Pfizer-BioNTech COVID-19 vaccine is held in a refrigerator at Soldotna Professional Pharmacy as shots are given on January 8, 2021. (Marc Lester / ADN)

It’s been just over three weeks since Alaska’s first batches of COVID-19 vaccine arrived in a UPS plane that landed at Ted Stevens Anchorage International Airport one Sunday night in mid-December.

The state received nearly 87,000 doses of Pfizer and Moderna vaccine for the months of December and January, plus additional doses for tribal members, military members and veterans.

But as of Saturday, only a little over 25,000 people eligible for the state shots had actually gotten vaccinated.

Limiting factors include resistance among some health care workers, struggles to recruit more providers and issues getting vaccine into long-term care centers.

There’s also been an ongoing and highly publicized bottleneck for seniors so interested in getting vaccinated that they overwhelmed an apparently unprepared state distribution system without enough vaccine for everyone 65 and over to get a shot right away.

More than 220 Alaskans have died with COVID-19. State data shows nearly 85% of them were 60 or older.

It’s unlikely large numbers of Alaskans will get vaccinated without a combination of more small providers, like pharmacies or doctor’s offices, and mass clinics like an Anchorage School District event a few days ago and another this weekend at the Alaska Airlines Center in Anchorage, with more scheduled in the days and weeks ahead.

Alaska’s experience is by no means isolated, though it is complicated by the state’s isolation. Rural providers are moving precious vials by boat, plane and even snowmachine or dog sled, according to Alaska Public Media.

Around the country, states rolling out a much-awaited vaccine program with little federal oversight and no centralized distribution system are running into long lines, reluctant recipients and other problems.

Fairweather, LLC Advanced Nurse Practitioner Jyll Green sanitizes David Stevenson's arm before giving him his first dose of the Pfizer-BioNtech COVID-19 vaccine at the Alaska Airlines Center in Anchorage on Saturday, Jan. 9, 2021. (Emily Mesner / ADN)

In the first phase of vaccination, almost every state followed federal guidelines: health workers and long-term care facilities. But then the next levels of prioritization started to vary widely between states. Alaska, like a number of others, moved up seniors before essential workers.

“Not having a uniform national strategy is difficult, confusing,” said Laurel Wood, a past manager for Alaska’s vaccine program who’s now a public health coordinator at the Immunization Action Coalition, a national nonprofit. “But at the same time, I’m not sure that it would work the best to say that everyone in every location in the United States must do this exactly the same way.”

As of Friday, Alaska ranked fifth in the country for COVID-19 vaccinations per capita.

Three weeks, hundreds of shots

Soldotna Professional Pharmacy, a Kenai Peninsula fixture for 38 years, began administering shots on Dec. 17, a day after a Toyota Sienna minivan dropped off 975 vaccine doses at Central Peninsula Hospital.

Pharmacist Justin Ruffridge gives a shot to Riverside Assisted Living resident Judy DeVito on January 8, 2021. (Marc Lester / ADN)

Since then, the pharmacy has given hundreds of shots to people in nursing homes and assisted living centers as well as places like the Hope Community Resources center.

Then, as 2021 began, people over 65 got notified they would be next in line for the vaccine, weeks ahead of schedule. Last Wednesday, they were able to make appointments. Slots filled immediately.

“The general senior public broke our phone system,” said Justin Ruffridge, the pharmacist and an owner of the store, which has since added several clinics. “We have a total of 25 available lines into the pharmacy. They were all filled up for about 4 1/2 hours.”

Ruffridge said the rollout for seniors was simultaneously frustrating and encouraging: A group that wants shots, that without them faces higher mortality rates and more isolation than any other, is getting them before anyone thought they would.

“Frankly, in my mind and I think a lot of people’s minds, we weren’t going to be where we’re at today until the end of January,” he said. “Things came at everybody really fast.”

Pharmacist Justin Ruffridge fills a syringe with COVID-19 vaccine before giving and injection at Soldotna Professional Pharmacy on January 8, 2021. (Marc Lester / ADN)

What’s behind the holdup?

Because there’s still not enough vaccine doses for all the Alaskans who want them, the state convened an allocation advisory committee composed of various health care experts including ethicists, pharmacists and doctors statewide.

The committee’s job is to put together recommendations by adapting federal vaccine allocation guidelines. Then, the state’s health department and vaccine task force review the recommendations before issuing the official guidelines, according to a process outlined on the department’s website.

Hospital-based health care workers and staff and residents in long-term care centers became the first Alaskans to get the first dose of vaccine. Some are already getting second doses.

Interest from front-line hospital workers was strong, top health officials said recently, estimating nearly 80% of roughly 15,000 eligible people got shots.

Then the pace slowed.

The next group included community health aides, where some areas such as the North Slope Borough at least initially reported fewer than half wanted to be vaccinated.

Amanda Bybee and Tanya Salmon, who work as aides for Southcentral Foundation in the tiny Iliamna Lake village of Igiugig, say they spent hours at work debating the pros and cons before deciding to get vaccinated, both to protect themselves and to demonstrate their safety to the community.

