Biden admin remakes vaccine strategy after mass vaccination sites fizzle

The Biden administration is rethinking a costly system of government-run mass vaccination sites after data revealed the program is lagging well behind a much cheaper federal effort to distribute doses via retail pharmacies.

The government has shipped millions of doses to the 21 mass vaccination hubs, or “pilot” community centers, in states such as California, Florida, New York, Illinois, Massachusetts and Texas. The hubs are part of a $4 billion federal system that funds more than 1,000 smaller vaccination locations across the country and provides other vaccination support — such as supplies — to states across the country. The Federal Emergency Management Agency did not respond to repeated questions about how much the pilot sites cost.

Despite the money the federal government has spent on the mass-vaccination pilot sites, they are administering just a fraction of the shots given across the country each day. Federal data show the retail pharmacy program — which has signed up 21 chains and 17,000 stores — can reach far more Americans in a shorter time, according to four senior officials with direct knowledge of the matter. The bottom line, those sources said, is that more Americans seem to be willing to walk to their local pharmacist to get the vaccine than to travel to a federal vaccination site for the shot.

That represents a shift in strategy for the Biden administration, which touted the hubs as a powerful tool to rapidly accelerate the nation’s vaccine rollout and a symbol of the president’s push to give the federal government a larger role in the pandemic response. But FEMA data obtained by POLITICO make clear that the pharmacy sites are far outpacing the stadiums, arenas and convention centers enlisted as mass vaccination sites.

The vaccination hubs, which are run by FEMA and staffed in part by National Guard troops and other Pentagon personnel, have administered just 1.7 million doses since the beginning of February. Over the last two weeks, the sites gave about 67,000 shots a day, according to a series of internal FEMA briefing documents and data sets obtained by POLITICO. That’s roughly 2.5 percent of all doses administered nationwide during the same period, according to data published by the Centers for Disease Control and Prevention.

By comparison, the federal retail pharmacy program reported March 11 it had administered nearly 1 million doses over a single day. Over the course of the next four days, the program’s pharmacies administered more than 5 million more doses, according to the federal vaccination data obtained by POLITICO.

“It’s clear that Americans feel comfortable relying on their local pharmacies for the vaccine,” said one senior Biden health official. “The retail pharmacy program will keep growing and I think you will begin to see more people going down the block to CVS to get the shot than driving maybe an hour to the federal sites to get it.”

Another senior administration official pushed back on the assertion that the FEMA pilot sites were too expensive and not as efficient as the retail pharmacy program, saying the two serve different functions. The official said the American economy is losing several billions of dollars a day as a result of the pandemic and that the mass vaccination sites essentially pay for themselves.

FEMA did not respond to repeated requests for comment.

The federal government’s decision to increase the number of doses it sends to pharmacies comes as the administration races to ensure that every American adult has access to a Covid-19 shot by May 1. Administration officials are also mindful of Biden’s goal of getting the country closer to normal by July 4.

While the mass vaccinations sites often run smoothly and with minimal wait times, federal officials have made the calculation that leaning on the retail pharmacies over the next several months is more tactical and significantly cheaper.

In a call with the nation’s governors March 16, Jeff Zients, the White House Covid-19 response coordinator, said the retail pharmacy program was quick, efficient and the dominant non-state channel for vaccine distribution, according to two individuals with knowledge of what was said on the call.

Administration officials said they are not at the point where they are planning to shut down any of the federal pilot vaccination sites; four more sites started operations this week. One senior administration official said the additional sites will add to a “complex puzzle of ensuring the maximum number of Americans are able to get their shots on any given day.”

But senior officials inside the White House and FEMA have raised serious questions about how long it makes sense — fiscally and strategically — to keep them open. That conversation has intensified in recent days as some governors, including Republican Ron Desantis of Florida, have previously and publicly pushed back against the sites opening.

Discussions about enlisting FEMA to help build up the sites started during the transition, according to two people with knowledge of those conversations. The major concern at the time, those sources said, was that the U.S. did not have an easy way to quickly increase vaccination capacity that could supplement what states were already doing.

Knowing that vaccine supply was poised to increase sharply over the following months, the Biden team was under pressure to set up the mass vaccination sites within a few weeks. And it did. As each week passed the federal government sealed deals with states to use large buildings and sports centers.

But as the retail pharmacy program rolled out, it became increasingly clear that the pharmacies had more reach.

“Everyone said, 'Is it efficient? Is it cost effective?’ But I don’t think that was the primary consideration," said Craig Fugate, former FEMA administrator in the Obama administration. "Speed was the number one priority. Do you want to do it fast or do you want to do it cheap? Some of this is just brute force.”

The Biden team’s original strategy for the pilot sites was not only to increase the number of doses going out daily across the country but also to distribute the vaccine more equitably by reaching underserved populations. Officials say the pilot vaccination sites are fulfilling that goal. As of mid-March, 65 percent of people vaccinated at the sites are “racial and ethnic minorities,” according to an internal FEMA memo obtained by POLITICO.

