Miscommunication between staff and volunteers forced Tulare County Public Health to throw away 11 doses at Feb. 9 clinic in Tulare; chain pharmacies begin offering vaccinations in Tulare County
TULARE COUNTY – During the most massive and aggressive vaccination program in human history, there was bound to be some issues. And while most of those issues have taken place at the federal level, county health departments are not immune to mistakes in a race against a virus becoming more contagious by the day.
Tulare County Public Health threw away eleven vaccines after overdrawing more doses than were scheduled during the vaccination clinic held Feb. 6 at the International Agri-Center in Tulare. The county said once drawn into syringes, the vaccines could not be saved and could only be given to people who had already received their first dose. After the last scheduled appointment, the county realized the error and was forced to discard the vaccines, which are not viable for very long once they are out of below freezing temperatures (minus 70 degrees Celsius for Pfizer and minus 20 for Moderna).
“Our highest priority is to distribute COVID vaccine in a safe, secure, and equitable manner, with zero waste of the precious COVID vaccine, and we believe it is of the utmost importance to get this vaccine into an arm, rather than see it wasted,” Tulare County Health and Human Services Agency (HHSA) said in a released statement.
Tulare County HHSA Director Tim Lutz said it is a challenge to coordinate volunteers and volunteer groups helping to staff the massive vaccination clinics the county has been holding in Tulare and also at COS in Visalia and Porterville College in Porterville. He said there was a miscommunication between those filling the syringes and those administering the shots during the clinic in Tulare.
“This was a really unfortunate circumstance,” Lutz said. “We work hard not to have wasted dosage.”
The issue was brought up by Supervisor Pete Vander Poel during the Feb. 9 meeting of the Tulare County Board of Supervisors. He asked if there was a Plan B so vaccines will not be wasted in the future.
Lutz said county officials are actively working to identify if county personnel failed to follow protocol, which is to draw only enough vaccine for residents with confirmed vaccination appointments and only draw vaccine when those with confirmed appointments have arrived at our drive-thru vaccination clinic, thus ensuring no vaccine is wasted. He said the county will be reviewing current policies and procedures and make any necessary improvements to prevent this from occurring in the future.
“As far as wasted vaccines, we have identified what went wrong and a plan to minimize that, correct?,” Supervisor Larry Micari asked.
Lutz responded, “Yes, absolutely.”
Carrie Monteiro, spokesperson for Tulare County HHSA, said about 80% of the county’s population in Phase 1A—healthcare workers and related fields—have received a first dose and about 20% have completed their second dose. The county is currently vaccinating those in Phase 1B, Tier 2 which includes those 65 and older, educators, first responders, social workers and those working in the food and agriculture industry. Monteiro said preliminary surveys show there are about 80,000 people in Phase 1B Tier 1 including 54,000 age 65 and older, 25,000 ag workers, 5,000 educators, and a few hundred law enforcement personnel. This population will need to be vaccinated before moving onto Phase 1B Tier 2, which includes transportation, sheltering facilities, prisoners and homeless.
“We have no idea when we will have enough supply for all of those groups,” Monteiro said. “We have yet to get a stable number but are averaging about 3,000 to 5,000 doses per week.”
As of Friday, Feb. 12, vaccines were being supplied through the Federal Retail Pharmacy Program to residents 65 and older at a select few pharmacies in Tulare County. CVS is making appointments at its locations at 53 E. Olive Ave. in Porterville and at 109 S. West St. in Tulare. Rite Aid is now accepting appointments at stores located at 262 N. Highway 65 in Lindsay and 5212 W. Walnut Ave. in Visalia. Monteiro said federally qualified health clinics, such as Family HealthCare Network, and rural health clinics, such as those operated by Kaweah Delta, private practices and major employers will soon be rolling out vaccines as soon as supplies are available.
“It is all still based on eligibility,” Monteiro said. “When we get more doses, we try to move quickly to schedule an additional clinic.”
Lutz said the county had received 41,000 doses combined from Pfizer and Moderna, or enough to provide 20,500 people with the needed two doses. As of press time, 26,770 people had received the first dose and 6,712 had received the second dose. Tulare County is receiving about 1,950 doses of Pfizer and 2,500 doses for Moderna each week, but there are still no guarantees on how much of either the county will receive each week.
“It’s still frustrating the variations on our allocations,” Lutz said.
Residents have also had trouble confirming their vaccination appointments. During the Feb. 9 meeting, county supervisors said constituents were frustrated by the lack of confirmation for second doses. Vander Poel said people are feeling like a number when they call the county’s COVID hotline or the countywide information line at 2-1-1. Micari asked if more could be done to respond to those calling in and asking for an appointment for their second dose or simply looking to confirm an appointment prior to getting in line at one of county’s mass vaccination clinics.
“If we could follow up so they don’t drop off the radar,” Micari said. “There are some little nuances I think we could look at.”
Lutz said roughly a quarter of the people who have received their first dose do not have appointments for their second, so HHSA staff will be reaching out to them to provide them with an appointment at the next vaccination clinic. Lutz said their have received reports some emails were filtered into spam folders and some phone numbers were provided or entered with transposed numbers.
“Some of these were manual entries,” Lutz said. “There is a lot of back end work our staff is getting caught up on.”
Second doses are more complicated because they require the person return almost exactly three or four weeks after receiving their first dose. The doses also have to match, meaning they must be from the same manufacturer, Pfizer or Moderna, and they must be administered by the same provider, i.e. a pharmacy or county staff. Pfizer requires 21 days between the doses and Moderna 28 days. Monteiro said those wanting to schedule a first dose should call 2-1-1 or the county vaccine hotline at 559-685-2260. If you are not eligible, you will be added to the queue and contacted when you become eligible. Those needing a second dose should call the county hotline if they have not received an appointment.
To address the concerns, Lutz said HHSA added 10 more staff members to call center last week. “We don’t want people not hearing from us,” he said. Lutz said Tulare County will also be added to the state’s vaccine appointment scheduling system known as My Turn sometime this week or next. The system asks several questions before notifying if you are eligible to receive the vaccine. If you are, it will schedule you for a first and second dose at a vaccination clinic in your county. For more information, visit myturn.ca.gov.
Vander Poel also received a call from a Superior Court judge asking if they could be prioritized. Lutz said court staff would certainly be near the top of the list, including clerks, public defenders and District Attorney prosecutors, to prevent the justice system from grinding to a halt.
School district administrators and teachers unions have also been asking when they will be eligible, with the exception of those over the age of 65. Later that night, the Visalia Unified School District board unanimously approved a resolution in support of expediting vaccinations for teachers and staff because a “substantial public purpose exists to request that Governor Newsom and state health officials prioritize … all public school district personnel.” See the full story on page 7. Monteiro said two smaller vaccinations clinics were held on Feb. 10 for about 300 educators and public safety personnel.
Supervisor Eddie Valero asked what was being done to prioritize unincorporated communities, whose populations may not have internet access, be sure if they eligible or be aware of when and where upcoming vaccination clinics will take place. He asked if county staff had broken down the vaccines by zip codes of those who have received shots to see if any areas were being missed.
Lutz said it has been difficult to do a lot of tracking as the county has attempted to roll out the vaccination as quickly as possible to the highest priority populations based on state guidance. Without knowing when and how many doses the county will receive each week, Lutz said it is difficult to be more organized without a steady supply of the vaccine.
“We are very concerned about this,” Lutz said. “We know we need to do better of targeting disadvantaged communities.”