This year’s chaotic vaccine rollout is wildly different than before. Can we fix it in time?

After Judy Le heard that the latest COVID-19 vaccine was approved, she set up an appointment at her local CVS pharmacy in Charlottesville, Virginia to get vaccinated. With an upcoming trip planned, she wanted to get as much protection as possible against the virus. But the morning of her appointment, the store called to cancel because they ran out of vaccines, she said. 

“I’ve just been reading a lot about more cases right now, so I just wanted to get it sooner rather than later,” Le told Salon in a phone interview.

On September 11, the Federal Drug Association (FDA) approved the latest COVID-19 vaccine formulated to protect against some of the strains circulating now, but the deployment of this round of vaccines looks very different than the initial rollout, where public health officials went so far as partnering with barber shops to ensure vaccines were distributed to communities. 

These vaccines are the first that aren’t rolled out by the U.S. government, and without funding that was directed to public health programs in the state of emergency, the outreach is nowhere near what it was at the height of the pandemic, said Lori T. Freeman, the CEO of the National Association of County and City Health Officials (NACCHO). 

As a result, some people ready to roll up their sleeves to get the latest COVID-19 vaccine are being met with delays, canceled appointments and out-of-pocket costs. Meanwhile, pharmacists are walking out of CVS pharmacies and demanding the chain hire more staff to handle an overwhelming workload, while Rite Aid prepares for bankruptcy.

“Without a pandemic, without a public health emergency, and with COVID dollars clawed back with the debt ceiling negotiations, all of that money for big campaigns is lacking,” Freeman told Salon in a phone interview.

All insurers are legally required to cover the COVID-19 vaccine, and the federal government is stepping in to pay for vaccines for those who lack insurance through the Bridge Access Program. But insurers have been slow to implement these vaccines into their systems, leading to the stuttered rollout of the vaccine, said Dr. William Schaffner, an infectious disease and health policy professor at Vanderbilt University Medical Center.

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“There have already been people who have gone to their pharmacies and physician’s offices looking for the vaccine and have discovered that they haven’t been covered yet, so that means they’re going to have to come back again,” Schaffner told Salon in a phone interview. “A vaccine deferred is often a vaccine that is never received, unfortunately.”

Lead Director of External Communications at CVS Health Amy Thibault told Salon in an email that delays were due to supply issues.

“Our pharmacies are receiving the updated COVID-19 vaccine on a rolling basis, but we’re experiencing supplier delivery delays,” Thibault wrote. “Regarding coverage, we’ve seen significant progress with payers updating their systems to enable coverage for the updated COVID-19 vaccines.”

Although the public health emergency ended in May, people continue to be hospitalized and die from COVID-19, with more than 1.1 million Americans killed by the virus since the pandemic began. Nationally, COVID hospitalizations have been steadily increasing since June, along with the rise of Omicron variants like EG.5 (nicknamed “Eris”) and FL.1.5.1 (nicknamed Fornax.) The vaccines are predicted to work against these strains of the SARS-CoV-2 virus, which evolves naturally in ways that will sometimes render vaccines next to useless. This is why new shots must be developed with some regularity.

Meanwhile, approximately 18 million Americans have developed long COVID and data suggests that number will continue to rise with more infections. Although the immunocompromised, elderly and people with other health conditions are the most vulnerable to severe infection, COVID-19 continues to be one of the top 10 leading causes of death for children in the U.S.

This rollout, including mRNA vaccines from Pfizer and Moderna, boosts immunity toward Omicron variants. The Centers for Disease Control and Prevention (CDC) recommended the shots for everyone 6 months and up and projects that this could prevent 400,000 hospitalizations and 40,000 deaths over the next two years. 

One reason the CDC gave this blanket recommendation was simplicity, Schaffner, who attended the CDC’s advisory committee meeting, said. This stems in part from parallel messaging on this year’s “triple threat” of influenza, COVID-19 and respiratory syncytial virus (RSV), the viruses that could cause significant illness and death this fall and winter. A newly approved RSV vaccine now exists, which was recently recommended by the CDC for pregnant people and adults 60 and up to protect themselves.

However, people are already vaccine-hesitant and pandemic-fatigued, thus complicating an already full vaccination season, which could reduce uptake. In a survey released this week by the Kaiser Family Foundation (KFF), just 23% of Americans said they definitely planned to get the latest COVID-19 vaccine, and another 23% said they might.

But even those who want the shots may struggle to actually get them. Nursing homes, which have been decimated by the pandemic, have been waiting for vaccines, according to a recent report from KFF Health News (which is not affiliated with KFF), but neither the RSV or the COVID shots have been easy to get.

“This is a much more complicated vaccination season than we have ever had before,” Schaffner said. “I think this year will be a learning experience both for the general public and for providers.”

Not everyone agrees with the CDC’s approach. Dr. Paul Offit, Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, said that if fewer people are expected to get vaccinated this year, the vaccine should have targeted the people most at risk for being hospitalized first. That’s what public health officials from the U.K., Germany and some other European countries did.

“I think the best messaging comes with being straightforward with the American public about who really most benefits from this because I think that gives you your best chance of getting people in those groups to get vaccinated,” Offit told Salon in a phone interview. “You could argue when you say ‘give it to everybody,’ that is interpreted as everybody is equally at risk — when that’s not true.”

However, the healthcare system is very different in the U.S. than in European countries, Offit added.

“We don’t have a national health system and this is where that shows,” he said.

Regardless, the question remains about how many people will take the new vaccines. Only about one in five people got last year’s bivalent booster and one in four adults in the U.S. are completely unvaccinated, according to CDC data and the KFF survey. Although it has been improving over time, uptake has been particularly low in Black communities, in part because vaccination sites are disproportionately located in white neighborhoods but also because of decades of mistrust built up in response to prior medical malpractice.

Notably, just 6 million doses have been put aside for the uninsured through the Bridge Access Program, when at least 27 million people in the U.S. are uninsured, Freeman said. The demand for vaccines is a moving target that distributors are trying to balance without losing money, she added, especially because these vaccines have to be kept cold and take resources to store and administer.

“Six million doses split out in that way doesn’t seem to be a lot of doses or a lot of coverage,” Freeman said. “We really don’t know what the demand is going to be.”

Schaffner said he expects some of the wrinkles in the rollout to smoothen out over time. Although Le wasn’t able to find a Moderna shot near her home in Charlottesville, which she preferred, she was able to get vaccinated with a Pfizer vaccine in the next few days from a local Walgreens. Although the pharmacy staff was doing the best they could, she still had to wait an hour and a half to get the vaccine, she said.

“It’s really a crucial moment,” Freeman said. “This is the best time to make sure that people that want it and need it most get it.”