Vaccination efforts in Washington have been sluggish. About a third of the doses delivered to providers to ward off COVID-19 have been administered.

Providers in Washington had given the shots to 201,660 people as of Monday. About 625,000 doses have been delivered to Washington with another 123,275 expected to arrive this week.

There is a lag in data reporting, and the state Department of Health numbers show the minimum number of doses that have been given to people.

State officials assign much of the blame for the delay on the federal government, which at first opted to let states create their own vaccine plans before pivoting this week in the waning days of the Trump administration. The changes include last-minute announcements for how states distribute the doses.

The U.S. Health and Human Services Administration announced this week it would be releasing second doses, rather than holding them back for people who have already received the first shot.

Additionally, HHS told states it would begin allocating doses based on which states were administering the most. HHS Secretary Alex Azar also told reporters states needed to prioritize all adults ages 65 and older for the vaccine.

State health officials now worry they do not have enough vaccine doses in the pipeline.

“The federal partners of ours released in the media (Tuesday) some additional information and it left us uncertain on the path forward; we are still seeking clarity into the vaccine supply,” Washington state Secretary of Health Dr. Umair Shah said this week.

“What has not changed … is that the vaccine supply for next week has not been altered, the key in getting more doses into states, so those states can get them to local communities and into the arms of people,” Shah said. “However, without consistent and enhanced vaccine supply, by making pronouncements we are simply having people get into even longer lines, which only adds to the frustration and consternation.”

Yet state health officials will be moving into the next vaccination phase faster than expected – perhaps by this weekend. This means vaccinations will also be prioritized to all residents older than 70, and those older than 50 who live in multigenerational households.

In late fall 2020, the federal government kicked vaccine distribution planning to the states, leading to 50 slightly different plans nationwide to distribute, prioritize and get people inoculated.

U.S. Sen. Patty Murray, who will soon take the helm of the Senate Health, Education, Labor and Pensions Committee, thinks the lack of national planning hurt the country’s efforts from the beginning. She put forward a plan in late summer 2020, but the Trump administration went another direction.

“The current administration never put a plan together. Their plan was: it’s up to the states,” Murray said Tuesday.

The result she said, has been “chaos.”

“I think the most important and quick thing we need to have is a very clear plan that is very clearly communicated to states, health care providers, families and people themselves, so they know how it’s going to be,” Murray said.

Not all Spokane County providers have doses

Coordinating vaccine distribution is the state Department of Health’s responsibility. The agency receives orders for doses from each registered vaccine distributor in the state, and then tells the federal government what it needs. The government or vaccine manufacturers then ship doses to sites throughout the state.

So far, the distribution has varied and has been relatively unreliable, according to hospital and state officials. Hospitals report getting delayed shipments or shipments of far fewer doses than they expected, and while this is projected to improve, it makes planning difficult, they added.

The state plans to release a vaccine dashboard with dose information and allocation numbers later this week. This dashboard will show how many doses have been administered, including a first- and second-dose breakdown, as well as the percent of the population fully vaccinated.

Some vaccine distributors, including health clinics, health districts and hospitals, have yet to receive doses.

In Spokane County, 50 medical providers have signed up to be vaccine distributors. While 32,675 doses have been delivered, some distributors, such as CHAS, have yet to receive a single shipment. The Spokane Regional Health District, which tries to keep tabs on the effort, acknowledged it doesn’t know or have access to the number of people who have had a shot.

The Department of Health will not disclose specific sites in the county that have received doses, but some county-level data will be available when the state launches its online vaccine dashboard.

The health district has given about 1,500 vaccines to first responders in drive-thru clinics and received another 1,100 doses this week. The district is not holding doses back and is vaccinating at its drive-through site and through other partners at congregate care sites.

Providence Sacred Heart and Holy Family Hospitals have also administered most of their allocated doses. As of Monday, they had received between 8,000 and 9,000 doses and will have given about 6,000 shots by the end of Monday. Providence has scheduled health care workers for vaccinations through early February, which is where the remaining doses are targeted.

Slow rollout for long-term-care vaccines

The largest hold-up in administering doses has not been within hospitals, but instead with the long-term care vaccination program administered by the federal government, CVS and Walgreens.

