As they refine a complicated distribution strategy, health care workers in Western Pennsylvania have been forced to give covid vaccine doses to people who are not in top priority groups to avoid wasting precious leftover shots.

After long days of vaccinating front-line health care workers, nurses have described calling friends and family members, frantically trying to find someone willing to receive the shot at the last minute.

Public health experts and state officials say such a recourse is not ideal, but it’s the best hospitals can do to contend with one of the Pfizer vaccine’s key requirements: once taken out of cold storage, vaccine vials spoil if not used within six hours. They can’t be refrozen.

“Not letting doses go to waste is the top priority,” said Dr. Graham Snyder, UPMC’s medical director of infection prevention and hospital epidemiology. “We have had some times when there’s been a bit of a scramble to make sure the vaccine gets to somebody, but as each day passes, we’ve worked to do that process in a clear and more organized fashion.”

UPMC and Allegheny Health Network acknowledge it is possible vaccine has gone to workers outside the recommended priority groups — for now, front-line health care workers and those in long-term care facilities. But both health systems said they are developing a way to streamline the process. They said they have started creating call lists of people on standby — including priority workers not affiliated with the hospitals — to receive leftover doses as they become available.

The delicate balance for hospitals giving the shots — and the scramble at the end of long clinic days — is understandable and often unavoidable, experts say.

Expert: A typical, correct practice

No one should be faulted for going outside the federal guidelines in many of these cases, said Dr. Amesh Adalja, a Pittsburgh-based infectious disease expert.

“It’s a typical practice, and it’s the correct practice,” Adalja said. “We have to not be dogmatic about priority groups when the alternative is that the vaccine will be wasted.”

The vaccines currently approved for emergency use authorization by the U.S. Food and Drug Administration, made by Pfizer-BioNTech and Moderna, each require incredibly specific storage conditions and procedures for use. Moderna’s vaccine, for instance, requires vials to be thawed for two and a half hours in a refrigerator. Then, they must sit at room temperature for 15 minutes and be swirled before each withdrawal.

Pennsylvania Health Secretary Rachel Levine has encouraged vaccinators to use up their vaccine doses, no matter who is available.

“We do want to make sure we get vaccines into arms,” Levine said last week at a virtual news conference. “If a hospital or other vaccine site doesn’t have someone from (priority group) 1A, but they have someone from, for example, 1B, and the vaccine would go to waste, please give the vaccine.”

Staying in step with the federal guidelines is a challenge for multiple reasons, one being that the categories are broad and apparently open to interpretation.

UPMC, for example, has vaccinated some IT and corporate employees who work remotely. Snyder insisted the system was not deviating from the top priority groups.

“It’s true, and it’s happening,” Snyder said. “The way we have viewed it is … it takes more than just people who have contact with patients to maintain our ability to care for patients. And the spirit of the 1A approach is ‘Let’s maintain the ability of our health care systems throughout the United States to maintain the ability to take care of patients.’”

Snyder said UPMC, which has more than 90,000 employees, has not given vaccine to “anybody who’s not supporting our ability to care for patients.” He said vaccinating nonclinical staff has not taken away from doses meant to go to hospital employees or nonaffiliated health workers. He also said some hospitals may have gotten further down their list of prioritized workers more quickly than others and, therefore, had doses to spare for administrators.

Ethically dubious?

But even health care workers who have received their vaccines find the situation ethically dubious.

Jodi Faltin, 32, a nurse at UPMC Shadyside hospital, said she knew of multiple system executives who have been vaccinated, while respiratory therapists, housekeepers and others who are in and out of covid rooms each day are still waiting on their first dose.

“It seems a little unfair,” said Faltin, who received her booster shot Monday. “It does bother me.”

Hospitals and other vaccine providers had to shift their distribution strategy quickly when state officials mandated that at least 10% of hospitals’ vaccine be allocated to nonaffiliated health workers. It’s the responsibility of the hospitals, Levine said, to reach out to outside organizations and schedule vaccinations. Both of the region’s largest health systems said they are allocating more than 10% to those workers.

Dr. Amy Crawford-Faucher, chair of family medicine at Allegheny Health Network, noted that vaccinating nonaffiliated health workers presents an additional challenge for hospitals seeking to stick to the federal guidelines: It’s harder to verify that unaffiliated people belong in the state’s 1A phase without slowing down the entire system.

Crawford-Faucher said no corporate employees or remote workers at Highmark have been vaccinated yet, and they won’t for some time. Some nonclinical staff members are being vaccinated, she said, because Allegheny Health Network had the capacity and they are still “health care-related workers.”

The network has prioritized immunizing staff who work directly with covid patients, she said.

It’s not a perfect system, Crawford said. In fact, it’s pretty frustrating. Crawford said she has had regular phone calls with her father-in-law in Philadelphia, who asks her why some nonclinical staff can be immunized while people in at-risk groups or over the age of 65 are still awaiting their first dose.

She said the network is ready to start immunizing those groups at any point, but it hasn’t been authorized to do so by the state.

“I tell him, I get it,” she said. “It’s tough, and it’s not perfect.”

Pennsylvania has allocated 367,814 doses of the vaccine, according to the Department of Health’s dashboard. That includes 38,214 doses in Allegheny County and 9,584 doses in Westmoreland County. There is little specific data available on state and federal levels to track where doses are being allocated.

Neither hospital system could provide specifics about how much vaccine they have on hand, saying only that they have the capacity to keep vaccinating those who are eligible and are ready to take on the next phase when authorized.

Excela Health

Excela Health received its first shipment of Pfizer’s covid-19 vaccine Dec. 17. It received 975 doses for each of its three hospitals — Westmoreland in Greensburg, Frick in Mt. Pleasant and Latrobe.

By the time the second shipment arrived last week, about 450 doses remained from the first delivery because of extra doses contained in the vials as overfill, Excela spokeswoman Robin Jennings said.

Extra doses have been added to those available to Excela staff and other community health care workers under the 1A designation, she said.

Discussions of the best way to vaccinate the population come while Pennsylvania as a whole lags behind other states in distributing immunizations. Several states, including neighboring West Virginia and New Jersey, have announced vaccine availability for senior citizens, and some have started vaccinating teachers and other groups in the second priority phase, called 1B.

Meanwhile, state and local health officials continually pass the blame to the federal government. They have received limited information about how much vaccine they will be allocated each week and when it will be arriving.

As a result, providers say, it is difficult to notify front-line workers and schedule appointments efficiently. Snyder said each UPMC hospital doesn’t know how much vaccine it is getting in any given week “until it (is) on the truck coming to us.”

Crawford-Faucher said AHN is juggling the tasks of scheduling thousands of nonaffiliated health workers and preparing for the next phases — including people over 75, first responders and grocery store workers — without knowing how much vaccine will be available in the coming weeks. She said the whole system is “fuzzy.”

The U.S., as a whole, is running far behind — the goal had been to inoculate 20 million people by the end of December — and The Washington Post on Friday reported the federal government stopped contributing to its stockpile, likely disrupting states’ allocations and their ability to expand access to vaccines to the general population.

“It is extremely troubling and disappointing to learn that Pennsylvanians who want and need the covid-19 vaccines will have to wait even longer because Operation Warp Speed does not have the vaccine reserves that just this week HHS promised to release to us,” said Barry Ciccocioppo, a Pennsylvania Department of Health spokesman. “For Pennsylvania, that means the approximately 1 million doses that should have been in the reserve are gone, and we are left with our limited weekly vaccine allocation.”

Staff writer Renatta Signorini contributed to this report.

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