At 71 years old, Lisa Soli was delighted to snag a coveted COVID-19 vaccine during a clinic last month at Overlake Medical Center in Bellevue. But when the retired educator asked about her second dose, the nurse told her they weren’t scheduling boosters and wished her luck finding one.
Soli has been searching ever since.
“You just have to get lucky, and it shouldn’t be that way,” she said. “This is critical life-and-death stuff for those of us over 65.”
With vaccine in short supply everywhere and hundreds of thousands of eligible people in Washington still scrambling for their first shots, a new worry is emerging: Will second injections be available within the recommended time frame?
State health officials say they are committed to ensuring timely second doses for everyone who gets vaccinated, and are working to improve allocation. Several vaccine providers — like Kaiser Permanente, QFC and King County’s mass-vaccination sites — make it easy to schedule second doses as part of the initial appointment.
But in other cases, people are forced to embark on a frustrating and stressful quest as they watch the clock tick down.
Vaccine manufacturers and the U.S. Food and Drug Administration recommend second doses be administered three weeks after the first for the Pfizer injection and four weeks later for Moderna’s version. The U.S. Centers for Disease Control and Prevention recently revised its guidance to say a six-week interval is acceptable for both vaccines.
David Jones, of Edmonds, got his first shot at a Snohomish County vaccination site at the Arlington airport. “It was so well-organized, I was very impressed,” said the 68-year-old retired high school principal.
But he didn’t get a follow-up appointment. Snohomish County had to shutter three of its mass vaccination sites this week, and Jones has no idea whether the Arlington drive-thru clinic will be operating by the time his second shot is due.
Using the state health department’s map of vaccine providers, Jones has been methodically searching for an open slot. He hasn’t found any, nor can he tell which facilities are offering the Pfizer vaccine he received for his first dose.
“There’s nothing posted on any website about the type of vaccine, and the truth is, they may not know what they are going to get,” he said.
Several hospitals and clinics refused to schedule a second dose for Jones, because he received his first shot somewhere else.
Hilarie Cash, 68, and two of her work colleagues encountered similar roadblocks after getting their first shots at Overlake. After days online, filling out the same forms over and over, they finally got second-dose appointments at a Seattle University clinic operated by Swedish Medical Center.
But her colleagues, whose slots were for Wednesday, were turned away when they arrived at SU because they didn’t get their first doses there.
“The lack of organization and clear communication is just mind-boggling,” Cash said.
Vaccine providers are equally frustrated, because most have the capacity to inoculate many more people — but don’t have enough vaccine or enough predictability to schedule out into the future. Both the Swedish-Seattle University clinic and a clinic at the University of Washington have stopped offering new first-dose appointments and are focused on administering second doses and previously scheduled first doses.
“We’re new at this, and we didn’t anticipate this level of scarcity,” said Kevin Brooks, chief operating officer for Swedish. The clinic’s scheduling software, which isn’t able to set up first and second appointments simultaneously, also wasn’t able to identify or warn off second-dose-seekers who got their first shots elsewhere.
“We have been flooded with folks who received their first dose from other locations,” Brooks said. “As a result, many people who got their first dose with us have not be able to schedule their second dose.”
The Washington State Department of Health (DOH) on Thursday agreed to provide additional doses to cover the rush of unexpected customers as well as the clinic’s own patients, heading off the need to cancel appointments.
Cash’s colleagues, who were spurned on Wednesday, got follow-up messages inviting them back to the Swedish-Seattle University clinic. Cash has an appointment Monday. “I am planning to go,” she said, “and not leave until they give me my second shot.”
Portions of every incoming vaccine shipment the state receives are earmarked for second doses and vaccine providers place their orders accordingly. For example, UW Medicine’s COVID-19 vaccine clinic is scheduled to receive 7,500 second doses and 4,000 first doses for the week of Feb. 8, said Cynthia Dold, associate vice president for clinical operations.
Providers aren’t supposed to stockpile vaccine or dip into one pot to backfill the other.
“DOH has let us know they are in essence guaranteeing these second doses,” Dold said. “So the bottom line is: if you get your first dose from us, we are ensuring you can come back for your second dose.”
Providers don’t usually get all the doses they order, but second dose orders are generally prioritized. “There might be times our pharmacies are only allocated second doses and won’t be able to give first doses due to this prioritization,” Tiffany Sanders, corporate affairs manager for Quality Food Centers (QFC) said in an email.
In a media briefing Thursday, Acting Assistant Health Secretary Michele Roberts said the state is working to “make sure the second doses are really available and in the right places.”
For the sake of consistency, tracking and planning, it’s preferable to get both doses at the same location, health experts say.
“If you shift people around, one of the challenges is that people are just going to sign up for 15 or 20 different sites to make sure they get it, and then what happens when you have all those open slots?” said Dr. Steven Pergam, infectious disease specialist at the Fred Hutchinson Cancer Research Center and director of infection control for Seattle Cancer Care Alliance. “We don’t want people shopping around if we can avoid it.”
But it’s not always possible to go back to the same place, Roberts acknowledged. So DOH is encouraging providers to find a way to accommodate people in that situation. The agency is also urging providers to schedule second doses at the time of the first shots.
That didn’t happen at Snohomish County’s Arlington clinic because officials were anxious to get vaccine in arms and decided not to wait until a better tracking system could be developed, said Jason Biermann, the county’s emergency management director.
“We rolled it out quickly and focused on getting the first doses delivered,” he said in a briefing this week. A new computer system is expected to go online soon that should eliminate future problems, he added.
Overlake Medical Center declined to discuss its approach to second doses, but issued a statement saying it has identified and is reaching out to people who have not yet been scheduled.
From an immunological standpoint, there’s no cause for alarm if your second shot is slightly delayed beyond the recommended interval, Pergam said.
Even a single shot of either vaccine offers a significant level of protection against the novel coronavirus, with effectiveness estimates ranging between about 50% and 80%. “There’s more flexibility than most people realize,” he said.
However, there are still a lot of unknowns about how long protection lasts — even after two doses.
The U.K. and several other countries are deliberately delaying second doses by up to 12 weeks in order to get at least one injection to more people. A recent analysis of the AstraZeneca vaccine widely used there — though not yet approved in the U.S. — found that a three-month lag between the first and second shots actually boosted effectiveness.
Some experts have called for a similar delayed-dosing approach in the U.S., but so far, federal officials have advised sticking as closely as possible to the schedules that were tested in clinical trials and shown to work.