The federal government gave states even more incentive this week to make sure they're getting COVID-19 shots injected into arms as quickly as possible.
States that don't efficiently immunize their people — and report the data accurately — won't get as many doses of COVID-19 vaccines as states that do. The change in the way vaccines are being distributed comes as the virus continues to spread across the nation, filling hospital beds and killing people at a record pace.
Michigan officials say every dose received by the state is in the hands of those who can administer them. But state data showing a substantial lag between doses shipped out and those injected continues to frustrate both eager residents desperate for a vaccine and state officials earnestly trying to get it to them.
Measuring Michigan's success in quickly administering COVID-19 vaccines should be simple: Just gauge how many doses the state has received compared to how many doses have been injected into the arms of Michiganders. Then, compare that to the same data reported by other states.
Based on that assessment, Michigan had gotten 831,150 doses of vaccines as of Tuesday, and had administered 332,139 shots — about 39% of total doses received. Compared to other states, the CDC ranked Michigan 33rd nationally on Wednesday.
But evaluating the data isn't that simple, state officials say, and it could cost the state some of its share of the federal supply of vaccines if it doesn't fix its data reporting problems in the next two weeks.
"We do not have a real-time dose tracker at this point in the state of Michigan," said Sarah Lyon-Callo, the state's epidemiologist, in an interview Wednesday with the Detroit Free Press, Michigan Radio and Bridge Michigan.
Instead, what's posted on the state's COVID-19 vaccine dashboard shows the number of total doses that have been shipped from manufacturers Pfizer and Moderna, and includes doses that are still in transit.
"It means that it's ... left the loading dock," Lyon-Callo said. "It doesn't mean that it's in the hands of the provider" who'll give the injection.
Lyon-Callo said the state doesn't have average shipping time estimates, but said: "These are overnight shipping arrangements, so they are supposed to be very rapid," whether they're coming from Portage-based Pfizer or Massachusetts-based Moderna.
Complicating matters are reporting problems.
"It wouldn't surprise me at all if there are more doses that are in people's arms, and they just have not made it through to the dashboard," Lyon Callo-said.
Hospital systems and county health departments are supposed to report to the state within 24 hours the number of COVID-19 vaccines they've injected. The Michigan Care Improvement Registry tracks vaccinations, including coronavirus immunizations.
But CVS and Walgreens, which are handling vaccinations at long-term care facilities in Michigan and other states, have 72 hours to report those shots, which muddies the data, Lyon-Callo said.
Adding to the mess, state health officials discovered 38,000 coronavirus doses they hadn't been able to track, Lyon-Callo said, because 55 providers didn't have federal enrollment codes.
"Our whole system for pulling data about COVID-19 doses and attributing them to different providers in the state ... is based on enrollment codes," she said. "So when you are a site who is receiving vaccine, it's a federal asset. You're supposed to be enrolled in the federal program. We ran into a problem earlier on where we discovered that ... some health care providers were passing the vaccine on to another provider within their system."
"We figured out that problem with help from a couple of hospital systems and were able to fix that," Lyon-Callo said. "We found about 38,000 doses that way that had not reached us. So that has been corrected."
Tricia Foster, the state's chief operating officer, said Wednesday that every dose the state has gotten from the federal government has been distributed to a health care provider who can administer it.
These health care providers have been given the goal of injecting 90% of those doses within seven days of receiving them. The dashboard doesn't reflect doses of vaccine that have been scheduled, but have yet to be administered.
"I want to be very clear: The state of Michigan is not sitting on doses of vaccines," Foster said. "Every provider is working diligently to schedule through all vaccine doses within a week of receipt."
In a week's time, Foster said the state has gone from vaccinating about 12,000 people a day to 33,000 daily immunizations.
"That’s progress. But we still have so much more work to do," Foster said.
Lyon-Callo said the state is "working very hard" to improve the data so it more accurately reflects how many doses of the vaccines the state has, and how many it has administered.
In the meantime, Foster said state officials are focused on boosting the volume of doses the state is getting from the federal government.
Gov. Gretchen Whitmer asked the federal government for permission to buy 100,000 doses of the Pfizer vaccine directly from the pharmaceutical company to help in the state's effort. She also joined a coalition of eight governors who successfully appealed to Alex Azar, the U.S. Secretary of Health and Human Services to release the doses the federal government had been holding back.
"There is currently not enough supply to allow every eligible Michigander to obtain a vaccine appointment," Foster said. "We’re as disappointed as you.
"Our overall goal is to get at least 70% of Michiganders age 16 and over vaccinated as soon as possible. … That means 5.6 million residents. In the best of circumstances, this would take considerable time. We were originally told that Michigan would receive 300,000 vaccines per week, and planned accordingly. But that weekly number has been significantly reduced. For example, Michigan has only received 60,000 Pfizer vaccines per week for the past few weeks, and those have been distributed to providers.
"Our original plan was to vaccinate nearly 50,000 people per day, and that is impossible with the number of vaccines we are receiving each week. There’s not enough vaccine to go around. ... We need the federal government to step up and get more vaccines out the door so that you can get an appointment to get your vaccine."
During a press conference on Wednesday, Whitmer called for a national strategy for coronavirus immunizations.
“When we started with COVID, I observed that there was not a national strategy and it was difficult and it meant states had to figure out how to buy our own PPE (personal protective equipment) and we did that," she said. "States had to figure out how to conduct testing. We did that, too. But it took time to ramp up. The same is true for vaccines because there still isn’t a national strategy. We are building this as we are going."
It's complicated, she said, by very particular storage requirements for the vaccines — Pfizer's needs to be stored at minus 94 degrees Fahrenheit — consent forms, scheduling first and second doses, plus planning the staffing immunization clinics with people trained to give shots and emergency medical personnel who can respond in case there's an adverse reaction — all while having an uncertain vaccine supply.
"We're pushing them out as soon as they come into our possession," Whitmer said, "but I want people to understand a little bit about that process."
Foster said any provider that isn't administering all of the shots it gets within a week "is a problem," and the state is working to ensure that happens.
"Nobody is where we want to be at this state," Foster said. "We are getting better each and every day. And the greater the supply that we get, the easier it will be to get through that original plan, that 50,000 shots in arms per day."
Contact Kristen Shamus: email@example.com or follow her on Twitter @kristenshamus.
Michigan Radio, Bridge Michigan, and The Detroit Free Press are teaming up to report on Michigan hospitals during the coronavirus pandemic. We will be sharing accounts of the challenges doctors, nurses and other hospital personnel face as they work to treat patients and save lives. If you work in a Michigan hospital, we would love to hear from you. You can contact reporters Robin Erb firstname.lastname@example.org at Bridge, Kristen Jordan Shamus email@example.com at the Free Press and Kate Wells firstname.lastname@example.org at Michigan Radio.