Staff photo by C.B. Schmelter / Hamilton County Health Department worker Shelly Donahue gives a shot of the COVID-19 vaccine near the Hubert Fry Center at the Tennessee Riverpark on Wednesday, Dec. 30, 2020 in Chattanooga, Tenn.

The stumbles in Hamilton County's COVID-19 vaccine rollout have quickly overshadowed the record-breaking development of the vaccine and the cheered arrival of doses in the Chattanooga region in mid-December.

In the past two weeks, residents have been left frustrated, confused and discouraged by the long lines, limited doses and poor communication. Local health officials are urging patience this week until more doses become available in Hamilton County.

But, given the challenges in and out of the county's control, it is not clear if the rollout will improve anytime soon.

Becky Barnes, Hamilton County Health Department administrator, told the Times Free Press this week the department is "looking at other options" for distribution locations but offered no further information. Barnes said efforts to ensure the vaccine is widely accessible to all county residents are "in the planning stages."

The lack of more detailed communication from the health department, especially around ensuring equity in distribution, angered some residents who said it mirrors mistakes from the spring in making COVID-19 testing available and accessible to all residents.

During a Jan. 6 county commission meeting, commissioner Warren Mackey questioned Barnes and Hamilton County Mayor Jim Coppinger about what plans they had to use other sites for distribution. The two officials said the health department would distribute vaccines nonstop if supplies were available. Distribution locations take two or three weeks to set up, Coppinger said.

Mackey questioned why such sites are not being announced or set up for when vaccines arrive.

"We can't just give platitudes to each other. We have to be furious and go after this thing very hard," Mackey said during the meeting. "We're trying to use the Riverpark as our site. That's not going to be enough. We know that. So why not just, right now, start experimenting and put it out maybe inside or other locations and work the bugs out so we can get on with our lives?"

Coppinger, in response, praised Gov. Bill Lee's response to the pandemic in Tennessee and said people in both political parties have worked hard. The county mayor said the vaccine was developed in record time and he did not expect to be putting shots in arms this quickly.

In November, Pfizer announced its vaccine was 90% effective and a month later received emergency use authorization. Moderna's vaccine, which is 94% effective, was approved a week later. Yet, despite weeks of notice, states and local health departments have struggled to develop effective distribution plans.

They face a limited supply of doses provided by the federal government. At the same time, the two available vaccines require ultracold storage, including the Pfizer vaccine needing -70 degrees Celsius, and both are delivered in large numbers in a single box. The doses have a short shelf life once they are removed from their packaging.

Dr. Michelle Fiscus, medical director for the Vaccine-Preventable Diseases and Immunization Program in the state health department, told nonprofit leaders on a call this week the state is not receiving enough doses to make the vaccine available at multiple locations.

At Hamilton County's only distribution location, people reported waiting in line for more than six hours this week only to be turned away because the health department ran out of doses. On Wednesday, people got in line seven hours before vaccinations were scheduled to begin.

On Dec. 31, the county closed its vaccination site only to discover extra doses hours later. Those doses were then given to anyone who was available, not those who were in eligible categories, such as health care workers.

Local demand is far outpacing supply as the population of those eligible for the vaccine far exceeds available doses. Residents aged 75 or older, along with people in phase 1a1 and 1a2, such as health care workers, first responders and home health care staff, are currently eligible for the vaccine, though many health care workers were vaccinated through their employers. The county expanded eligibility for the vaccine on Dec. 30.

During the Jan. 6 commission meeting, Coppinger said the county has approximately 30,000 residents aged 75 or older. Yet, the county had around 3,200 doses to distribute in the three days the vaccine was available to people in eligible categories.

Some older county residents have felt overlooked in the distribution plan with many reporting being unable to sit in their cars for hours to wait for a dose. Ora Hudson, 78, said the county health department's distribution site is not accessible for older adults.

"I don't know who arranged all this but they don't know what they're doing," Hudson said.

