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Florida public health experts say state must do better on vaccine, but be patient

Demand currently far outpaces vaccination supply, leading to a mess for county health departments.
Pat Moore, with the Chester County, Pa., Health Department, fills a syringe with Moderna COVID-19 vaccine before administering it to emergency medical workers and healthcare personnel at the Chester County Government Services Center, Tuesday, Dec. 29, 2020, in West Chester, Pa.
Pat Moore, with the Chester County, Pa., Health Department, fills a syringe with Moderna COVID-19 vaccine before administering it to emergency medical workers and healthcare personnel at the Chester County Government Services Center, Tuesday, Dec. 29, 2020, in West Chester, Pa. [ MATT SLOCUM | AP ]
Published Dec. 30, 2020
Updated Dec. 31, 2020

Amid public clamor for more information on how to get a coronavirus vaccine in Florida, county health departments are swamped, and public health experts say it appears the state has not provided much guidance.

They also say a lack of communication from the state and local agencies is making the process harder for Florida residents and officials alike.

Related: "Absolute chaos:" Floridians want coronavirus vaccine answers

Florida must “do better” with its vaccine rollout and communications, but the public must also have patience, said Florida State University professor Leslie Beitsch, a former Oklahoma commissioner of health and former deputy secretary for the Florida Department of Health.

“Take a deep breath,” he said. “We need to be able to count on local officials to be transparent and clear with their plan, but at the same time, if everyone calls the health department at the same time, it will simply close down the switchboard, and then nobody will get through. Everyone wants the protection of a vaccine, but we must be patient and let it roll out a little bit as the logistics become clear to everyone involved.”

In the meantime, he said, it’s important that people not let their guard down and continue with masking and social distancing so as not to spread the virus and further tax an already overburdened health system.

Related: Florida seniors are swarming vaccine distribution points

“These people in health departments have been working 16 hour days since March,” Beitsch said of county health departments across the state. “We’re asking people who have been literally inundated with expectations and workload to now add another layer of complexity.”

Beitsch said some issues could stem from Florida differing from CDC guidelines on who receives the vaccine next. Florida Gov. Ron DeSantis’ plan calls for those 65 and older to be vaccinated next, while the CDC recommends first vaccinating essential workers. Beitsch said seniors first could be a reasonable way to do it in a state with so many elderly residents, but it does not make for a smooth rollout if local health departments were planning for something else. “That only adds to the chaos.”

And he noted that while public health departments are working to distribute the vaccine, the resources and preparedness of the local private hospital systems they partner with will likely have a huge influence in how smooth vaccinations go.

The main issue at the moment, said Dr. Marissa Levine, director of the Center for Leadership in Public Health Practice at the University of South Florida, is that demand for the vaccine far exceeds the supply, and health departments do not want to promise more than they can deliver.

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Levine said Florida should have an advantage in that local county health departments are all technically part of one large system, the Florida Department of Health.

“I worked in Virginia, in a similar state system during H1N1, and the advantage is you can implement things more quickly and uniformly,” she said. “But it does not seem like we’ve done that.”

Instead, she said, the public health departments are all doing something different, and seem to have been left to “figure this out on their own with not necessarily a lot of guidance” from the state.

Levine said while she does not think that anyone in public health is surprised by the rocky start — “it has been obvious to people in pub health all along that we don’t have the infrastructure” — the thing that has been glaringly missing is communication.

“It has been extremely quiet, and people are clamoring for information,” she said. “In emergency situations, even if you don’t know what’s going to happen, it’s really important to tell people what you do know, what you don’t know, when you might know more, and how people can find that information when you have it. We have not done that in Florida, particularly at the state level.”

Public health organizations at the local level have been pushing for more funding for emergency preparedness for years, Levine said, but still suffer from a lack of resources.

“I believe there is funding in the most recent bill, but it’s not here now, and it was needed long before today,” she said.

It’s funding, she said, that could go to needed supplies, space, nurses, security and more staff to work on communications and strong digital infrastructure to allow people to make appointments or find the closest place to be vaccinated.

“You don’t create nurses overnight, so even when the money arrives you’re limited in how much you can ramp up,” Levine said.

Everyone is working with “aspirational goals,” said Jay Wolfson, Senior Associate Dean for Health Policy at the University of South Florida’s Morsani College of Medicine. “We said we’d vaccinate 20 million when we didn’t even have 20 million doses. But you have to set a goal, usually just out of reach, in order to inspire all the players in the game.”

Wolfson said he’s concerned, but optimistic, about how the coming weeks and months of vaccinations will go. “Remember, this is like nothing we’ve ever done before,” he said.

The one example he keeps thinking of is George Washington’s controversial decision to inoculate troops against smallpox during the Revolutionary War.

“Our nation’s founding father, in a real war against a tangible enemy made a command decision to do something extremely controversial medically, and turned the war around, and demonstrated his extraordinary leadership,” Wolfson said. “That’s the kind of leadership we need.”

Wolfson expects things to be smoother once vaccines by Johnson & Johnson and AstraZeneca are approved. They don’t require the ultra-cold storage that makes current vaccines logistically difficult. The Johnson & Johnson vaccine also won’t require a second dose.

As for now, “I’m getting calls. My colleagues are getting calls asking, ‘When will I be able to get the vaccine? If you’re not getting it today, can I have your place in line?’.”

Wolfson said that better communication and transparency about the distribution plan is important for maintaining trust in the vaccine, especially in populations that are wary about the safety of it.

“We still don’t know if we’ll be setting up drive throughs every 10 miles, or doing it in a parking lot, or having people go somewhere else,” he said. “But I think we can work all of that out. What we need is a published plan.”

Wolfson said that while health departments across the state should get on the same page in some respects, he believes different strategies in different communities is the right approach.

“What happens in Osceola or Lee counties, the way it’s spreading, is likely very different from Pinellas or Hillsborough,” he said. “You want to give local authorities the ability to protect their populations. They know best. I’m a big believer in that.”

But, he said, those approaches need to be thoughtful. Wolfson saw the photos from southwest Florida, where people camped out overnight to get a vaccine.

“You don’t want to do first come, first serve, and have a bunch of 80-year-olds standing in line. That’s where leadership comes in.”