Publix gets 1 out of 4 Florida coronavirus vaccines, but officials don’t know where shots will go

Florida officials say the arrangement with Publix is “imperfect” but that it prioritizes getting as many people vaccinated as quickly as possible.
A Publix Super Markets store located along U.S. 19 in Tarpon Springs.
A Publix Super Markets store located along U.S. 19 in Tarpon Springs. [ CHRIS URSO | Times ]
Published March 2, 2021|Updated March 3, 2021

State officials have shipped 70,000 COVID vaccine doses a week to Publix’s central distribution hub in Lakeland in Central Florida, without knowing exactly where the shots will go, a Miami Herald analysis of state vaccine distribution data from the past five weeks and interviews with state officials found.

The grocery chain — a major financial supporter of Gov. Ron DeSantis — is the state’s single-largest vaccine supplier and receives nearly a quarter of Florida’s available doses without providing state officials a store-specific distribution plan ahead of time, according to Jared Moskowitz, the director of the Florida Division of Emergency Management, the agency leading the vaccination campaign.

What’s unusual is not that a retail chain with pharmacies is involved in distribution efforts. It’s that in Florida, Publix made unilateral decisions about distributing 23 percent of the state’s weekly doses, the most received by any provider in the state for the past six weeks, according to distribution data obtained and analyzed by the Herald. Public health officials do not know which specific stores receive vaccines until after the shots are administered, Moskowitz told the Herald. The chain reports “shots in arms” to the Florida Department of Health only after they are given.

Moskowitz said Florida’s arrangement with Publix is “imperfect” but prioritizes getting as many people vaccinated as quickly as possible.

“My mindset is about speed,” he said.

After publication, Moskowitz contested the description of Publix’s decision-making on where to distribute weekly allotments of vaccines as “unilateral,” but provided no details about the state’s involvement in shaping those plans.

Concern that Publix is not a public health expert

Experts interviewed by the Herald say Florida’s arrangement with Publix underscores a lack of public health principles guiding the state’s vaccination campaign.

“Publix is not a public health entity. It should not be relied on to make decisions about the geographic distribution of vaccines,” said Tom Hladish, an infectious disease expert at the University of Florida. “That is something that should be informed on current transmission and the history of the pandemic in the different parts of the state. You should be targeting places that have more susceptible people.”

Florida’s weekly allocation data include specific locations for vaccines headed for hospitals, major vaccination sites such as Hard Rock Stadium and Tropical Park, for example, and the destination county for smaller “mission-focused” deliveries of doses to places like Black churches. Publix was the only exception, and shows a lump sum given to the chain without a county-level distribution breakdown.

The Herald’s analysis of Florida’s vaccine distribution did not account for some 30,000 doses shipped to hospitals in the month of February, which were set aside for healthcare workers and the medically vulnerable.

While many retail chains in Florida are receiving vaccines, Publix is the only one receiving doses from the state government. The federal government separately supplies vaccines to Publix, Sam’s Club and Winn-Dixie. The state distribution data provided to the Herald do not include vaccines distributed by the federal government.

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A spokesperson for the Centers for Disease Control and Prevention said that the weekly vaccine allocation for the federal pharmacy program is divided per capita and then allocated to the retail chains, who decide “in close coordination” with federal health officials how many doses will be shipped to each location based on supply, how much capacity the stores are estimated to have, and demand.

In response to questions about its distribution decisions for the doses provided by the state, Publix spokesperson Maria Brous said in an interview last week, “Doses vary by location and many factors go into that decision process.” She provided no further details in response to follow-up questions.

Moskowitz conceded that not knowing ahead of time makes it difficult for the Department of Health to achieve its goal of dividing the state’s total weekly supply among the state’s 67 counties based on each county’s portion of Florida’s 65-and-older population, the most vulnerable to severe infection.

“What’s going to Publix comes out of the equitable distribution based on the 65+ older population,” Moskowitz said. “If I didn’t take into account Publix’s [doses] … the county that had Publix would be getting more doses if it didn’t count against the 65+ distribution.”

