As many adults in South Carolina still struggle to find COVID-19 vaccine appointments, the state health department is sticking to a methodical but slower approach of sending vaccines in small quantities to the state's rural areas. Meanwhile, the state's largest hospital systems say they haven't been entrusted with nearly as many doses as they could conceivably handle.
The result seems to prioritize making sure each community, however small, has access to the life-saving shots over all-out speed, even as the state languishes at the bottom of national rankings for the percentage of its population with shots in arms.
On March 25, President Joe Biden doubled down on his promises for his first 100 days in office, investing $10 billion in stimulus, saying the country will vaccinate 200 million Americans and open eligibility to everyone by early May. South Carolina is opening up eligibility even more quickly than that. Gov. Henry McMaster announced on March 26 that anyone 16 and older could get a shot starting on the last day of the month.
But one hospital administrator in the Lowcountry said these targets are unrealistic for South Carolina unless shipments to the state, and to hospitals, speed up.
Delivering health care to rural parts of the state has always been a challenge, and leaders heading up the vaccination effort in South Carolina deliberately chose a strategy of sending small shipments of the Moderna vaccine to local providers and pharmacies. But there has been a tradeoff: With this approach, South Carolina's Moderna vaccine is moving out at one of the slowest paces in the country, according to a Post and Courier analysis of data from the Centers for Disease Control and Prevention.
Anthony Poole, chief clinical officer with Fetter Health Care, gives a Johnson & Johnson coronavirus vaccine to a man at the Arthur Christopher Recreation Center on Fishburne Street on March 24, 2021. Fetter Health and the Charleston Recreation Department teamed up for the pop-up event. Brad Nettles/Staff
By comparison, the Pfizer vaccine, handled mostly by the state's hospitals, is flying off of shelves at one of the fastest rates in the nation. Hospitals are asking DHEC for more.
Vaccine data seems to bolster the hospitals' argument: The health systems are the most efficient providers in the state when it comes to administering coronavirus vaccines. As a group, they had already given out 98 percent of the 602,000 first shots delivered by March 23.
But letting hospitals, which are grouped in the state's more urban centers, handle all of the roughly 235,000 first doses of the vaccine expected statewide in the coming week also wouldn't make for an equitable rollout.
"DHEC is taking great effort to distribute small amounts of Moderna vaccine to many, many providers around the state in order to get into small communities," a spokeswoman for the agency said. Even so, the state at one point ranked 48th in shots in arms, and has struggled to break out of the bottom 10 of all states in the percent of the adult population vaccinated.
DHEC acknowledged there is room to improve getting the Moderna vaccine out, and the spokeswoman said, "the state, as a whole, is making notable progress in speeding up its Moderna utilization rate."Â
It is hard to know why other states' Moderna shots are getting out faster, given that comparing states head to head is just about impossible. Plans for distributing vaccines were left up to each state, and as Nick Davidson, DHEC's senior deputy for public health, put it: "There's probably as many different strategies to rolling out the vaccine as there are states."Â
High hopes
The first weeks of the vaccine's rollout in South Carolina were mired in disorganization.
Hospital leaders exuded optimism at first. Officials at both MUSC Health and Prisma Health told legislators in January they could vaccinate 10,000 people every day.
Reality fell far short of those hopes.Â
The number of people on MUSC's waitlist topped out at 51,000, and for weeks, the health system wasn't scheduling new appointments at all. Winter storms clogged the nation's supply chain. On one occasion in early February, a truck arrived at Prisma Health's Greenville operation without any of the expected doses at all — just other supplies — prompting the system to send part of what came to its Columbia operation north, a local TV station reported.
Now, shipments of vaccine to the state have evened, and DHEC has set a minimum amount each hospital can expect to receive each week.
That minimum amount has still been a disappointment for some hospital systems, which say they could do much more. In its statement, DHEC said that while it used to determine how much each provider would receive based on how quickly it used its doses, under the behest of the state Legislature it switched to a model that has the agency sending doses to areas of the state based on population levels on March 8.
MUSC is now averaging between 12,000 and 15,000 vaccines given per week, and maintains it could handle 70,000 per week if it had the doses.
Dr. Danielle Scheurer, chief quality officer for MUSC Health, has said, "the math just doesn't work out" for South Carolina meeting the goal of getting every adult vaccinated before the summer at the pace the state is moving.
She said MUSC was entrusted with much of the state's COVID-19 testing operation, and mass vaccination events are not much different.
"We average eight minutes per patient. We've totally got this down," Scheurer said. "It's not like we're the only ones that can do it, but we are certainly willing and able, and we got state funding to do this. So, we may as well do it. We just need the vaccine."