Tanya Salmon, a Southcentral Foundation community health aide in Igiugig, gets vaccinated against COVID-19 in Iliamna on Tuesday, Jan. 5, 2021. (Southcentral Foundation photo)

“Ultimately vaccines are one thing that I felt have always proved themselves,” Bybee said during a recent interview. “We thought back about polio and other outbreaks. They fell off the face of the planet with vaccines.”

“We’re just ready for things to open back up and feel semi-normal again,” Salmon said.

But overall as more health workers became eligible, state officials say, fewer than expected wanted to get vaccinated.

The next eligible group expanded to other health care workers, a broadly defined category that includes both clinical and home-based workers. State officials estimate anywhere from 30,000 to 50,000 people are part of that group.

The state’s chief medical officer, Dr. Anne Zink, said she thinks that are “quite a few” people who are eligible but have yet to get the vaccine but said it was hard to provide specific numbers.

Health care workers around the country are balking at shots, citing concerns about side effects and the speed at which the vaccine was developed.

More providers needed

The state is also still trying to get more providers to register to provide the vaccine in the first place.

There are thousands of possible vaccine providers around the state, according to Erin Narus, the state’s pharmacy program manager. About 430 had registered as of early January.

The tricky logistics of COVID-19 vaccinations are part of provider wariness, Narus said. Both require cold storage — Pfizer’s needs to be used within five days — and at least 15 minutes of monitoring post-shot. So that means a provider needs to have someone available to keep watch over patients, and make sure they don’t leave. They also need to provide enough space for social distancing.

Alaskans 65 years and older began receiving their first doses of the Pfizer-BioNtech COVID-19 vaccine at the Alaska Airlines Center in Anchorage on Saturday, Jan. 9, 2021. (Emily Mesner / ADN)

Another hurdle: Each vaccine vial comes with multiple doses. Flu shots are easy, Ruffridge said: a doctor’s office can just grab a single-dose vial from the fridge anytime they want to vaccinate somebody.

But with the COVID-19 vaccines, a provider needs to get six people (for Pfizer) or 10 people (for Moderna) lined up for appointments so they don’t waste any, he said. “If you have a small clinic, and only see a small number of patients, you’re not going to enroll until you have a single-dose option.”

Long-term care challenge

Interest in getting vaccinated is high at the state’s long-term care facilities, where residents have spent many months in isolation.

But that part of the state’s program is also one of the most challenging and complex, Zink said during a recent briefing. Despite “significant progress,” she said, the process has been considerably slower than expected.

It’s not clear how many eligible long-term residents still haven’t gotten vaccinated.

Hurdles range from getting consent of the person being vaccinated to getting people into the facilities to do the vaccinating.

At some Soldotna homes, complications arose getting permission from patient guardians, as well as the need to wait to vaccinate people with active COVID-19 infections.

Pharmacist David Blossom of Soldotna Professional Pharmacy gives a vaccine to Riverside Assisted Living resident Colleen Kennedy on January 8, 2021. (Marc Lester / ADN)

Complications also arose with a federal partnership with Walgreens and CVS to handle vaccinations at such facilities, providers say. In Soldotna, Ruffridge said his pharmacy stepped in when the local Walgreens store struggled to get a traveling team to facilities.

Zink said Thursday she had been on the phone with the heads of both Walgreens and CVS.

“We don’t have great visibility as a state on exactly how the outreach is going to these facilities where vaccine is happening and as a result, it’s been hard for us to figure out exactly where we need to intervene,” she said.

In a statement posted on the company site this week, a Walgreens executive denied any delays associated with their pharmacies. The company says it expects to finish all first doses in skilled nursing facilities by the end of January.

Some of Alaska’s nursing homes have completed their vaccination series while others have just begun, according to Jared Kosin, president of the Alaska State Hospital and Nursing Home Association. Nearly 90% of residents have opted to get vaccinated but participation is lower for staff, Kosin said, adding he expects that to change over time.

One facility told him vaccine days feel like a party for some residents.

“It seems like there is a universally strong desire by residents to get this (vaccine), and it’s bringing a sense of relief that’s celebrated for sure,” he said.

The senior snag

Most seniors originally didn’t expect to start getting their first doses until next month.

Then state health officials announced in late December they planned to divert somewhat from a federal recommendation to vaccinate people 75 and older and essential workers next. In Alaska, that next category includes people like teachers or grocery store employees and people who work in the seafood industry, as well as people in congregate settings like prisons and shelters.

Instead, they made people 65 and over eligible after health workers.

People wait in line during at the public COVID-19 vaccination site at the ASD Education Center on Thursday, Jan. 7, 2021. (Bill Roth / ADN)

That decision was motivated by concerns that many seniors here don’t live in long-term care centers, so they’d miss out on the first phase of shots, state officials say. Alaska has the fewest nursing homes per capita in the country.

It was clear there wouldn’t be enough vaccine for everyone right away. There are more than 90,000 Alaskans over the age of 65, though some are eligible for shots through other categories.