With nearly one of every four of Florida vaccines’ final destination unknown, the calculations for allocating the remaining doses are guesswork rather than informed public health decisions.

Depending on the week, Moskowitz said, the state has based its plan for the remaining available doses on everything from an assumption that Publix would distribute the vaccines equally between stores to building spreadsheets that use store-specific vaccination administration data from the previous week to make educated guesses as to how Publix plans to use the next week’s supply.

The lack of location-specific distribution plans from the grocery chain leaves the Department of Health unable to account for any of those changes until after they happen and could cause the state to unintentionally undersupply some counties with vaccines while oversupplying others.

The guessing game around the distribution of nearly a quarter of Florida’s total vaccine supply might help explain why different parts of the state have varied so significantly with vaccine coverage. A handful of counties have vaccinated 70 percent or more of their 65 and older population, while most of the rest of the state hovers around 50 percent, according to data published by the Florida Department of Health.

Zinzi Bailey, a research professor at the University of Miami who studies healthcare inequities, said that a successful vaccine campaign depends on transparency and accountability. The state should be sending more doses to health officials who have the ability to target people most at risk for getting or spreading COVID, and less to a private partner with no publicly available distribution plan, even if that partner has experience in distribution and logistics, Bailey said.

“There shouldn’t be a question about where those doses were administered,” she said. “If there is a discretionary fraction of vaccines, that should be the smallest fraction.”

The Herald found that less than 4 percent of the state’s total vaccine supply went to vaccination initiatives through churches and other community outreach centers, which officials have said are a critical part of the efforts to reach underserved communities.

“I am a little bit worried about that level of accountability for almost a fourth of the vaccine allocation in the state compared to 4%, which would be going to mission-oriented work,” Bailey said.

Florida Keys resident Charlene Chapman, 69, said that she and her husband spend every Monday, Wednesday and Friday morning on the Publix website trying to book a time to get vaccinated. (Chapman’s husband was a Herald photographer for 40 years, who retired a decade ago.) Every time except one, the bar tracking available slots has reached “100 percent reserved” before they had a chance to schedule.

Chapman, a breast cancer survivor, took the only slot the couple found available and was vaccinated at her local Publix on Feb. 12. She still has not been able to get an appointment for her husband or an 87-year-old neighbor she’s trying to help. Chapman said she is frustrated because there’s no way to know if the Publix down the street is getting 10 doses or 100 each week.

With more Publix locations opening for vaccines around the state — the food retailer announced last week that COVID-19 vaccines would be available at all of its stores in Florida — which were not on the early lists — Chapman is concerned that vaccines are getting routed away from Monroe County residents.

“We worry, are they really ever going to get it back?” Chapman said. “There’s no information here at all.”

Other states handling it differently

Although no two states are handling vaccine distribution in exactly the same way, Florida’s hands-off approach to distributing vaccines through Publix differs from other states.

The grocery store chain Giant provides vaccines at stores in Delaware, Maryland, Virginia and Washington D.C.

Delaware tells Giant how many doses the chain will be getting and asks how many should be sent to each specific store, according to Samir Balile, pharmacist and Giant’s clinical programs manager. Other states simply send doses directly to individual stores, he said.

“It’s important that jurisdictions work with their retail pharmacy partners to make sure vaccines are equitably distributed and allocated to communities in need,” Balile said.

In Pennsylvania, Rite Aid, Topco and CVS all receive vaccines to specific stores based on an allocation plan designed by public health officials, according to Maggi Barton, deputy press secretary for the Pennsylvania Department of Health.

Barton said the health department makes its distribution plan based on providers’ current allocations, amount on hand for distribution, amount administered, population, percent positivity and death rates.

Hladish, the UF epidemiologist, said there is no one simple answer as to the best way to distribute vaccines. But he said, like Pennsylvania, Florida health officials should be creating statistical models that consider, for example, which parts of the state have generated more transmission, population density, the age distribution of various areas and the prevalence of the disease there, as well as how many deaths a place has endured.

