On Dec. 22, Gov. Greg Abbott sat in a conference room at the Ascension Seton Medical Center in Austin and rolled up his sleeve for the cameras. A nurse pricked a dose of Pfizer’s COVID-19 vaccine into his left arm and state officials and hospital staff in the room applauded.
Abbott then threw up his arms: “It’s that easy,” he said.
The event was a celebration of a major milestone in the battle against the coronavirus. Although cases were still mounting in Texas and new hospitalizations were climbing, 1.4 million health care workers and vulnerable Texans were set to receive the vaccine by the end of 2020, Abbott said, with millions more to come soon after.
But in the days since that celebration, getting that vaccine to the people eligible to receive it has proven far from easy. The vaccine’s rollout has been marred by poor messaging from state officials, technical errors and logistical delays.
As the final hours of 2020 ticked away, it was unclear whether anyone in the state knew how many doses of the vaccine had been administered here. And after state officials had expressed concern that vaccines were going unused and urged providers to give them to anyone who was eligible, many who met the qualifications were finding it difficult — if not impossible — to track down anyone with vaccines to give. Many counties asked Texans to sign up via an iPhone application or through an online registry, and some elder Texans are finding those technologies onerous.
The confusion left medical experts and people urgently awaiting the vaccine frustrated and questioning how the state would be able to handle smoothly administering vaccines to a population of nearly 30 million in the coming months.
“All of this seems to have been avoidable if it had been properly thought through,” said state Rep. Donna Howard, D-Austin.
Mixed messages and confusion
State officials never planned to administer the vaccines themselves. Instead, a state panel would set their own eligibility guidelines based on recommendations from the U.S. Centers for Disease Control and Prevention. State officials would allocate an appropriate number of vaccine doses to providers, such as pharmacies, doctor’s offices, hospitals and medical clinics. The providers would receive shipments from the federal government.
Shipments of the vaccine first began arriving at Texas hospitals on Dec. 14. The limited supply, under Phase 1A of the state’s rollout, was reserved for front-line health care workers and residents and staff members of nursing homes and other long-term care facilities, which have been decimated by the virus. State officials estimated there were 1.9 million Texans eligible in that first tier.
One week later, on Dec. 21, Dr. John Hellerstedt, commissioner of the Texas Department of State Health Services, announced that Texans 65 and older and people who are at least 16 with certain medical conditions, would be next in line. Health officials said it would likely be at least a few weeks before that group, referred to as Phase 1B, could receive their vaccinations.
But two days later, Hellerstedt moved up the timeline. The state’s vaccine tracking system, ImmTrac2, reported “a significant portion of vaccine in Texas may not be administered yet,” according to a letter he sent to health care providers that had received shipments of the vaccine. Hellerstedt directed providers to “administer their entire allotment with all deliberate speed.” At the time, DSHS spokesperson Chris Van Deusen said the Dec. 23 letter was meant to encourage providers not to wait until everyone in the 1A group had been vaccinated before moving on to the 1B group.
Abbott gave a similar message on Tuesday. In a tweet, he suggested that an excess supply of vaccine was available and criticized providers for not moving quickly enough to administer it.
"A significant portion of vaccines distributed across Texas might be sitting on hospital shelves as opposed to being given to vulnerable Texans," he said.
That same day, Hellerstedt directed providers to “immediately vaccinate” all eligible Texans, including those in the 1B group. State data showed at the time that just 136,700 people had been vaccinated with at least one dose of the vaccine, a fraction of doses reportedly available. Earlier, state health officials said 1.4 million doses were allocated to providers across the state before the end of the year, but by then their allocation estimate had decreased to 1.2 million.
The state data suggested that there was an ample supply of vaccine — enough to expand eligibility to the 1B group weeks ahead of time. But in reality — as thousands of Texans would soon discover — doses of the vaccine remained in short supply.
Carrie Williams, a spokesperson for the Texas Hospital Association, challenged Abbott’s claim that there was an excess inventory of vaccines, saying the industry is moving as fast as possible.
“We are certainly not sitting on vaccine,” Williams said. “Vaccine is not sitting on hospital shelves.”
Vague messaging from state health officials left Texans who were desperate to get vaccinated without clear answers of where and how they schedule a vaccination. Many frantically called pharmacies, where they get their flu shots, for help.
Marie Theresa Hernandez, who is over 65 and a professor of world cultures and literatures at the University of Houston, said a new surge in COVID-19 cases has put her and her family on edge. In recent days, the vaccine confusion added another layer of stress: false hope.
Earlier this week, her adult children in Austin and London were led to believe over social media that vaccinations were easily available in her home of Fort Bend County. But after two days of calling around, Hernandez could not find anyone who could give her one.
"We're all kind of in limbo,” she said.
But mostly, she misses her grandchildren in London.
"We didn't get to see them this year because of COVID," she said. "We were hoping then maybe with the vaccine we could go a little sooner than later and now, it's like, we have no idea."
Pharmacies like CVS and H-E-B say they are still focusing on vaccinating medical workers or people in long-term care facilities. They don’t have enough doses to vaccinate the general population, they said.
Dya Campos, H-E-B’s director of government affairs, said Thursday the grocery chain’s pharmacies have the capacity to administer around 100,000 doses of vaccine each week. Just a week after receiving its first shipment of 28,000 doses of vaccine, the company has administered or scheduled every single dose. Now it’s left waiting for the state to tell it both how much vaccine it will receive in its next shipment and when that shipment will arrive.
