In the midst of the chaos of the Capitol insurrection, a second impeachment, and a presidential inauguration, the District is forging ahead with its COVID-19 vaccination rollout. DC Health started vaccinating the city’s health care workforce the week of Dec. 14. In the weeks that followed, DC Health began vaccinating residents and staff of long term care facilities, along with residents 65 and older. Altogether, the groups total at least 171,320 eligible people. The District has largely kept with the latest CDC Advisory Committee on Immunization Practices recommendations.
DC Health Director Dr. LaQuandra Nesbitt has said that the agency has no intention of entirely vaccinating one priority group before moving on to the next. Keeping with that philosophy, DC Health just announced it will begin vaccinating public school teachers and staff that work or plan to work in person the week of Jan. 25, as well as members of the Metropolitan Police Department and District government personnel. DC Health will continue to make appointments available to seniors, who’ve so far reserved appointments almost immediately. (The rollout for seniors was also riddled with technical difficulties and botched communication.) The agency will consider zip code when freeing up vaccination appointments, given emerging geographical disparities.
City Paper spoke with Dr. Ankoor Shah, the interim principal deputy director for DC Health and the COVID-19 vaccine program lead, about the District’s vaccination plans. The rollout has its challenges, given that the federal government is only telling states and localities how many doses it will distribute a week in advance. “It causes a strain not only on the public health infrastructure, but also on the providers because they are planning one week at a time,” he says. The conversation has been lightly edited for brevity and clarity.
Washington City Paper: Why did DC Health decide to first release appointments to eligible residents in priority zip codes and then to all zip codes? And should we expect to see this practice until vaccinations reach the general population?
Ankoor Shah: We’re trying to create an equitable vaccination program … An example of that is when we decided to move to Phase 1b—seniors 65 years and older—we ensured there was a call center and a phone option, as well as the online option, to ensure that seniors who are having technological difficulties or may not be as tech savvy have that other opportunity as well to answer questions and register. Similarly, geographically speaking, we have over 25 access points with vaccinate.dc.gov for individuals to get a vaccine that could be close to them. [They are] in all eight wards.
When we opened up the registration for 65 years and older … appointments got taken up very quickly. But then when we looked at who those appointment registrations were, there wasn’t equity in access to, or the actual registration and scheduling, specifically in some of our Northwest wards, Ward 3 for example. And then there were some wards who actually had less ability to actually get that appointment confirmed. And this could very well just be due to the inequities that exist geographically among the city, specifically with more resources in one area versus the other. So the same areas that had less ability to get registered are the same areas that have a higher burden of COVID-19 morbidity and mortality. So therefore, we wanted to create equitable access through registration as well. And by doing that, we actually open up registration for those wards, so there is access there, and then [we] open it up for the rest of the city. That’s kind of our general framework and how we got to that decision.
We are going to continue it this upcoming week. And we will always look at the data to see when we’re evening the playing field for access to registration, and make those decisions on an iterative basis.
WCP: Is DC Health going into these wards that have, as you observed, less resources than others? I’m thinking of 5, 7, 8. What kind of outreach is DC Health doing to level the playing field outside of releasing appointments to eligible residents in priority zip codes?
AS: When we’re talking about equitable access to the vaccine, it’s a lot of what we talked about—it’s kind of brick and mortar, getting those active vaccine sites, and very much logistical and technical in terms of registering, scheduling appointments. But there’s this whole other factor of ensuring there’s adequate information out there, in terms of when it is time to register the appointment and then also information around the vaccines—the safety, the side effects of it, and making sure any people with vaccine hesitancy have their questions answered. What we’re doing is really kind of now leaning a lot more on our public messaging and using our partners in community-based organizations and faith organizations as well, to help push out the message. I wouldn’t say it’s what DC Health is doing, it’s actually what the District government is doing, leveraging every lever that we have, our engagement with communities, to get the word out and answer questions.
WCP: Explain why DC Health decided to move to the next priority groups, teachers and police, when we have only given the first shot to 3,200 of the 84,000 residents 65 and older? The demand is still high among seniors, and we are receiving a scarcity of doses.
AS: When we are framing our prioritization, there’s actually two buckets we’re thinking about. One bucket ensures we vaccinate the people who can get the most sick or die from the virus … We started with nursing homes, which we all agree, they could get the most sick. And then right after that, seniors, those 65 and older, who have a higher risk as well. And you’re absolutely right, that demand is through the roof and we’re likely to continue with them for a while.
But then there’s this whole other bucket of prioritization as well, and that is preserving societal functions, which have their own kind of set of priorities. For example, in December, we started with health care workers as the group to preserve societal functions. We need our health care workforce to take care of COVID-19 but also non-COVID-19 patients. So the District now, as we move on to the next part of that bucket of priority, we made an intentional decision that the education sector is actually the most important, and those that are serving public school students, namely [DC Public Schools] and charter schools, should have access to vaccines.
It’s almost two parallel tracks moving on. Again, the majority of the vaccine will be focused on the morbidity and mortality track because that is really directed to saving lives. But then there’s always going to be some focus on the societal functions.
WCP: Some seniors are anxious to see D.C. move on to the next groups and are worried that less appointments will be made available to them. What do you say to those seniors?
AS: I would say that it’s the preserving societal function group, that the number of vaccines is roughly—very largely, roughly speaking has always been around, is going to be around the same, because it was focused on health care workers. Now we’re moving on to another societal bucket. That is going to continue to be roughly the same and that really shouldn’t affect the other avenue, which is preventing morbidity and mortality. And right now in that market, it’s mainly 65 years and older. So their access writ large did not and should not change. They shouldn’t be expecting it to go down and down because there are so many more people in the pie. Their line of supply is going to continue as long as the demand is there. And that may change week to week, of course, and it might swing by the thousands or more. But we’re going to have it be as consistent as we can moving forward.
WCP: Public school teachers and staff who already signed up for in-person learning are getting vaccinated. When should the rest of public school employees, along with private school staff and child care workers, expect to get vaccinated? And what is the priority scheme among MPD and District government personnel?
AS: The in-person staff of child care providers, for example, are still within that Phase 1B … We have to stratify every time … I can’t tell you a date, but they are still part of that same phase. Same thing with private school educators … Again, it’s just we have to always re-stratify based on our limited supply … So for all the essential workers, it’s about in-person, who’s in-person for essential. We have to understand, there’s the Department of Public Works staff that’s out there right now. There’s community engagement workers out there right now and they are not getting prioritized. School teachers are. So we want to really prioritize those that are in person providing essential services in Phase 1 than anyone who’s not in person.
WCP: How does DC Health plan for second shots? I know seniors have been booking their second shots weeks in advance, so how do you know they’ll be enough for them and existing priority groups and groups to come?
AS: Second doses are tied to first dose delivery. So any time we send a first dose, there’s a second dose coming in just three weeks after that. That’s automatic. So that supply chain is there. Whoever is giving the first dose as a provider, you’re responsible for scheduling the second dose appointment as well. So the portal, vaccinate.dc.gov, is only for first doses and then the provider schedules that second appointment.
WCP: How will D.C.’s vaccination roll out be different under the Biden administration?
AS: I’m not sure. I think we’ll find out next week. For all intents and purposes, it seems as though there’s going to be a stronger federal footprint, more guidance and likely more support in different ways to local jurisdictions, which could only be a positive.
WCP: It sounds like the Biden administration hopes to deliver more doses. Do we have enough vaccination providers? Do we have enough trained vaccinators? How is DC Health preparing for more doses?
AS: For example, if we receive double our vaccine allotment next week, we will use it. We have the provider network, we have the vaccinators, and as you know, we have the demand.