Vaccination Problems Worst in States Hardest Hit by COVID

Brenda Goodman and Andy Miller

January 14, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

It felt like Christmas when "Santa Rick" Rosenthal, who runs Northern Lights Santa Academy in Atlanta, snagged a rare slot to receive one of the first COVID-19 vaccines doled out to seniors in Georgia.

“Santa Rick” Rosenthal and dozens of other seniors waited for hours in the cold for DeKalb County health offiicials to perform vaccinations.

He didn't even mind that his appointment was at 5:20 in the morning.

The 68-year-old finished treatment for stage 4 cancer that had settled in his legs last September. His 91-year-old father-in-law died of COVID just a week ago.

A vaccine against a virus that's proving to be more deadly for seniors, men, and those with significant preexisting conditions could most surely save his life and his livelihood.

"I'm thrilled to have the opportunity to get this. I am in a high-risk category, and even though Christmas is over, when you're Santa, people come up to you. Santa could be a super spreader. We have to be very careful," he says.

Then it seemed the Grinch might have kept Santa Rick from his shot.

When he pulled into the parking lot at a big box store outside Atlanta, however, he joined a line of cars idling their engines to keep heaters running against the pre-dawn chill.

Dozens of seniors sat in their cars for hours in the early morning outside Atlanta for a promised vaccination.

Everyone waiting had confirmed appointments with the DeKalb County Board of Health. But the white tents they were supposed to drive through for quick service were empty.

In the early hours of the morning, there was no way to get any information. They called 911. They called the CDC. They called the city's non-emergency information line.

No one was sure what to do. So they waited.

I'm furious," says Gerry Tosone, 66, "I haven't been anywhere or done anything in months." Her appointment was scheduled for 3:52 A. M.

The U.S. government's race to beat back the pandemic with vaccines — dubbed Operation Warp Speed -- has faltered in its last phase: Getting badly needed doses to the public.

In Florida, seniors camped out overnight in long lines for first-come, first-serve doses. The demand caused many health departments to rethink that strategy and switch to appointment-only bookings instead. Across the country, seniors eager to secure a shot have crashed phone lines and websites.

In some places, systems were so overloaded that some health departments began offering appointments to get an appointment, starting a wait list so people could be contacted when new appointments opened up.

In Dekalb County, Joel Denbo, 67, of Brookhaven, said he just assumed the county was vaccinating people through the night the way they conducted mass vaccination for polio in the 1950s.

Craig and Kathy Chastney, of Decatur, GA, had each jumped on their home computers and kept refreshing the link for 2-and-a- half hours before they secured their slots on Friday.

"I have been up all night I was so excited," Kathy says. The Chastneys haven't seen their grandchildren in Texas for a year. The vaccines would give them their family back.

When they realized their 6:15 a.m. appointments were worthless, they tried to rebook only to discover they couldn't get an appointment until spring.

The pain of the rocky rollout isn't evenly spread. Instead, new data show the problems are concentrated in states that can least afford to have them.

"It's worrisome right now that we're seeing that the bottom states for this are all southern states," says Amber Schmidtke, PhD, an epidemiologist and former assistant professor of microbiology at Mercer University School of Medicine in Macon, GA, who has been analyzing COVID data trends.

New data show the bottom five states for vaccine administration are all in the South, a region that's home to the nation's poorest and sickest patients, according to the CDC.

In these states, patients are more likely to fall ill with COVID, they're also more likely to die of it, according to a new report from the non-profit data lab, Surgo Ventures, which has ranked counties based on a vulnerability index. The vulnerability index takes into account more than 40 different variables, including things like age, income, education, race, population density, and health care to give areas a score between 0 and 1.

Georgia, which is highly vulnerable to COVID with an overall score of 0.92, has passed out just 22% of its vaccine doses. Alabama, which has a vulnerability score of 0.96, has given just 23% of its vaccine. North Carolina, with a score of 0.94 has given just 28% of its vaccine. Mississippi, which scores 0.88, has doled out 30%.

Those states contrast with North Dakota, which has a low score of 0.1 in its vulnerability to COVID and has used more than 80% of its doses, and West Virginia, with a score of 0.18 has doled out 67% of the doses it has received,.

"Vulnerable communities have had extremely hard time of it this past year and not necessarily always gotten the support and the resources that they deserve and need, and then to see that exacerbated with the vaccine rollout is incredibly alarming," says Christine Campigotto, who manages the COVID program for Surgo.

Some experts worry that those disparities could worsen if the federal government carries through on a plan, announced yesterday, to allot new doses based on how quickly states are passing shots out now.

In 2 weeks, states will get new doses based on the "pace of administration" and the share of their populations over age 65, Alex Azar, secretary of the U.S. Department of Health and Human Services, said at a press briefing.

Azar said that would give states strong incentive to correct any faulty reporting and keep doses from being stored away in freezers by hospitals.

But experts said the new formula could doom states that have done little else to control the rampant spread of the virus.

"Given that there aren't any government interventions planned to limit disease transmission in this current surge — no ban on mass gatherings, no mask mandates — really the only thing we have to bring disease transmission down is the vaccine," says Amber Schmidtke, PhD, an epidemiologist and former assistant professor of microbiology at Mercer, who has been analyzing data on the pandemic in the U.S..

Georgia is number six in the nation in terms of receiving doses, but as of Tuesday, was 47th among states for administration. If doses are adjusted down, "That might mean Georgia will be among the last states to vaccinate its population," Schmidtke says.

On Tuesday, Georgia Gov. Brian Kemp blamed data entry problems and hospitals holding doses for the lag.

"We expect [providers] to be administering those doses quickly and as safely as possible,'' he said in a press briefing. If that does not happen, Kemp said, the state will take possession of those vials. "If it takes me firing up my pickup truck and doing it myself, so be it."

Eric Nickens a spokesperson for the DeKalb Board of Health, blamed a computer glitch for the problems at the vaccine site where Santa Rick and others were left waiting in the cold. He says scores of eager seniors had jumped on a sign-up link that accidentally went live on the site before they had set the booking system with the correct hours. He estimated everyone who booked one of the early slots would have their appointment honored.

"We deeply apologize for the inconvenience this may have caused. We're pleading with the public for patience. There is only so much vaccine," Nickens says.

Around 9 a.m. after waiting for 4 hours in the cold – "I'm from the North Pole, I'm used to it," he said ―Santa Rick finally got his shot. He made a video to send to his fellow Santas.

He told the nurse who gave him the shot he would put her on the Nice List.


Santa Rick Rosenthal, Owner, Northern Lights Santa School, Atlanta, GA.

Joel Denbo, 67, of Brookhaven, Ga

Gerry Tosone, 66, Atlanta, Ga.

Craig and Kathy Chastney, of Decatur, Ga

Alex Azar, Secretary, U.S. Department of Health and Human Services, Washington, DC

Amber Schmidtke, PhD, former assistant professor of microbiology at Mercer University School of Medicine, Kansas

Christine Campigotto, program manager, Surgo Ventures, Washington, DC

Brian Kemp, Governor, Atlanta, Ga.

Eric Nickens, spokeman, DeKalb County Board of Health