long-term care has once again been left behind in the state’s response,” the PHCA said in a press release. The association represents more than 600 LTCFs in the state.
During the first four months of the pandemic, from March 17 to July 17, 2020, about 4,800 long term care facility (LTCF) residents died due to Covid-19, according to state data. The four months from Nov. 17, 2020, to March 17, 2021, saw about 6,700 LTCF deaths — 40 percent more than the first wave, and an average of approximately 250 deaths per week.
The PHCA has said previously that after the initial six to eight weeks of the pandemic, it was no longer invited by the administration to lend strategic advice.
Those feelings were reinforced after seeing the emails.
“On October 1, 2020, the Pennsylvania Department of Health invited various stakeholders to participate in a vaccine task force that would develop a statewide rollout plan. Representatives from long-term care — experts on the front lines — were not included in those discussions,” said Zach Shamberg, president and CEO of the PHCA.
“Fast forward to December, as the vaccine arrived, our workers and residents were forced to watch as Pennsylvania’s hospitals were prioritized, and other states implemented plans to immediately distribute vaccines to their long-term care facilities.”
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The PHCA believes that the FPP was only meant to be one tool of many available to the state, and that it could have pushed ahead with other delivery strategies.
“In Florida, which is comparable to the number of long-term care facilities and residents in Pennsylvania, state leadership prioritized long-term care with the vaccine rollout. They didn’t wait for the Federal Pharmacy Partnership to begin,” Shamberg said.
“When they received the vaccine the week of December 14, they allocated supplies to select hospitals and strike teams, instructing those groups to vaccinate frontline health care workers and residents of long-term care facilities.
“A week later, they increased that effort when they launched their Federal Pharmacy Partnership program,” Shamberg continued. “By the time Pennsylvania began administering vaccines to long-term care, Florida was already administering second doses to the state’s vulnerable residents. And West Virginia, our neighbor to the south, had already completed long-term care.”
“By the time Pennsylvania began administering vaccines to long-term care, Florida was already administering second doses to the state’s vulnerable residents.
The new findings add to previous reports showing that the vaccine rollout stumbled badly in the commonwealth.
Just as first shipments were being received around the country on Dec. 14, Pennsylvania still had not “disclosed how many doses are anticipated or how the vaccine will be allocated once it gets here,” according to a Pittsburgh Post-Gazette report.
“The state released an interim vaccine plan Friday [Dec. 11], but it doesn’t detail which regions or facilities will get the initial doses, making Pennsylvania and Puerto Rico the only places that haven’t released that information, according to a New York Times survey.”
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Confusion existed at the federal level as well. According to Health and Human Services memos obtained by CBS News and reported on Dec. 14, “HHS explicitly instructs providers that the ‘earliest the program can turn on is Dec 21st,’ referring to administering the Pfizer vaccine.”
Also worth noting is that even if Pennsylvania did not start getting shots into arms on Dec. 28, it was not alone in that regard. Other states like Michigan, Wisconsin, Arizona and others did not get their FPP program moving until the 28th.
Yet other states did proceed before that time. A report from The Hill noted that vaccinations in LTCFs began on the 21st through the FPP program for 12 states, matching the claim from the PHCA in its December press release.
In Florida, a state with one of the highest senior populations in the country, vaccinations began on Dec. 16, even as a local news report said, “Gov. Ron DeSantis says he is getting ‘mixed signals from the bureaucracy’ about the ability of pharmacies CVS and Walgreens to quickly administer the vaccines to nursing home staff and residents.”
West Virginia led the nation in vaccinating seniors in LTCFs, even though it opted to forgo the FPP entirely. Before the New Year, Gov. Jim Justice announced the state had delivered both doses to all nursing home residents in the state.
Todd Shepherd is Broad + Liberty’s chief investigative reporter. Send him tips at email@example.com, or use his encrypted email at firstname.lastname@example.org.