The program, which long-term care facilities had to opt into last year, was supposed to begin vaccinating residents and workers at long-term care facilities on Dec. 28. The rollout has continued to drag on weeks later.

Michele Roberts, the assistant secretary at the Department of Health running the state’s vaccine response, said there have been meetings this week with CVS and Walgreens to speed the vaccines to these vulnerable residents and their caregivers. The plan, she said, is to get vaccines into the long-term care homes in the next three weeks.

The long-term care vaccine program in Washington had 139,425 doses of vaccine waiting to be used this week, a sizable portion of the state’s vaccine supply. Yet the coordination to get those shots into the arms of elderly residents and the workers who care for them has been slow.

In Spokane County, for example, 12 long-term care facilities and four adult family homes have received doses through the program as of last week.

Across the state, 771 long-term care facilities will be vaccinated through CVS pharmacies. Of those, 194 facilities have received vaccines thus far.

Skilled nursing facilities, which were supposed to get vaccines first due to higher at-risk patients who live in these settings, will all be finished by Jan. 17, according to the Department of Health.

The remaining long-term care facilities, which include assisted living facilities, are scheduled to receive vaccines by Jan. 24.

The Walgreens vaccine program has 1,658 long-term care facilities enrolled.

All long-term care facilities in the Walgreens and CVS program should have vaccines by Jan. 24 or sooner, according to the state health department.

Hospitals play a big role

In addition to treating more than 1,000 patients statewide for COVID-19 in hospitals, those same facilities are also pulling together vaccination plans and schedules to finish vaccinating all health care workers and staff in hospitals statewide.

Hospitals around the state that are vaccinating their workers and other health care workers are not experiencing a lot of delays, said Cassie Sauer, CEO of the Washington State Hospital Association.

“There’s really not delay; they are injecting people as fast as they can get them in,” Sauer said. “The biggest thing is scheduling.”

Previously, every person who a hospital vaccinates is considered a patient, which adds to scheduling and paperwork for the hospital, especially if they are not an actual patient. The state hospital association asked the Department of Health to consider an emergency rule or order to alleviate this.

Shah signed an order this week that did just that, enabling hospitals that are having to vaccinate people who are not considered their patients or not in their electronic medical records system to go without registering them as a patient. It allows them to record the vaccination in vaccine reporting software, but not the person’s electronic medical record. The bookkeeping has been a challenge for some hospitals.

Some hospitals still do not have enough vaccines to give shots to all health care workers who want them.

“Our delay is having enough vaccine,” said Dr. Kevin Caserta, chief medical officer of Providence in the Vancouver area. “I would add that knowing sooner rather than later is also beneficial because it tends to be towards the end of the week when we know how much we’ll get the following week, so if we knew a couple weeks in advance, that would be helpful.”

It is common among distributors to be told they are receiving a certain number of doses, only to receive much less. This makes scheduling vaccine clinics and appointments challenging for providers.

The other holdup is hesitancy among staff.

“We have a group of people who are reluctant to get the vaccine and as we wait to hear from them it’s hard for us to schedule other people who are not hospital-based,” said Dr. Karthikeyan Muthuswamy, an emergency room doctor at St. Clare Hospital in Lakewood. “There’s a little bit of delay caused there.”

He said about a third of the staff eligible at his hospital were hesitant initially, and the emergency room doctors there led by example and got the vaccines first so their staff could observe them for potentially adverse reactions. Now he and other hospital administrators anticipate some of these “watchers” might sign up to be vaccinated.

State health officials echoed their continued need for more accurate and forecasted projections of what doses they will receive in order to begin moving faster.

“We need information on the long-term stable vaccine supply,” Roberts said. “Right now what we have from the federal government is a week-to-week number without any long-term projections, so that absolutely has to be resolved so we know what’s coming.”

Shah said the department has to strike a balance between ensuring there are enough doses and getting people ready to receive them.

“If we do not do it right or well as a system, that’s going to just start all of the various things you’ve seen across the country: people in lines, systems overwhelmed or crashing, or just some level of misunderstanding, frustration or chaos,” he said.

“Our message is we’re going as fast as we can, but we need to do better – and we will.”

Correction: A previous version of this story incorrectly stated the age of vaccination for Phase 1B. All Washington residents over the age of 70 qualify for that phase of vaccination. We apologize for the error.