The federal government disperses the Covid-19 vaccine through multiple channels and relies on states to do the bulk of vaccinations. Each state health agency coordinates with county health agencies to distribute their allotment of vaccines through state-run sites or other local community centers and health care programs. How each state allocates its doses depends largely on population and funding for public health programs.

Last week, for example, more than 16 million doses were allocated to states and about 5.8 million to the federal retail pharmacy program, according to an internal FEMA memo.

The federally run programs also require significant state involvement and coordination. A vaccination site in New Jersey, for example, might be run out of a local church or hospital and overseen by local officials, but it could be receiving federal funding in the way of cash, personal protective equipment or staffing. Any site in the country that receives federal assistance in some way is designated a federal site, according to two senior administration officials.

Nearly 7,000 federal employees, including 2,000 FEMA staff and 2,000 Pentagon personnel, are now helping run vaccination sites, according to another internal FEMA memo obtained by POLITICO and dated March 23. The National Guard has deployed about 30,000 National Guard personnel, including almost 2,000 vaccinators. It is unclear how many federal personnel are helping staff the federal pilot vaccination centers specifically.

About 720,000 doses went last week to the 950 federally funded health centers across the U.S. — community-based health care facilities that traditionally target underserved populations. Only 415,000 went to the 1,000 FEMA run community vaccination sites.

Not every pilot site runs the same way. The federal government classifies its mass vaccination sites as Type 1, 2, or 3. Type 1 sites are usually located in large buildings such as stadiums or convention centers and can vaccinate 6,000 people a day. Type 2 sites, such as hospitals, can vaccinate 3,000 people a day. And Type 3 centers can vaccinate 1,000 people a day.

A second group of mass vaccination sites are run largely by state and local health care partners outside of the umbrella of FEMA’s pilot vaccination centers.

These other sites often receive federal funding in the form of supplies and staffing but they are largely overseen by states. For example, New Jersey National Guard personnel are outside and inside one such site at the convention center in Atlantic City to direct the flow of people. Inside, federal vaccinators, some wearing FEMA insignia, are lined up at tables, administering the shots. Nurses and doctors from a nearby health care facility are also present to help with vaccination.

On a normal day, the Atlantic City site doles out about 4,000 doses a day, officials there said. That’s more than the number of doses being administered at some of the pilot sites.

While the federally run mass vaccination sites are hitting their overall mark most days, there is variation between locations. According to interviews with eight people who were vaccinated at one of the mass vaccination hubs over the last several weeks, the sites in New York and New Jersey have run relatively smoothly, with minimal wait times. Others, including those in California, Florida and Pennsylvania have experienced some level of overcrowding. Some people in those areas said they are having difficulty finding vaccination appointments at the sites.

And not every site is hitting its vaccination cap every day, according to the internal FEMA data obtained by POLITICO. A site in Erie, N.Y., hit about 80 percent of its cap over the course of three days last week. Another center in Duval, Fla., reported hitting only 52 percent, though the vaccination rate at the site has increased since after receiving additional first doses of the Pfizer vaccine.

Other sites are surpassing their daily target. One mass vaccination site in Miami administered 173 percent of its target over the course of three days last week. Similarly, a site in Dallas administered 170 percent of its target in the same time period.

Senior Biden officials working on the federal government’s rollout of the mass vaccination sites say the data is constantly being updated as not every site is reporting its numbers each day.

Despite the lag in reporting, though, overall the mass vaccination pilot sites are still not administering anywhere near the number of doses of the federal retail pharmacy program. And while FEMA is in the throes of opening more mass hubs — including one in Yakima, Wash., and one in Atlanta — an increasing number of pharmacies are also beginning to distribute the vaccine. More than 17,000 pharmacy locations had begun distributing the Covid-19 vaccine as of March 17, according to an internal FEMA briefing obtained by POLITICO.

Several governors have expressed to the White House that they are unhappy with the federal sites vaccination numbers being included in their state-wide totals, arguing that they bring their averages down. The complaints have surfaced over the last three weeks as governors continue to press the CDC to change the way it reflects the vaccination rate on its public facing dashboard. Two senior administration officials with knowledge of those conversations say the CDC is working on a new dashboard that will separate out the federal vaccination programs from the state programs.

When that happens, Zients said on a recent call with governors, some state vaccination rates will plummet because the retail pharmacy program will also be separated out from their totals.

Meanwhile, as vaccinations continue to ramp up across the country, some senior administration officials are beginning to question whether the money its spending to stand up the mass vaccination sites, as well as some of the smaller community vaccination centers, is worth it.

“We see enormous potential with the retail pharmacy program,” one senior Biden health official said. “More and more pharmacies sign up to distribute each day.”

Others argue FEMA’s pilot sites are filling a major gap in the vaccine rollout because they are situated in areas populated by traditionally underserved populations. And if they were to shut down, the federal government would lose a crucial platform for fulfilling its promise to ensure the Covid-19 is distributed equitably.

Given that, cost shouldn’t necessarily prohibit more FEMA pilot sites from opening, Fugate said – because the country is still in the middle of a deadly pandemic.

“When all the dust settles the critics come out and ask, ‘Why do you spend so much money to do something?'" Fugate said. “In a disaster….the priority is speed.”

Rachel Roubein contributed to this report.