Software engineers. Public relations specialists. Medical records clerks.
Faced with no-shows at immunization clinics and leftover doses, some Wisconsin hospital systems are offering COVID-19 vaccines to staff who do not work with patients or in medical settings, under an interpretation of vaccine prioritization guidelines that federal advisers say is a stretch.
At least one hospital system — Advocate Aurora — has opened up vaccine appointments to all employees. At other health systems, employees listed as administrators or public relations specialists have received vaccines, according to social media posts.
Wisconsin is still finishing the first phase of its vaccine rollout plan, which includes long-term care facilities and health care personnel, with a focus on front-line hospital staff.
Track COVID-19 in Wisconsin: See the latest data on cases and the vaccine rollout
Both the CDC and the state health department define Phase 1A health care personnel as “individuals who provide direct patient service” or “engage in healthcare services that place them into contact with patients who are able to transmit SARS-CoV-2, and/or infectious material containing SARS-CoV-2 virus.”
The decisions by some hospitals to include employees who work from home and do not interact with patients have raised eyebrows in Wisconsin and other states.
And even members of the U.S. Centers for Disease Control and Prevention committee that formulated the guidelines say they have been surprised at the variety of ways in which hospitals have interpreted them.
“The 20-year-old or 30-year-old IT worker — no one would have ever thought that person would be in the first group,” said committee member and University of Iowa coronavirus researcher Dr. Stanley Perlman. “It ended up morphing into a more general type of distribution than we would have envisioned.”
The slower-than expected vaccine rollout around the country has made the problem worse, Perlman said — with many elderly or immunocompromised people growing frustrated to see younger or healthier people getting vaccinated first.
Advocate Aurora spokeswoman LeeAnn Betz confirmed in a statement Friday that the company is opening COVID-19 vaccine appointments to all employees.
“As we expect a continued increase in our staffing needs, vaccinating more of our team will allow us to redeploy individuals as needed to support expanded vaccine clinics for patients and community members,” Betz wrote.
At Ascension Wisconsin, a spokeswoman said the organization employs people who “both work from home and also enter healthcare settings in their role and have the potential for direct or indirect exposure to patients or infectious materials.”
“These individuals are health care personnel eligible for vaccination in accordance with CDC and DHS guidance,” the spokeswoman wrote.
When it comes to workers coming into contact with “infectious materials,” Perlman clarified that the committee was envisioning staff working in research labs processing specimens that may contain the virus — not, for example, administrative employees handling paperwork.
“Somebody touching a piece of paper in a hospital, I wouldn’t think of any extra risk,” Perlman said. “But it is very, very hard to go through and make these fine distinctions, and have it be right.”
‘It’s far better to get a shot in somebody’s arm than throw it out’
Some public health experts and federal officials, like U.S. Health and Human Services Secretary Alex Azar, have emphasized the need for efficiency even if it means that vaccines are not being distributed in order of highest need.
Over the past week, the U.S. has averaged a record-breaking 3,000 coronavirus deaths per day.
“It would be much better to move quickly and end up vaccinating some lower-priority people than to let vaccines sit around while states try to micromanage this process,” Azar said at a Jan. 6 briefing on Operation Warp Speed.
In a statement last week, Wisconsin Department of Health Services spokeswoman Jennifer Miller said state health officials “have been clear with our vaccinators about who the intended recipients are of the vaccine in this phase.”
“We do know that sometimes to use all doses of thawed vaccine, some people outside of Phase 1A may receive a vaccine,” Miller said in a statement. “There is also some latitude within the definitions that may result in some providers interpreting the guidance differently from each other.”
Both the Pfizer and Moderna vaccines have to be frozen at cold or ultra-cold temperatures. Once thawed, a Pfizer vial can last in the refrigerator for five days and a Moderna vial for about 30 days. However, once punctured or diluted, both the Pfizer and Moderna vials must be used within six hours.
Each vial of the Pfizer vaccine contains five to six doses; Moderna vials contain about 10.
In some states, dramatic examples of people jumping the queue for vaccines have been decried as cronyism. In Florida, for example, a nursing home offered vaccines to members of its board and major donors, the Washington Post reported.
But that doesn’t seem to be the norm, said Ajay Sethi, an infectious disease expert with the University of Wisconsin-Madison. He said the top concern should be that no doses go to waste.
“It’s far better to get a shot in somebody’s arm than throw it out. Throwing it out is a complete tragedy,” Sethi said.
“If it’s happening to the point where the original plans are being abandoned, then I think that would be an issue,” Sethi added. “But I don’t think we’re at that stage right now.”
Fewer health care workers agreeing to be vaccinated than expected
Arthur Kaplan, head of the Division of Medical Ethics at NYU School of Medicine, said part of the problem is that vaccine refusal rates have been higher than expected.
Hospital systems contacted by the Journal Sentinel did not directly answer whether vaccine hesitancy has been a factor in creating leftover doses.
But early reports from around the country suggest the number of health care workers who are delaying or declining the vaccine is higher than expected. Last month, Ohio Gov. Mike DeWine said about 60% of nursing home staff elected not to take the vaccine. In New York last week, Gov. Andrew Cuomo estimated 30% of hospital and nursing home employees are expected to refuse it.
At a press briefing on Monday, DHS Deputy Secretary Julie Willems Van Dijk said the department is not tracking how many health care workers declined the vaccine.
However, Willems Van Dijk said vaccine hesitancy is “definitely is part of the reason why we haven’t gotten to 100% yet.”
At a meeting of the State Disaster Medical Advisory Committee last week, several members brought up reports of leftover doses and vaccine reluctance among health care workers.
“What we’ve heard more and more is that there are organizations that end up with unfilled slots in their immunization schedules who would like to reach out to members that would technically be in that next (rollout) group,” said Dr. Jim Conway, a professor of pediatrics at UW-Madison.
But the committee has not yet quite finalized who is eligible for that next phase.
Gundersen Health System’s Dr. Rajiv Naik said health care workers who do not interact with patients, such as IT technicians, should be included as soon as possible because of their critical role in a hospital’s day-to-day functions. He acknowledged that some health systems have already started vaccinating them.
“I know some vaccinating entities are not following the letter of the ‘law’ that we put together with the guidelines,” Naik said. “In our organization, I have been pretty precise about sticking to the face-to-face providers.”
Perlman, of the CDC committee, said vaccinators should use “common sense” when it comes to distributing leftover doses.
“If you have the person who’s in housekeeping changing trash cans in hospitals versus somebody who is an administrator sitting in an office or at home doing IT work, clearly the guy who’s changing the trash cans should be immunized way ahead of the other two,” he said.
50 different strategies for prioritizing doses
But some critics, like Kaplan, said public health officials should have created guidelines for how health systems prioritize leftover doses.
“They did not anticipate and talk about the reality that the location and the logistics are going to drive allocation as much as any priority list or recommendation,” Kaplan said. “We didn’t plan properly.”
Another factor is the federal government’s flexible approach to vaccine guidelines, he said. Each state — and in some cases each local health department or vaccinating entity — can deviate from the federal guidelines. In Florida, for example, Gov. Ron DeSantis ordered people 65 and older would be the first to be vaccinated.
“The more you have disparity in what states or cities or counties are doing, the less support there is for following rules, both by the people giving out the vaccines and people taking them,” Kaplan said. “When you have 50 different strategies, that is really problematic for keeping support for the priorities.”
Raquel Rutledge of the Journal Sentinel staff contributed to this report.