“I don’t think that a grocery store chain has the capability to do that kind of analysis,” Hladish said.

In Florida, Publix has worked independently of county health departments running vaccination sites overrun with demand.

“We basically have knowledge of [Publix] giving vaccines, but we don’t have the intricate knowledge of how many,” said Jeff Tambasco, the director of emergency management in DeSoto County. But he said he’s not concerned. “We know the vaccines are being administered. At the end of the day, that’s the most important part.”

Barry Burton, Pinellas County administrator who oversees the county’s vaccination program, was unaware that Publix’s doses could affect the county’s allotment.

“We are not told about [Publix’s] allocation usually. Sometimes we provide some of ours but they get a direct state allocation and even a fed allocation. It’s complicated,” Burton said. He agreed with Tambasco: Private retail partnerships are important to the overall effort.

“As vaccine supply increases we need the hospitals, CVS, Walgreens … contracts to come on line so there is the capacity to deliver on volume,” he said.

Concerns about unequal access

The race to vaccinate Floridians is a multi-pronged effort by necessity. Retail chains across the country have filled in gaps in public health infrastructure.

“Some of these Publixes have really filled a need, getting into communities in a convenient way,” Gov. Ron DeSantis said at a press conference on Feb. 5.

But Publix has not served all Florida residents equally.

In February, Publix offered vaccines first in areas that tended to be both wealthier and whiter than average, according to an analysis using data from the U.S. Census Bureau and lists of Publix stores offering vaccines from Feb. 1 and Feb. 23.

At the start of February, none of the 324 Publix stores offering vaccines were in Florida’s eight counties where census data show over 25 percent of residents are Black. By Feb. 23, Publix had opened 36 vaccine locations in two of those counties. The others still had none.

The funneling of so many doses to Publix comes with a backdrop of months of stark disparities in how people from wealthy ZIP codes are getting vaccinated at higher rates than in poorer ones. The Miami Herald has also found that the state’s vaccination campaign is leaving behind Black residents of South Florida, who have disproportionately low rates of getting shots.

In Palm Beach County, which initially received vaccines solely through 67 Publix locations, the Sun Sentinel reported in January that county commissioners voiced concern that the locations of the stores privileged some residents over others.

“”I use the term ‘vaccine desert,’” said County Commissioner Melissa McKinlay, the Sun Sentinel reported. “We’re moving all of this into the hands of Publix” and yet it’s 108 miles from the Publix in Loxahatchee Groves to the store at State Road 80, she said.

Health experts say even without the ambiguities brought on by Publix’s lack of transparency, Florida’s simple, age-based model leaves out important public health considerations.

Michael Lauzardo, a pulmonary disease specialist with the University of Florida, said the state has thus far distributed the vaccine like a commodity, based on demand, rather than a public health resource.

“You’ve got to generate demand and get more supply to meet that,” Lauzardo said. “We can’t just treat this like a commodity. It’s a necessity.”

Doses should be distributed to parts of the population in a given county that might be more vulnerable to the disease or more prone to spreading it, he said. Otherwise, he said, as demand starts to tick down, certain demographics — young people, those living in rural areas and African Americans, specifically – will have less coverage.

“We need a strategy to be able to engage those groups because we don’t get to herd immunity without them, and nobody gets left behind,” Lauzardo said.

Bailey, the research professor at the University of Miami, stressed that the state needs to demonstrate that its resources are being allocated fairly in order to quell concerns in the very communities they are seeing fall behind in vaccination rates.

“Otherwise, we are fueling further distrust in the process,” Bailey said. “Distrust in vaccination, distrust of the medical system, and distrust of government systems.”

Herald staff writer Devoun Cetoute, Times/Herald Tallahassee Bureau staff writer Mary Ellen Klas and McClatchy White House Correspondent Michael Wilner contributed to this report.