‘Don’t hold back any doses’: How a conference call with the Pa. Health Department led to vaccine delays

Medical providers were following instructions from the state when they gave Moderna COVID-19 vaccines earmarked for people awaiting their second doses to people in line for their first doses, according to the group representing Pennsylvania health systems.

“Hospitals complied with the Department of Health’s orders to not hold back any vaccine doses, and to get shots into as many arms as possible,” Hospital and Health System Association of Pennsylvania spokeswoman Rachel Moore said in an email.

“In addition, the department committed to the provider community that second doses would be available when requested. Now, there is new pressure on the supply of second doses.”

Both the Moderna and Pfizer vaccinations require two doses to be effective. People who got the Pfizer vaccine are not affected by this issue.

Penn State Health was on a conference call about two weeks ago, during which, according to spokesman Scott Gilbert, the health department “specifically directed providers to not hold back COVID-19 vaccine doses for second vaccinations.”

The department told providers additional vaccines “would be made available for use as second doses,” Gilbert said. “Penn State Health followed this directive, as it has all [health department] guidance since vaccines initially became available in Pennsylvania in December.”

Department of Health spokesman Barry Ciccocioppo confirmed that Executive Deputy Secretary Keara Klinepeter participated in a call with providers hosted by the Hospital and Health System Association about two weeks ago.

He said it has been a “common refrain” from department officials to tell providers not to hold back first doses.

“She believes that she shared the standard refrain,” Ciccocioppo said.

He said he did not know exactly what Klinepeter or others told providers.

“I do not have a recording of that call to know if the statement you have in quotes is an accurate accounting of what was said or who said it,” he said. “In the interest of transparency, I am offering you the best recollection of what may have happened.”

The health department had emphasized not to hold back vaccines because it was concerned some providers were setting aside first doses, Ciccocioppo said earlier.

“I understand that providers were hearing, you know, don’t hold back any doses, don’t hold back any doses, and some providers may have taken that literally…using the shipment that came for first doses and the shipment that came for second doses.”

The department is still working to determine the extent of the problem. There are dozens of providers in the commonwealth. In checks with several of them, Rite-Aid and Geisinger said they are not affected because they hadn’t used any second-dose vaccines as first doses. University of Pittsburgh Medical Center, WellSpan Health, and Lancaster General Hospital did not respond to requests for comment.

The health department had not issued written instructions to providers on how to use the vaccines, but it will do so now, Ciccocioppo said.

Additionally, the department plans to hold daily calls with vaccine providers, instead of one per week.

“We are course-correcting and implementing abundant controls to protect against this moving forward,” Ciccocioppo said. “The providers must be our partners in implementing this solution, or step away from administering vaccine.”

As many as 100,000 people will face delays in getting their first or second shots as a result of the miscommunication, the department estimated. The state plans to reroute some first-dose vaccines to people who need their second shots over the next three weeks.

It’s okay to wait up to six weeks after the first shot to get the second one, according to the Centers for Disease Control and Prevention. The state assures people whose second doses have been delayed that they will get them within that window. Providers will contact people if they need to reschedule appointments.

Snowstorms and weather-related power outages in parts of the southern U.S. are adding to delays.

“Earlier this week, hubs from which vaccine is distributed were significantly affected by winter weather,” the department said Friday. “Moderna vaccine was not shipped from the distributor on Monday, Tuesday, or Wednesday of this week. The CDC is working with shipping partners to resume shipments as quickly as possible.”

Pfizer vaccines also were not sent out Monday, while “a limited amount” was shipped Tuesday and Wednesday.

“There will be a significant backlog of orders for distribution as the federal government and the distributors work to begin shipping again,” the department said. “The federal government is working to catch up as efficiently as possible.”