The leader of Virginia’s push to vaccinate residents against COVID-19 says the state was right to ask that people on health department waiting lists have priority for appointments to receive doses at 36 CVS pharmacies across the state through a federal initiative President Joe Biden announced last week.
However, Dr. Danny Avula acknowledged that Virginia’s attempt to get a “head start” for tens of thousands of people on state waiting lists backfired on Tuesday, when CVS opened its online portal for appointments at 5:15 a.m., two days early. People seeking vaccinations quickly grabbed open slots meant for people 65 and older who had already registered with the state.
“Not an ideal rollout,” said Avula, the state’s vaccine coordinator, during a news conference on Tuesday afternoon. “But at the end of the day, we are thinking of it as a way for us to pull down more vaccine in Virginia.”
CVS, the state’s initial partner in the Federal Retail Pharmacy Program, will receive 26,000 doses of COVID-19 each week from the federal government, a boost of almost 20% in the state’s supply. But state officials remain concerned about the Virginians who aren’t able to take advantage of the opportunity even though they may be the most vulnerable to the disease.
“This is an issue both of fairness … and also of equity,” said Avula, former director of the Richmond and Henrico health districts who has been at the front line of the COVID-19 pandemic for almost a year. “This is not a system that allows equitable access.”
The technology-heavy process favors people with internet access, Avula added, a factor that works against low-income or rural areas.
While local health departments have worked to eliminate vaccination barriers through mobile clinics and partnerships with community organizations catering to hard-hit populations, chain pharmacies like CVS are not always near the ZIP codes harboring high numbers of COVID cases.
In Richmond, one of the localities where CVS is distributing vaccines, ZIP code 23234 — which is 75% Black or Latino and has had more than 1,100 cases since vaccinations began in December — has one location within a 5-mile radius.
ZIP code 23221, which is 87% white and state data shows as having the second-lowest number of cases in Richmond in the same time frame, has at least five.
Without CVS prioritizing the people who live in those localities — there aren’t restrictions to outside residents traveling to access a vaccine from CVS — the process risks shutting out under-resourced neighborhoods and widening the racial and ethnic disparities of vaccinations.
As of Tuesday, available data shows 72% of people vaccinated have been white and less than a third are 70-plus — an age group that accounts for 75% of the state’s deaths.
Virginia and CVS
Virginia chose to partner with CVS — as did Maryland and the District of Columbia — at the recommendation of the Centers for Disease Control and Prevention because of the company’s size and reach in the state’s population centers.
State health officials said Virginia hopes to partner with additional pharmacies in subsequent phases of the national program.
“We recognized there are places in the state where there are gaps,” said Stephanie Wheawill, the state’s director of pharmacy services.
Local health directors already can direct state vaccine supply to other pharmacies in parts of the state that aren’t served by CVS, Avula said in an interview on Tuesday, “and that is happening in many parts of the state.”
He also said Walmart and other companies in the retail pharmacy partnership “will be phased in over the next few weeks.”
“The program is not really controlled by us at all, so I don’t have clarity on when exactly this will happen, or how much vaccine will come through these additional pharmacies,” he said.
CVS opened online registration for vaccination early on Tuesday, hours after announcing that it would not begin taking appointments for two days. The national pharmacy chain said it opened the online portal to accommodate Virginia’s concerns about giving first access to people who had already registered for vaccination with their local health districts.
“The state of Virginia asked us to open our scheduling system early for those who preregistered for a vaccination through their local department of health,” CVS spokesperson Amy Thibault said. “We have accommodated this request and Virginians who preregistered can now look for available appointments in our system.”
Avula said the early release was a “core fundamental issue with how this was rolled out” that benefited “people who get up super early and they’re trolling the internet.”
“This is not a system that allows equitable access. That’s what we’re fighting for and, unfortunately, we weren’t able to work it out in this scenario.”
Some health districts apparently were able to get people from their waiting lists into appointments at CVS, but state officials said the company could not limit online access to vaccination slots for people who had waited weeks on state lists for the opportunity.
Avula said CVS tried to accommodate the state’s concern, but ultimately could not deliver a “technological solution” to prevent people who weren’t already registered for vaccination from taking the available appointments.
“That was the right thing to do … to get all our folks who were on these waiting lists into these appointments,” he said.
‘Everyone is frustrated’
However, the unannounced decision to open the reservation portal early intensified confusion for Virginians who said all appointments were gone by the time they realized that CVS had begun registering people online.
“Everyone is frustrated and wants to understand,” said Lynn Spitzer, a Richmond resident whose 73-year-old husband, Chip, had already registered with the city health department but couldn’t get an appointment.
The stakes are high as Virginia and 10 other states look to take advantage of the new federal partnership that Biden announced on Feb. 2 with 21 pharmacy companies — including those inside grocery markets and networks that include independent community pharmacies.
Avula said he was unsure how many people on local health waiting lists were able to take advantage of the opportunity for early access to appointments at CVS stores participating in the initial rollout.
CVS’ Thibault told The Roanoke Times, “Some of the local health departments apparently did notify the patients who preregistered that the scheduling tool was opening to give them early access.”
She did not specify which local health districts sent notifications, or whether people in one part of Virginia were able to register for vaccines at a CVS store in another part of the state.
Dr. Cynthia Morrow, director of the Roanoke City and Alleghany health districts, said during her weekly briefing Tuesday that the central office was coordinating with CVS, but that it did not yet have a system to share all of the local health districts’ surveys.
Morrow said she would welcome the opportunity to coordinate with CVS.
“At the end of the day, what we all need to recognize is that the more opportunity for vaccine, the better off we are as a community,” she said.
“While in the ideal world, we would be able to coordinate and make sure that those who were first in line get vaccine, it’s far more important that we recognize that vaccine is getting into arms,” she said. “I am confident CVS will have a system in place to ensure it is getting into the right arms.”
Finding shots — in Abingdon
Surprised by the decision to open the scheduling portal early, Roxanne Grandis said she was able to make an appointment for her parents, both 78 and living in Henrico County, at a CVS in Abingdon, about 4½ hours from their home.
“I literally just went through the long list of cities trying each one over and over,” Grandis said in an email. “And I finally saw I could get the spots in Abingdon, so I did. They did not ask about preregistration at all.”
The online appointment system requires people to give their age and verify their eligibility as someone 65 or older who “already is on a local health department wait list in Virginia.”
It then asks them to: “affirm that I have answered the question truthfully and to the best of my knowledge, and acknowledge that I may be asked to verify my eligibility information at my appointment. I also affirm that I will only book an appointment in the state for which I have answered these eligibility questions.”
Avula said CVS will require people who arrive for appointments to show identification and proof of age, but won’t require them to verify they were already registered with the state.
“We’ve hit a dead-end in terms of getting our folks preregistered,” he said at the news conference on Tuesday.
Thibault said people who had preregistered at local health districts “are NOT automatically registered for an appointment at CVS.” She also said CVS would open appointments on Thursday to anyone 65 or older, regardless of whether they had already registered with a local health department.
“Appointments were filled quickly [on Tuesday] due to the limited supply of vaccine we will be receiving,” she said. “Additional appointments will open as we receive additional doses next week.”
Luanne Rife of The Roanoke Times contributed to this report.