Medical experts and researchers from across the country have applauded Tennessee's COVID-19 vaccination plan, which was among the first in the nation to consider social vulnerability in distribution. But, one month in, it is unclear how well the state's focus on equity is being implemented.
As of Thursday, the demographic breakdown of administered doses was 44% unknown by race and 31% unknown by ethnicity, according to data from the Tennessee Department of Health.
Bill Christian, associate director in the department's Office of Communication & Media Relations, said the state is working to improve the process.
"Current functionality of the software used to capture information during mass immunization events does not allow for the capture of this information," Christian said in a statement. "[The health department] has asked the vendor to update the software so this information can be collected going forward."
The state is not making available county-level demographic data about who is receiving the COVID-19 vaccine.
Dr. Rebecca Weintraub, assistant professor of global health and social medicine at Harvard Medical School, said such specific demographic data is important to ensure everyone has access to the vaccine and at-risk populations are protected.
"We need to know - as academics, as policy makers, as the general public - who's receiving the vaccine so that we can support those communities, those counties that need not only additional supply, but additional services to reach those who may not have a smartphone to make an appointment, for example, or couldn't travel to a stadium or a local retail pharmacy to receive the vaccine," Weintraub said.
Similar to operations related to distribution of vaccines, there has been little federal support for a unified tracking system, she said. The U.S. Centers for Disease Control and Prevention, along with the states, has asked for more support but not received much funding, Weintraub said.
"Right now, we have an incomplete and imprecise understanding [of] which Americans, which folks in Tennessee, have gotten vaccinated," she said.
Tennessee ranked fourth in the nation among states reporting racial vaccine data for the largest gap between the percentage of Black residents in the state population and the percentage of Black residents who have been vaccinated, according to an analysis by Kaiser Health News. White residents are being vaccinated in the state at double the rate Black residents are, according to the analysis.
Medical experts and researchers across the country have praised Tennessee's vaccination for considering questions of equity. For example, according to the plan, "individuals at higher risk due to age or health condition should be vaccinated ahead of younger and healthier individuals in the phase."
Black residents are 3.7 times more likely to be hospitalized with COVID-19 than whites, and Hispanic residents are 4.1 times more likely to be hospitalized than white residents, according to the CDC.
Dr. Harald Schmidt, assistant professor of medical ethics and health policy at the University of Pennsylvania, said health department leaders are making sincere efforts to create a smooth rollout.
"It really is outstanding what Tennessee is trying to accomplish," he said. "Now, the other aspect is, the devil so often is really in the details. And personally, I really think it's important that we cut health departments some slack here. You've seen a lot of press coverage recently how the vaccine rollout has been disappointing and chaotic and all sorts of very disparaging language."
Christian said the Tennessee Department of Health monitors the 89 rural counties under its control to ensure they are following the vaccination plan. The state's six metro counties, including Hamilton, have more autonomy. However, these counties are in frequent communication with the state, Christian said.
The next stage of vaccine distribution, specifically in getting shots to vulnerable or vaccine-hesitant communities, will be difficult. The two available vaccines, from Moderna and Pfizer-BioNTech, require ultra-cold storage and have a relatively short shelf life, making it difficult to use mobile clinics or release them at various locations, such as local pharmacies, that may not have the infrastructure to keep the doses cold.
"What's happening in this country right now has never happened before - we basically are having a mass vaccination of hundreds of millions of people, and the logistical challenge is off the charts," said Robert Chamberlain, co-founder and CEO at Applied Health Analytics. "And the complicated aspect of it is, the further you go down the distribution channels, the more complex the distribution becomes."
At a news conference last week, Becky Barnes, administrator for the Hamilton County Health Department, said her organization is in the early stages of developing an educational campaign for populations that are vaccine hesitant. Barnes told the Times Free Press the department was working on a plan earlier this month and said the same thing in the opening days of December, when the first doses of the vaccine were set to arrive in the county.
Few details about what the rollout or education campaign will look like have been provided to the public.
Glen Nowak, director of the Center for Health and Risk Communication at the University of Georgia, said it makes sense that many state distribution plans are broad and offer few details about operations.
Providing more specifics, although difficult, will be important. Many health departments are underfunded and understaffed, he said.
"It takes a lot of work to get down to develop a really detailed plan. And it requires a lot of resources," Nowak said. "Most health departments, they don't have a lot of staff and most of the staff they have are nurses or medical people. They're not communications people. They're not logistics people."
On Sunday, the Hamilton County Health Department announced its new vaccine appointment system, along with eight days of availability for the first dose for eligible groups.
Staff writer Elizabeth Fite contributed to this story.
Contact Wyatt Massey at firstname.lastname@example.org or 423-757-6249. Follow him on Twitter @news4mass.