Updated COVID-19 shot slowly rolls out in Texas, but access is spotty

Linda Murphy pulls up doses of the Pfizer vaccine into syringes at a clinic organized by the Travis County Mobile Vaccine Collaborative at Rodriguez Elementary School on July 28, 2021. (Credit: Sophie Park/The Texas Tribune)

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Updated COVID-19 shots are becoming increasingly available in Texas after weeks of hiccups and distribution glitches since the vaccine was approved for people 6 months and older last month, providers say.

But availability is still spotty as hospitals, pediatricians and pharmacies work directly with drug makers, instead of with the state and federal government, to secure their COVID-19 vaccines for the first time.

As a result, doses aren’t arriving at providers’ offices across the state at uniform, predictable intervals — largely dependent on individual providers ordering according to their own anticipated demand and availability of staff, as well as working out logistics over insurance payment for the vaccines that have historically been covered by the government. It’s a system typical for other common annual vaccines, but new to the COVID-19 protocol.

“It has been challenging,” said Laura Ehrlich, a parent and a communications specialist in Austin. “Three different pharmacies told me they didn’t have the vaccine because it had not been approved by the FDA for children under 5. Of course, that is not true — but I’m concerned about that mis- or dis- info by pharmacists.”

At Texas Children’s in Houston, officials have not been given any indication that there will be shortages, but they have not yet begun to offer the shots to their pediatric patients — although they expect to get that going some time during this month, said Dr. Stanley Spinner, chief medical officer and vice president of Texas Children's Pediatrics and Texas Children’s Urgent Care.

“We have been working quite diligently on the logistics of being able to get it,” Spinner said. “It’s just a matter of timing and logistics and being prepared to get it all rolled out.”

Shipments, too, are dependent on commercial distribution networks — creating a patchwork of access while COVID-19 rates fluctuate in recent weeks, even as demand for the shot is expected to be low.

“We have had patients calling our appointment line about COVID vaccine and asking their physicians about it at appointments, but not a huge number,” said Tamara Baker, senior director of clinical operations at Austin Regional Clinics.

At ARC, she said, the vaccine has begun arriving “in limited amounts” but more is expected “very soon.”

“There have been shipping delays, so info on arrival changes daily,” she said.

The U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention approved the updated vaccine for people ages six months and older in mid-September.

Shots began going into arms on Monday at University Health in San Antonio, spokesperson Shelley Kofler said.

On the first day, they administered 95 adult COVID-19 shots, she said. On Tuesday, the number climbed to 105, including two children, she said.

“We are monitoring interest and will match our supply with demand,” she said.

Austin Public Health is providing shots to children under age 11 but still waiting on doses for older patients to come in, officials there say. Officials with the drug store chain Walgreens told the Tribune in an email this week that they have the shots in pharmacies across Texas, although pharmacies in this state are not authorized to give the COVID shots to children younger than 3.

In more rural settings, providers have not reported any complaints about the availability of the vaccine, said John Henderson, executive director of the Texas Organization for Rural and Community Hospitals.

In Huntsville, pharmacies are distributing both adult and pediatric doses to patients and providers, although doctors say they are having to work hard to get parents interested in another round of COVID-19 vaccinations.

“Uptake is OK,” said Dr. Lane Aiena, a family medicine physician in Huntsville. “We’re trying to frame it as a, most likely, yearly shot like the flu, which seems to help people understand why we need ‘another one.’ ”

The situation is similar in El Paso, where pediatricians say that the low risk of serious COVID-19 illness in most children, combined with misinformation about the safety and effectiveness of vaccine, can be a hurdle — along with the fact that the federal government is no longer providing free access to everyone regardless of insurance coverage.

Medicaid and uninsured patients can obtain the vaccine for free, but providers are expected to bill insurance companies for those recipients who are covered.

“Co-pays or other costs related to updated COVID-19 vaccines will be a barrier for certain families,” said Dr. Glenn Fennelly, professor and chair of pediatrics at Texas Tech Physicians of El Paso. “Also, there have been supply and distribution issues that are impacting availability. “

But Fennelly says medical providers are expecting demand for the new COVID-19 vaccines will be significantly lower than in the past because it seems to be a lower priority for families.

Providers acknowledge that the admittedly soft rollout of the vaccine comes against a very different backdrop than in previous years — with much less government involvement and a bit less urgency.

Two years ago, cities and counties were offering cash rewards and gift certificates to those who got their COVID-19 shots. The state was sending mobile vaccination units to office buildings, neighborhoods, and remote communities, and was engaged in million-dollar public service campaigns designed to increase acceptance of the vaccine.

On a federal level, the CDC was vaccinating people at bars and sorority houses and staging regular press conferences urging the vaccine. The federal government was purchasing vaccines from makers like Pfizer and Moderna and distributing them to the states, which then allocated it to qualified vaccine providers.

Since then, the federal health emergency has ended and the state and federal governments have bowed out of the distribution chain. Providers now order the COVID-19 vaccine as they do other vaccines.

The Texas Department of State Health Services is now banned by the Texas Legislature from spending public money to promote the vaccine at all.

“We are out of the vaccine distribution business,” said Chris Van Deusen, spokesperson for the state agency.

Texas government officials are also not allowed to mandate the vaccine (or masks, for that matter) in government offices, buildings or places of employment in Texas — a ban some conservative lawmakers hope to extend to private businesses during a special session of the Legislature that starts on Monday.

Unlike previous vaccine rollouts, when the biggest obstacle was the supply, the current challenges are mainly over a lack of clarity on when the shot will arrive and where it will be available, as well as spotty information on how to pay for it and who qualifies.

Austin mom Melissa Britton-Reimer said she hasn’t gotten any good information on “why it’s been approved, sitting at the pharmacies, but not available” after she recently attempted to make appointments for her elementary-age children. She said she was told by the pharmacist that it wasn’t being offered and that there was no solid date when they will be available.

“Being told to just keep trying to make them an appointment wasn’t a very satisfying answer,” she said. “Who has time for that?”