JEFFERSON CITY — Missouri’s low national vaccination ranking and discrepancies between geographic areas and vulnerable populations were among the concerns raised by lawmakers during a three-hour meeting Feb. 3 with the state’s vaccination team.

The administration has received criticism regarding the state’s vaccine rollout after the Centers for Disease Control and Prevention released a report showing that Missouri ranked last out of all 50 states in vaccine rollout.

Discussing the ranking

The state allocates roughly 85,000 vaccine doses per week from the federal government. Adam Crumbliss, director of the Department of Health and Human Services Division of Community & Senior Health, said that for each dose, DHSS receives an average of three requests.

Still, some doses are not being used or not being reported as being used. Randall Williams, director of the state Health Department, said this issue stems from individual vaccinators, not the state.

“When you criticize us that we’re not vaccinating enough, you’re actually criticizing the vaccinators,” Williams said.

Williams said the state uses a “proven platform” in which large health care systems are required to administer and report vaccine doses within seven days of receiving them from the federal government. Williams said major facilities also “reach out to the rural communities around them, and it’s in their best interest to do that.”

These larger facilities are generally located in metropolitan areas, leaving rural counties at a disadvantage. In response, Gov. Mike Parson activated the Missouri National Guard in January. The National Guard holds nine mass vaccination clinics across rural Missouri each week.

Two groups are currently being vaccinated across the state: Missouri residents ages 65 and older and those with comorbidities that may cause them to become seriously ill if infected with COVID-19. These groups account for more than 2 million residents.

As of Feb. 2, 7 percent of Missouri residents have received at least one dose of the vaccine. Williams said roughly 20,000 doses are administered statewide per day.

Underserved groups

Representatives also addressed concerns that certain groups of vulnerable people within their respective districts aren’t getting access to the vaccine.

Rep. Kimberly-Ann Collins, D-St. Louis, drew attention to two populations that she felt may be due additional concern — homeless individuals and inmates providing unpaid government labor.

“To me, vulnerable people are those who have nothing,” Collins said, adding that people who are forced into close proximity, like many residents of her district’s homeless shelters, or those without access to basic health care resources like masks, face a greater risk from the virus.

Williams remarked that in structuring the early groups eligible for vaccination, they’ve considered risk factors of the body rather than risk factors relating to circumstance. He said that the plan defined vulnerable as those who are more likely to become sick or die when infected with COVID-19.

Williams said they would take into consideration other risk factors in the future but reaching individuals who may not have ties to health care, like homeless or isolated populations, will be a challenge.

Rep. Michael O’Donnell, R-St. Louis, also brought up the vulnerability of medical professionals like dentists, who work in necessarily close proximity to patients but aren’t yet specifically eligible for vaccination.

This, Williams said, was an unavoidable issue of low supply. He did not speak to why these professionals are not specified in higher-priority tiers. “For every dose we get,” Williams said, “we already have three requests.”

Both representatives from urban and rural districts expressed concerns about the ways in which their areas are underserved.

According to Williams, rural communities may often lack the health care infrastructure to vaccinate residents. Mass vaccination sites are intended to fill some gaps in these communities removed from major hospital systems. These are getting 24 percent of the doses.

Another 53 percent are going directly to large hospitals, often closer to cities.

Despite this, some representatives said it wasn’t reaching the right people or wasn’t enough.

“I’m here to tell you that the urban (area) feels forgotten too,” said Rep. Patty Lewis, D-Kansas City.

The rest of the doses are being distributed among local health departments, smaller hospitals and others. Williams said that local public health agencies “often are doing the work for populations that others can’t reach.”

This localized approach, along with strategies like reaching out to community leaders, are intended to help reach those groups who may not receive the vaccine otherwise.

As for expanding and reevaluating the tiers to vaccinate groups early — like Collins’s suggestion that unpaid prison labor should be considered government workers and vaccinated with others in Phase 1B, Tier 3 — Williams said they’d continue to consider suggestions but made no guarantees.

Partnerships

Health Department officials said that much of the earlier issues with the rollout were due to the fact that federal guidance under the Trump administration mandated that a specific amount of the state’s vaccine orders were to go to Walgreens and CVS.

Now, the Biden administration plans on sending shipments of vaccines directly to private partners and retail pharmacies such as Walmart and Health Mart.

Robert Knodell, the governor’s deputy chief of staff, also said lack of predictability from the federal government in regard to amount of doses played a role in the rollout confusion.

“The fact that we’ve never had even seven days to be able to plan for our available supply from the federal government has really prevented the kind of planning that we’re able to do,” Knodell said.

Williams said contingency planning regarding mass vaccination sites is dependent on the partnerships between the National Guard and an area’s local health department.

The National Guard has signed on medical students to act as primary vaccinators at those sites, Knodell said, adding that structural planning for that has been in the works for several weeks.

“Ultimately our goal is to ramp up the mass vaccination program,” Knodell said.

Vaccine dashboard 2.0

The DHSS is currently working on “vaccine dashboard 2.0,” a secondary section of Missouri’s vaccination dashboard that focuses on tracking where doses are distributed and when they are administered.

The federal government determines how much vaccine each state receives, which the state then distributes to various health care facilities based on need and the facility’s ability to quickly administer the vaccine.

However, the state never actually sees the doses before they reach their final destinations — Pfizer delivers its vaccine directly to hospitals from Michigan, whereas Moderna uses pharmacy corporation McKesson to deliver doses to their final destinations.

Crumbliss said the secondary portion of the dashboard should be available next week. The biggest problem officials are dealing with is ensuring that data is reported consistently, in order to provide the public with a transparent picture of where the vaccine is really going.