Smaller, independent pharmacies who are receiving supply of the COVID-19 vaccine directly from the federal government say DC Health is asking them to abandon their own scheduling systems and only vaccinate people who book appointments through the government call center and web portal, vaccinate.dc.gov. It’s unclear to these pharmacies whether the D.C. government is mandating them to do this, or if local officials are even allowed to do that, seeing as their vaccines come through a federal program. At least one pharmacist wants to keep his stores’ current scheduling system.
“They gave the impression that you have to do this, as in, you don’t have a choice,” says Dr. Michael Kim, owner of Grubb’s Care Pharmacy, the oldest pharmacy in the District.
Over the last week or so, more pharmacies started getting vaccine doses directly from the Centers for Disease Control and Prevention as part of the Federal Retail Pharmacy Program. Instead of depending on DC Health’s scheduling system, some pharmacies created their own platforms to manage appointments so patients can book directly through them. Pharmacies from Walgreens to Kalorama Care Pharmacy allow D.C. residents to bypass DC Health’s pre-registration and lottery systems and get vaccine appointments through them.
DC Health did not advertise these new opportunities, even though countless residents have traveled hundreds of miles outside the District for the vaccine. Some of those people say they are eligible to get vaccinated in D.C., according to DC Health’s guidelines, but limited shipment from the federal government meant demand outweighs supply. Now, it appears DC Health is trying to put a stop to these new opportunities and control more of the city’s supply.
DC Health declined to say whether the agency is forcing pharmacies to use vaccinate.dc.gov for scheduling. Instead, an agency spokesperson said they are “partnering” with pharmacies to ensure equity. “When providers use website links on a first come, first serve basis to schedule vaccination appointments, generally those with more resources living in more affluent areas of the city book those appointments,” the spokesperson said. “This further leads to an inequitable distribution of vaccine in DC.”
The agency says it is balancing equity and efficiency. Having vaccine appointments funneled through one system means residents who have the wherewithal to check multiple websites multiple times a day aren’t at an advantage. But having one system could also slow down vaccinations. Vaccinators are at the mercy of DC Health, which sets eligibility standards and informs people when it’s their turn to book an appointment. Giant pharmacies in D.C., which use vaccinate.dc.gov to book appointments, did not order vaccines from the federal government last week.
During a conference call on Wednesday morning, DC Health told local pharmacists to use the government portal instead of the ones they have created, according to Kim. Government officials cited inequity and confusion among the general public as reasons for the request. However, DC Health did not provide any further guidance, like how and when patients will be directed to go to pharmacies. “I’m kind of in limbo right now,” Kim tells City Paper. “There are a lot of questions right now that are unanswered.”
Kim says the federal government suggested pharmacies participating in the program will have to set up a scheduling system to administer the vaccine, so he created one for three of his stores that receive vaccines. Now, Kim has enough supply to book appointments through next Friday. However, not every slot at his pharmacies is filled because DC Health instructed him to stop registering people on Wednesday. His three stores located in Northeast, Northwest, and Southeast received just under 1,000 doses.
“By doing it through the District, we’re just subjecting people to go through all of the pain that they’ve been complaining about in terms of getting appointments and not being able to navigate the website,” Kim says. He says Grubb’s Care Pharmacy is prepared to operate its own scheduling system, just as it did so with COVID-19 testing. His pharmacy ran into similar problems with DC Health then too, he says.
Another vaccinator, Kalorama Care Pharmacy in Adams Morgan, says they were instructed to use the government portal instead of their own. The pharmacy had actually purchased software for scheduling appointments. The pharmacist, who requested not to be named, says Kalorama Care was able to vaccinate 36 people per day, and got another 200 doses this morning. Now, the pharmacist does not know how to proceed. The pharmacy has more than 200 people on its waiting list.
While the pharmacist says it could be good for them to vaccinate residents from all over the city, she worries that Kalorama Care won’t be able to serve the immediate community. Last week, Kalorama Care Pharmacy vaccinated a few seniors who were unable to get vaccinated through the portal. The pharmacist says by happenstance, she offered the shot to a 73-year-old customer who hadn’t received it. She offered the Johnson & Johnson shot while the customer was picking up a prescription.
Just days earlier, DC Health Director Dr. LaQuandra Nesbitt declined to give a yes or no response when asked if pharmacies get to decide whether or not to use the government portal. “We do expect as more independent pharmacies come on board as they are able to through the federal partnership—which has a goal of nearly doubling the current number of sites—there may be more that are unable to be interoperable with vaccinate.dc.gov,” she said during an April 5 presser.
Nesbitt added that her agency met with local pharmacies “very early on” to discuss how they’d set eligibility guidelines and create a scheduling system. “The theory is that no one will use their own system without consultation with DC Health,” said Nesbitt. (Kim disputes that such a meeting occurred.)
There are a number of larger pharmacies using their own portals. It’s unclear if Walgreens, for example, will continue to let customers book appointments on their own. Nesbitt said CVS is using its own portal to book appointments because it has the technical capability to do so. She also said the company negotiated with the government agency so their pharmacies only book appointments for residents over 65, school staff, child care and health care workers. This eligibility criteria is narrower than the city’s current standards. “These are negotiated agreements that they are not bound to be held to legally because they receive their doses directly from the federal government,” Nesbitt said.
Throughout the rollout, DC Health has had significant control of the doses sent to the city. Unlike neighboring Maryland and Virginia, Giant pharmacies in D.C. are only vaccinating individuals who book through the government portal and call center. The only vaccinators who do not seem to depend on vaccinate.dc.gov for scheduling are hospitals and community health centers, although DC Health is looking to have more hospitals use the portal. Community health centers were instructed to vaccinate their own patient population because they often serve hard-to-reach communities.
Since the pre-registration system launched March 10, 66,349 people have pre-registered, received an invitation, and booked an appointment, according to the mayor’s office. As of Wednesday, 192,286 have pre-registered and are awaiting an appointment.
The Bowser administration names equity as one of its operating principles for the pre-registration system. The vast majority of appointment notifications that go out to those who pre-register are people older than 65 or who have a medical condition that puts them at risk of serious illness from COVID-19. Half of the notifications go to people who live in priority zip codes, deemed as such because the communities were hit hardest by COVID-19 but have the least vaccination coverage. (Wards 7 and 8 continue to have the least vaccinations, according to government data, despite DC Health prioritizing zip codes in these wards.)
However, DC Health’s pre-registration system has not lacked complications. More than 1 in 3 seniors are not booking appointments when DC Health sends them a notification. Nesbitt believes it is because these seniors are getting vaccinated in other ways. Some seniors told City Paper that the technical issues of the retired Hunger Games-style portal discouraged them from registering again in the new system. The shot only became accessible to them when a mobile clinic was set up in their community. Less than 70 percent of seniors are at least partially vaccinated, well below the national average.
Giant pharmacies in D.C. also temporarily asked the federal government to stop sending them doses, according to the Post. A Giant spokesperson, Daniel Wolk, initially said it was because the company was awaiting an increase in appointments from DC Health, but later said it was because the company needed more personnel. Wolk tells City Paper that Giant will order more vaccines from the federal government this week and is “in a great position” to order each upcoming week. He declined to say what changed.