The Seattle Times sat down for a video chat on Wednesday with Dr. Umair Shah, who took over the top post at the Washington state Department of Health last month.
Shah came to Washington as cases of COVID-19 crested their peak and during the second week of vaccine administration. The vaccine rollout nationwide and in Washington has been slower than many had hoped. Shah shared his thoughts on what needs to improve and when we might approach herd immunity in Washington.
This conversation has been edited and condensed for length and clarity.
Q: On Wednesday, you acknowledged the vaccine rollout has been uneven in Washington state. And you promised to speed vaccination’s pace. Washington — at minimum — is using 32% of the vaccine it has received from the federal government.
We know that lagging data affects that number and that the federal program to vaccinate long-term care has been slow.
But I’ve not heard the department clearly articulate why so many doses that are in Washington remain unused. Has the health department identified the bottleneck or which part of the system is moving slowly?
Shah: The number one priority is to make sure Washingtonians are vaccinated as quickly as possible. We want to do it in a methodical, careful way because we don’t want to see what’s happening across the country where systems have been overwhelmed, and unfortunately, it’s been more chaotic than it needs to be. Because that also puts people at risk.
We are doing two things. One is to speed up all the processes, all the impediments that may be in play for vaccines to get into the arms of people. We’re also looking at where in the system the vaccines are. We’re not getting timely reporting into the systems from providers. There’s a big difference if a vaccine has been delivered and administered, but it’s not logged in the system, versus vaccines that are in the system that have not been delivered or administered.
Q: To be clear, is it a problem with the health department compiling and understanding the data? Or is it a problem with providers submitting the data?
It’s a combination. There are providers and health care systems that are doing things phenomenally well and on time. But our team started making phone calls to others. We were saying: “Well, it looks like in the system, you’ve got vaccine. We may want to potentially move vaccine because it looks like it’s not being administered.” And they would say: “Oh no, we’ve actually administered it; we haven’t entered the data yet.”
Q: I want to be a little bit more specific about the bottlenecks you have identified. What are the impediments? Because I think we’ve spoken in generalizations about that, but not been specific enough for the public to know what’s going on.
Some of the bottlenecks are not having good visibility on what consistent supply is from the federal government. It makes planning difficult. Providers are asking, “Can you give us a two-week or a three-week roadmap?” We don’t have that.
There’s a hesitation on the ground scheduling appointments that might need to be canceled. So when vaccines do arrive, there’s a lot of catchup, or speed-up, that providers have to do.
In a hospital system, there’s a willingness and understanding of their workers, the health care workers they’re going to vaccinate. When you try to look at how other providers, who are not linked with that system, who are trying to get appointments, there’s a hesitation here on how to do that. That’s why, this week, I signed an order that said health care systems do not need to treat the individuals coming for vaccines with the same requirements for medical-record entry you have for usual care. We’re in a mass-vaccination scenario.
Also, some of it is really just the basic logistics of a massive operation. No state around the country has a perfect system.
Q: On that point: West Virginia has used nearly 70% of the supplies received. South Dakota is at 57%, Texas is at 49%. What is your department’s goal? What do you want to see as far as the doses administered compared to doses received?
We are now at somewhere between 15,000 and 20,000 vaccines per day; we want to see at least double that on a daily basis. So we want to match the throughput of vaccines that are coming in from the federal government to the state to get that into the arms of people.
Q: The federal government has directed $68 million in COVID-19 relief funds to Washington and for vaccination. What will the health department use that money for?
Some of that is to help with the logistics. That can be everything from hiring personnel to technology solutions. We want to make sure our data systems are sound when it comes to reporting mechanisms. We’re seeing if any of those dollars can support data-system enhancement to get better real-time information to work with the providers to get vaccines back and forth and understand how much is administered and to create a dashboard-type visualization tool that allows community members to know what is happening in their communities.
Finally, it’s just for support that may need to be in place for alternative mechanisms of getting vaccines into arms: Healthcare providers, pharmacies, workplace vaccination clinics, but it can go all the way to mass vaccination, state-supported mass-vaccination efforts. That’s what we’re looking into for those additional dollars.
Q: The federal government has called for expanding access to vaccines to anyone over 65. You talked Wednesday about some concerns.
According to Washington’s prioritization plan and timeline, Washingtonians between 65 and 69 years of age, who don’t have multiple risk factors for COVID-19, will have to wait for vaccination until May. Can you explain the state’s reasoning? And what would your message be to that demographic?
Not necessarily to May. The timeline is a little bit uncertain because again, it’s dependent on the vaccine supply. We are definitely looking at the 65 and over group and seeing if that is the policy change that we want to make and add that group into the 1B phase, but we haven’t made or come to a decision yet.
It does no one any good if you expand the categories, but you don’t have enough vaccines. The line gets longer and longer, and what happens is those who are also vulnerable to adverse outcomes are simply not able to get the vaccine.
Q: Are people refusing the vaccine?
This is very challenging. Sometimes, people are refusing vaccination. They’re not telling people they’re refusing the vaccine, they’re just not going. We do not have the hard numbers yet. We’ve asked our partners to give us more information.
(Shah noted up to 30% of health workers in L.A. county were hesitating during an incredible surge of COVID-19 disease.)
We certainly feel that’s going to be the case across the country, including Washington.
Q: We have 7.6 million people in Washington. We have just over 200,000 doses administered. Will we reach herd immunity? And what’s our pace toward that goal?
Our goal is to reach it. We are looking at the population now that is above age 16. It’s a smaller number than 7.6 million. Our goal is 70% of that population. My goal is that when our kids are ready to go back to school in the fall … that we have enough adults vaccinated so our kids can go back to school safely in person. We are at 15-20,000 doses a day. We need to at least double that.