Right now, across its hundreds of Texas stores, it has none. Customers who call the H-E-B pharmacies receive pre-recorded answers saying they are not yet distributing vaccines to the general public.
“We are prepared to vaccinate more Texans, and we are just waiting to see how much allocation we're going to get on a weekly basis,” Campos said.
This uncertainty makes it nearly impossible to schedule people in the next phase. Once H-E-B does get more doses, Campos said eligible customers will be able to schedule a time to get their vaccine on the website or by calling. Eventually, if the pharmacy has enough doses, it hopes to accept walk-ins.
CVS, which plans to spend the next three months focusing on vaccinating 275,000 residents and staff at 2,000 long-term care facilities in Texas, is also not yet opening up vaccine appointments to the general public.
When that does happen — John Fratamico, a CVS district leader in Texas, said this could occur in March — customers will sign up for what Fratamico called a “round-trip ticket.” Using the pharmacy’s website or app, or a 1-800 number, eligible Texans will schedule both the first and second doses of the vaccine on a first-come-first-serve basis.
“In all our lifetime, think about it, nothing like this has ever come up,” Fratamico said.
Because CVS is focusing on long-term care facilities for the next few months, Fratamico said they will wait to figure out those plans with the state for the general public until closer to then.
In the meantime, CVS and H-E-B, as well as many other pharmacies, are inundated with questions from Texans wondering how and when they can get vaccinated.
Debbie Garza, the chief executive of Texas Pharmacy Association, cautioned that as hard as pharmacists are working to get this vaccine out, fielding calls could delay the process.
“This takes a lot of pharmacy staff time to explain over the phone,” Garza said.
CVS is encouraging its customers to download its app, which will send a push notification once they are eligible to schedule appointments.
Hospitals, many of which are waiting on shipments of the vaccine, are also being overwhelmed by calls from the general public seeking the vaccine. Williams, the spokesperson with the Texas Hospital Association, said this “creates further operational challenges” for hospitals flooded with COVID-19 patients.
On Thursday, the final day of an unprecedented year, more than 12,200 Texans were hospitalized with COVID-19, breaking a record for the fourth straight day. Texas' seven-day average rate for tests that come back as confirmed COVID-19 cases has also remained above what Abbott once called a “warning flag” level for more than a week while the state reported a near-record low 660 staffed ICU beds still available. Texas also reported 349 new deaths.
“Hospitals are in full force, vaccinating everyone they can while managing record-level hospitalizations,” Williams said. “And there are still hospitals that have not received any vaccine for their frontlines.”
Many rural and psychiatric hospitals, Williams noted, still have not received any vaccine for their front-line workers.
Data errors and delayed deliveries
The state has reported more than 282,000 people have received at least one dose as of Thursday. But local health officials say that number is surely an undercount.
DSHS did not respond to multiple requests for comment.
Abbott’s office did not answer a list of emailed questions, including whether he is receiving briefings on the vaccine rollout or who is leading the state’s efforts. Instead, spokesperson Renae Eze said in a statement that Abbott has directed DSHS and the Texas Department of Emergency Management to deploy medical teams to aid in vaccination efforts across the state.
“With new shipments arriving each week provided at no cost, the State of Texas urges providers to swiftly vaccinate as many people as possible from the at-risk groups rather than these live-saving vaccines and medications sitting on shelves,” Eze said, repeating a claim that many vaccine providers say isn’t true.
Part of the issue lies with the tracking system ImmTrac2, said Howard, the state representative. Her office spoke with DSHS staff on Wednesday and she participated in a regularly scheduled briefing between the agency and lawmakers.
She said health officials are trying to fix data entry errors in the system, which likely resulted in a major overestimation of available doses.
“More vaccine had been administered than was being revealed by the registry system,” Howard told The Texas Tribune. “I think [the decision to allow the 1B group to get vaccinated] was done before we had all the information we probably should’ve had, because there wasn’t the capacity to meet that new edict.”
Williams, of the Texas Hospital Association, said members of her association reported similar problems.
“With regard to state data on administered doses, we have no certainty it is accurate at this point in time,” she said. “The number of doses administered is higher than what’s indicated.”
Technical errors are just one facet of Texas’ vaccine struggles. Shipments from the federal government, which distributes doses of the vaccine to providers, have arrived damaged or late, Howard said. In some cases, expected distributions never arrived.
States across the nation have reported similar delays. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told NBC’s “TODAY” show that nationwide the rollout has been “disappointing.”
Some Texas providers are just now receiving doses of the vaccine that were scheduled to be delivered last week, Howard said. Next week’s allotment is expected to be much smaller than previous weeks, she said.
Other batches had to be returned or discarded because the vaccine, which must be stored at below freezing temperatures, arrived spoiled.
Meanwhile, hospitalizations continue to surge, Abbott has ruled out the idea of future lockdowns and the state has a long way to go before the vaccine could slow the spread of the virus. To finally get past the pandemic, public health experts have said the country needs to achieve herd immunity, when enough of the population has immunity from the virus that the spread slows. Some believe that herd immunity is only achieved when 80% of people — 24 million people in Texas — have the antibodies.
Peter Hotez, a vaccine expert and dean at the National School of Tropical Medicine at Baylor College of Medicine, tweeted Thursday that with 30 million people, Texas has its work cut out for vaccinating 80% of the state by the middle of the year — especially with the troubled roll out.
“We need to vaccinate almost one million Texans per week,” Hotez wrote. “Lots of work ahead.”
Disclosure: H-E-B, Texas Hospital Association, Texas Pharmacy Association and University of Houston have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.