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Vaccine sign-up struggles highlight state and federal challenges

Governors want the White House to coordinate its pharmacy and community health center distribution programs with states

The Biden administration’s new programs to get COVID-19 vaccines to pharmacies, long-term care centers and other sites are meant to ease state vaccine distribution — but in some cases they are having the opposite effect, and states are calling for more coordination.

Vaccine-eligible people often must compete for appointments at myriad disparate sites, and states are struggling to keep tabs on how much vaccine is needed. The White House agrees there’s a problem, but White House spokesperson Jen Psaki recently told reporters that officials don’t yet have a solution. In the meantime, COVID-19 response coordinator Jeff Zients is encouraging states to simplify COVID-19 vaccine sign-ups by merging pharmacy websites with state websites into one portal. 

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New Mexico was the first state to implement a statewide registration system, and at least 15 other states followed suit, according to the National Governors Association. States that have not streamlined their sign-ups, such as Maryland, require residents to check each individual vaccination site for availability, a slow process that will only get worse as states expand vaccine eligibility.

The COVID-19 vaccine distribution system is complex. The federal government sends first and second doses to states and territorial governors, who typically then distribute them to countries and localities.

Other federal programs, including the new ones created by President Joe Biden, add another layer. They send vaccines directly to long-term care facilities, pharmacies, federally qualified health center programs and Federal Emergency Management Agency sites — and state governments do not receive updates about these shipments. 

“We need better coordination between the federal government and the state government so we know what pharmacies they’re sending to, we don’t send to the same ones, local government doesn’t send to the same ones,” New York Gov. Andrew Cuomo, a Democrat, said during a recent COVID-19 news conference.

The National Governors Association recently asked the Biden White House to coordinate its pharmacy and community health center distribution programs with states. 

“If the federal government distributes independently of the states to these same entities without state coordination and consultation, redundancy and inefficiency may very well follow,” governors wrote to Biden.

At this point, federal officials could focus their efforts on helping states streamline their sign-up systems or creating a uniform plan for states to follow, said Jen Kates, a senior vice president with the Kaiser Family Foundation. If states have an easy blueprint to follow, it could help avoid disorganization. 

“It isn’t good if it works this way where every single day they try 10 times to get an appointment from 20 different websites,” said former FDA Chief Scientist Jesse Goodman. “Ideally we’d have a more user-friendly situation than that, especially for high-priority people.”

The federal vaccine supply is expected to surge in the late spring, but there currently aren’t enough doses for everyone who qualifies. Vaccine-eligible people often trawl several different websites and portals to access an appointment. If a person is on multiple wait lists, that can skew states’ vaccine tallies.

This vaccine deficit also creates competition and adds to the stress of vaccine sign-ups, noted Claire Hannan, the executive director of the Association of Immunization Managers. Consumers who are more tech savvy or have more time on their hands have a much better chance of getting the vaccine.

State officials are continuing to rethink their sign-up strategies. Four Pennsylvania state senators plan to soon introduce a bill to centralize vaccine registration, even though the state’s acting secretary of health, Alison Beam, threw cold water on the idea just a few weeks ago. When the concept first came up, Beam said a centralized signup system would be too complex and wouldn’t fix the core issue of having too little vaccine. 

“This legislation will reduce frustration, eliminate the need to spend hours searching for appointments and permit prioritization of vaccine distribution to our most vulnerable citizens,” the senators argued in a co-sponsorship memorandum. 

Cuomo blamed the federal government for not making more doses available as states expand their eligibility. He said the confusion around vaccine distribution likely would not end until April, May or June, when states have more doses.

“When you have increased dosages, that extensive distribution network will wind up being a positive, not a negative,” Cuomo said. “But there is a downside to coordination in the meantime.”

Preparing for the next pandemic

The White House says it is considering other ways to streamline sign-ups, and some policy experts are pushing them to use a national database, similar to But even if the Biden administration started building a centralized vaccine sign-up program tomorrow, public health experts say it would be too late — although they say the Biden administration can prepare for what’s next. 

“Even if we get it built and then this phase of the pandemic we’re in is over, we’ve never had a national vaccination network or system, and we need one anyway,” said Georges Benjamin, executive director of the American Public Health Association.

Benjamin, who also helped Maryland roll out its federal health insurance exchange sign-ups, said that creating a national registry would be simpler than the insurance sign-ups. When people sign up for insurance on the federal exchanges, they need to shop around and figure out what plans they might qualify for, but when it comes to COVID-19 vaccines, people only need to enter their age and some basic demographic information and await their turn.

Such a system might require the work of multiple technology companies, system engineers and health privacy lawyers. But some experts said a system like this should have been set up in the beginning of the pandemic, and if the Biden administration were to build one now, it would be playing catch-up. 

“At this point, a federal system is probably not going to work. If you can’t have one sign-up, maybe you can have one sign-up process,” said Kates.

“There are a lot of lessons learned for next time,” she added.

Emily Kopp contributed to this report.

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