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What's Behind Missouri's Low Rate Of COVID-19 Vaccinations


Missouri has made some unwelcome headlines as a state with one of the lowest coronavirus vaccination rates. It is not an outlier, though. Just about 8% of the nation's tens of millions of people have received their first vaccine dose. As Sarah Fentem of St. Louis Public Radio reports, vaccinating 328 million people is an enormous challenge and one that states seem ill-equipped to do efficiently.

SARAH FENTEM, BYLINE: All across the country, patients are scrambling to get a coveted coronavirus vaccine. The national rollout is simultaneously sluggish and chaotic. Most states have received a little federal guidance on distribution. That means clinics, hospitals and health departments are competing for irregular shipments of the vaccine. And at the end of the line, patients like Andy Stites are left confused and frustrated. Stites has serious health issues and spent the last year very afraid.

ANDY STITES: News of the vaccine came. And it was like really exciting because, OK, great, we're going to have something to at least prevent infection in some way, shape or form.

FENTEM: Stites lives in Missouri, and in mid-January, he and other people with chronic health conditions became eligible to receive the coronavirus vaccine. On a tip from a friend, he finally got an appointment at a local hospital. But soon after, he got another message. His appointment had been canceled.

STITES: And then to get that cancellation was really, really dejecting.

FENTEM: William Galston is a governance studies fellow at the Brookings Institution. He says while Washington helped companies develop the vaccines, it hasn't focused as much effort on distributing them.

WILLIAM GALSTON: The states, in turn, were left mostly on their own to take it from there. This is a situation that requires quasi-wartime-level mobilization in order to deal with it quickly and fairly.

FENTEM: Each state devised its own vaccine distribution plan, with chronically underfunded health departments leading the way. It's sometimes a slapdash effort, with states deciding weekly shipments for hospitals, mass vaccination events and local health departments. They don't get regular amounts, and that leads to appointments like Andy Stites' being canceled. In Missouri, there are hundreds of vaccinators applying to receive doses every week. The state can only fill around a third of those orders.

KELLEY VOLLMAR: I heard it called yesterday the Hunger Games of Health Department, which is kind of what it feels like.

FENTEM: Kelley Vollmar is the director of the Jefferson County Health Department, just south of St. Louis.

VOLLMAR: No matter how good you are and how pure of heart you're trying to be and do the right thing, it just - people are getting pulled in a lot of directions. And unfortunately, that's slowing the process down.

FENTEM: Vollmar calls the vaccination effort fragmented, one that's confusing for providers and patients alike. She says different sites or counties have different eligibility requirements. And someone who's eligible in one county may not be eligible in another.

VOLLMAR: The vaccinators have been somewhat independent of each other, and so there hasn't been this coordinated rollout.

FENTEM: Vollmar says a centralized system for appointments, sign-ups and dosage sharing would help. Just look at West Virginia, which has relied on a network of independent pharmacies with centralized leadership from its governor's office to vaccinate residents. Its vaccination rate is among the nation's highest. Dr. Ruth Carrico, a nurse practitioner and infectious disease professor at the University of Louisville, says giving people the shot just takes a long time.

RUTH CARRICO: It's not like just giving a flu shot. It is a lot more complicated - paperwork, the assessment, you know, all of the documentation that is done, the handling.

FENTEM: And the vaccines are finicky. They don't come in prefilled syringes like others. They need to be kept cold - supercold in the case of the Pfizer vaccine. They take a long time to thaw out. And once the vials are opened, they need to be used up quickly. And maybe the biggest hurdle is that drug companies aren't yet producing enough doses. And as states struggle with distribution, it could be months before many patients will receive that coveted shot.

For NPR News, I'm Sarah Fentem in St. Louis. Transcript provided by NPR, Copyright NPR.

Sarah Fentem