The state-backed health system received $45 million from the state Legislature in February to fund administration of vaccines.Â
Prisma Health is both the state's largest health system and its largest vaccinator. Dr. Rick Scott, a clinical leader and co-chair of its Vaccine Task Force, said the organization has been so eager to increase the supply of vaccines that calls were held directly between Prisma and Moderna leadership.Â
Prisma can move through its entire supply in about a week, Scott said, and purposefully holds only a small amount of vaccine in reserve.
"There's efficiency to big sites," he said.Â
But Scott said he sees benefits to multiple strategies, and even with its tentacles spread across the state, Prisma Health's reach only extends so far.
Other priorities
Speed might not be the top priority for all providers.
According to an analysis of DHEC's data by The Post and Courier, speed has not been the strong suit of the roughly two dozen government-designated health center organizations in South Carolina.
As a group, the health centers by March 18 had received about 19 percent of all the Moderna doses in South Carolina. Only about half had been used, however. The Primary Health Care Association, which represents those centers across the state, said the organizations are hyper-focused on targeting vulnerable populations with limited access to health care, in places ranging from Hollywood and Pineville to rural Wadmalaw Island.Â
Doing so takes time and careful efforts.
"When you are targeting areas and populations based on the greatest need, you cannot utilize stock as quickly,"Â the association said in a statement. Events are spread throughout the week and aren't held every day.Â
With limited staffs and an overwhelming amount of reporting requirements on their plates, the data available through DHEC may not be completely accurate, the association added.Â
At Hope Health, a community health center based in Florence, Dr. Heather Leisy, director of preventive medicine, said the organization has spread out vaccine appointments through mid-April. Leisy said because some patients are hard enough to reach to make an appointment once, Hope Health is doing its best to make sure no appointments need to be canceled because supply fell through.
As of March 26, Hope Health had received 4,500 first doses of the Moderna vaccine, and had given 1,701, according to the daily data every provider submits to DHEC. But it was also planning a mass vaccination clinic at the end of the week, expecting to give 1,500 doses.Â
In addition to data entry, Hope Health's limited staff are focused on reaching out to patients and coordinating their appointments, on top of the center's usual business, Leisy said.
Like many health centers and smaller providers in the state, Leisy said the shipments to Hope Health have been small and irregular, making planning difficult.Â
Even given the challenges, however, Leisy said health centers like Hope Health continue to play an integral role.
"We really see ourselves as in that gap, especially for rural communities where hospitals don't have a reach," she said. "We are extremely committed to doing that, no matter how hard it is."
How to judge each state's effort
Doctors' offices and other conventional sites alone don't have enough capacity to move vaccine quickly and stop the pandemic, national health leaders wrote March 10 in the New England Journal of Medicine. Mass vaccine sites are necessary.Â
Those large events are exactly what Charleston system Roper St. Francis had in mind when it set up a vaccine site at the North Charleston Coliseum, within sight of Interstate 526.
"This is a great step forward here, and an example for the rest of the state and possibly an example for the rest of the country,"Â Gov. Henry McMaster said while touring the site in early January. "Our main source of vaccinations is these hospitals."Â
But though the site has stayed open each day, the number of doses coming in doesn't match demand.Â
"We just want to do our part, and there's just frustration about our capacity and not being able to utilize it to help the community," said John Fowler, pharmacy manager for Roper St. Francis.
Recently, DHEC set new minimum vaccine amounts for each hospital. Roper St. Francis will get 6,000 to 7,000 first and second doses each week, and that regularity will help the system plan. It could still do more, however.
Roper St. Francis noted its high-traffic site in North Charleston wasn't reaching every community equally, so it has found partners that can help with outreach. In a recent example, the system partnered with the nonprofit Palmetto Palace to give out 500 doses of vaccine at an AME church on March 21 on Wadmalaw Island. All the shots were gone by the end of the day.
Every state has its own factors that make vaccines harder or easier to deliver. In South Carolina's case, the population skews older and less healthy.Â
Nilanjan Chatterjee, a Ph.D. researcher at Johns Hopkins University who specializes in biostatistics, said even given those differences, it is still fair to compare states by how much of the population has been vaccinated. South Carolina ranked 40th in that measure on March 24. Chatterjee said one could also consider what proportion of the population vaccinated is in the older, more at-risk age group.
In that respect, South Carolina would score in the top five. Chatterjee said that could be a sign the state's rollout has been more equitable than others. He also said any state that publishes as much data on the vaccine effort as South Carolina does deserves credit.