Alaska’s vaccine program encountered its first high-profile gaffes days after the official announcement came out New Year’s Eve that people 65 and older would be next in line, triggering broad confusion. It’s not exactly clear what broke down but it appeared the state wasn’t ready for the sudden rush.

Adding to the confusion, while many are still waiting, some seniors got vaccinated before they were technically allowed to even make appointments after officials decided not to make them cancel.

When official appointment scheduling for people 65 and older opened Wednesday, available slots generally filled up in less than a half-hour.

Anchorage resident Marcia Fischer, 69, said Friday that she had being trying unsuccessfully since Wednesday to make an appointment.

“I’m not a computer person,” Fischer said. “They just drive me up a wall.”

She set a timer for Wednesday at noon when appointments became available so her son could help her sign up. But all the slots were full by the time he helped her navigate all the online questions.

Fischer said Friday that she had tried the state’s vaccine hotline number three times, and is still waiting to hear back. She’s not sure what else to do.

Anchorage resident John Blaine, 81, had the opposite experience.

He and his wife spent several hours Wednesday trying to book an appointment but eventually got on a waitlist. Then, to his great surprise, someone working an Anchorage School District vaccination clinic not originally scheduled for seniors called him and told them both to come in right away.

Nurses at 10 stations administered the Moderna COVID-19 vaccine to the public at the ASD Education Center on Thursday, Jan. 7, 2021. (Bill Roth / ADN)

They got vaccinated that afternoon. Blaine said he’s grateful to have the protection, though with mixed feelings.

“I feel conflicted a little bit about getting the vaccine when people in the grocery stores and other places that come in contact with others all the time are not yet on that list,” he said.

While health officials knew there wouldn’t be enough vaccine doses right away, they say they decided to press on because there was unused vaccine available due to the slow health care worker pace.

They expected frustration, Zink said.

“But we also don’t want vaccine just sitting there,” she said during a recent media briefing.

Zink apologized to seniors for the difficult sign-up process and promised that the public health team was working hard to improve the process.

She said it will take at least a month to get through all the Alaskans 65 and older.

Scaling up to large clinics

Statewide, plans are emerging for numerous big clinics to start moving more people — especially seniors and also health care workers — through the process.

Even those won’t solve the problem entirely yet.

Fairweather, LLC Advanced Nurse Practitioner Jyll Green, right, speaks with a nurse before administering the Pfizer-BioNtech COVID-19 vaccine to a patient at the Alaska Airlines Center in Anchorage on Saturday, Jan. 9, 2021. (Emily Mesner / ADN)

In Anchorage, city officials announced a three-day mass vaccination clinic at the Alaska Airlines Center. Those 1,800 appointment slots filled up in less than four hours. Municipal health officials don’t expect more clinics until next month due to limited vaccine supply.

In Mat-Su, vaccination clinics for all eligible groups including people 65 and up are planned for the next two Tuesdays and Thursdays at the Alaska State Fairgrounds. There will be approximately 2,500 appointment slots available. The roughly 1,000 people on the Mat-Su Public Health Center waitlist get priority and will receive sign-up information Monday. Open registration for others will start at noon Monday at the state’s website, covidvax.alaska.gov.

In Homer, a two-day clinic is planned for people 65 and up on Jan. 15 and Jan. 16. Hospital officials there said that as of Friday, they hadn’t received any vaccine allocated for people 65 and up but hope to offer 600 doses at the weekend clinic.

In Juneau, there are plans to distribute about 1,100 doses of the Pfizer vaccine over three days starting Jan. 15.

Separately from the state’s allocation, roughly 28,000 doses received for December and January are going to tribal members through the Indian Health Service. Tribal health organizations are moving at a different pace from state officials — everyone 16 and up in some villages in the Yukon-Kuskokwim region could start getting vaccinated starting Monday.

The state’s future eligible categories include people 55 and over, additional essential workers and anyone over 16 in communities with limited water services. After that: the rest of the state’s essential workers and people 50 and up with two or more high-risk conditions.

It’s still not clear when vaccine will be available to the general public.

People stand outside the Alaska Airlines Center and check in Alaskans 65 and older for their scheduled appointments to receive the Pfizer-BioNtech COVID-19 vaccine in Anchorage on Saturday, Jan. 9, 2021. (Emily Mesner / ADN)

Opening up

On Friday, Ruffridge and Soldotna Professional Pharmacy colleague David Blossom traveled to nearby Riverside Assisted Living to give second doses of vaccine to residents.

Visitors have been restricted there since March. Darla Peterson, Riverside’s administrator, said the prospect of vaccines has lifted spirits.

The assisted center’s commons area looks out on a beautiful view overlooking the Kenai River. Staff try to keep residents engaged with activities, including bingo, nearly every day, according to Peterson.

Still, she said, residents have become more withdrawn during the isolation. Some have lost weight.

”They have not been able to visit and engage with families, and we’re starting to be able to see the actual mental decline in those individuals,” Peterson said. “With these vaccines, we’re going to be able start opening up here in the next couple weeks.”

The center hopes to allow visitors at the end of January.

The ADN’s Marc Lester contributed to this story.

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