During the commission meeting this week, Mackey questioned whether the county health department had plans to reach populations that do not find the Amnicola Highway site accessible, such as shift workers or others who cannot take off work.

A December analysis on vaccine distribution from the Kaiser Family Foundation emphasized the need for the vaccine to be available by car or walk-up and during hours that are accessible to people with varying work schedules. The report, from Dec. 3, noted how people of color are historically less likely to be vaccinated compared to white people because of barriers in access and a history of discrimination within American health care.

Carolyn Szetela, associate professor at Meharry Medical College's Department of Medical Education, said the "first come, first served" distribution method sounds fair at first but there are ways certain groups are advantaged.

"For vaccines, getting to the front of the line would mean: Who learns about the line-up first? Who is well-informed about the importance of getting vaccinated? Is the line-up in a trusted, accessible place? Is there transportation to get in? Do I have time in my day to go line up? And so forth. And, these characteristics that allow someone access to the front of the line typically come with social advantage," Szetela said.

On Friday, the county health department announced it would begin using an online appointment system, part of a statewide program to diminish long waiting lines. The online dashboard is expected to launch this week.

CARTA operates two bus lines that would reach the county's distribution site but the county uses a drive-thru method for vaccine distribution. Lisa Maragnano, executive director for CARTA, said her organization has told the health department it is available to help with vaccinations.

"They will reach out when they need our services," she said.

Barnes said the health department plans to use vaccination strike teams to reach some communities, similar to what is being done for residents of long-term care facilities. But such efforts are "still in the planning stages," Barnes said.

"It may take our county more time to go through this population than other counties around us, simply because there are more people in this category than in rural counties," Barnes said in a statement. "After these high-risk populations are vaccinated, we will turn our efforts toward other groups, and equity is always a consideration."

In May, the Unity Group of Chattanooga criticized the health department for not being more transparent with testing data and which communities were being hit hardest by the virus.

This week, the group again criticized the department for not doing more to educate and build trust among communities of color. Many Black Americans are hesitant to participate in sections of health care due to a history of racism and abuse, such as the 40-year-long "Tuskegee Syphilis Study," in which nearly 400 Black men were deceived into believing the Centers for Disease Control and Prevention was providing free medical care when instead the government was studying their untreated syphilis.

"There should be a very meticulous public education, outreach and engagement approach that would serve to alleviate the concerns of the community that may be raised, and help to provide the most detailed and transparent information possible in order to help ensure an orderly process in this endeavor," the Unity Group said in a statement. "The issue of availability is also a major concern. We must remove all the unnecessary and rudimentary barriers which might serve as deterrents for those individuals who might seek COVID-19 treatment, vaccination, and testing. Thus far we have not."

People of color are disproportionately infected and killed by the virus. Nationwide, Black residents are 3.7 times more likely to be hospitalized compared to whites and Hispanic residents are 4.1 times more likely to be hospitalized compared to white residents, according to the CDC. According to the Kaiser Family Foundation analysis, this disparity should lead health departments to prioritize racial and ethnic groups for targeted outreach and distribution.

Much of Tennessee's vaccination plan aligns with advice from leading health groups, like the National Academy of Medicine. The plan states that within each phase "individuals at higher risk due to age or health condition should be vaccinated ahead of younger and healthier individuals in the Phase."

Barnes said the National Guard is vetting people asking to receive a dose to ensure they are eligible but did not provide information about how the county is following the guidelines in the phase relating to higher-risk individuals.

Szetela said the rollout of vaccines is an opportunity for American communities to address systemic inequities in its public health systems.

"There was never an excuse for structural injustices that contribute to health disparities," Szetela said. "We need to take this awful pandemic as an opportunity to see and confront inequities in health care until one day in the future, we can say all people have access to the health advantages that our affluent nation can provide. We need to move towards social justice and correcting the root causes of health disparities every chance we get."

Contact Wyatt Massey at wmassey@timesfree or 423-757-6249. Follow him on Twitter @news4mass.