Many Illinois residents felt hopeful last month when a Chicago doctor became the first person in the state to receive a COVID-19 vaccine.
But for some, that optimism has turned into confusion and frustration over the slower-than-expected pace of inoculations, even as the state prepares to move to the next phase of vaccinations in coming days.
Many wonder whether it will be possible to accelerate vaccinations in the next phase, which will include people ages 65 and older and front-line, essential workers such as teachers, public transportation workers and grocery store employees. The state is planning to start vaccinations for those groups Jan. 25, though some areas of the state are starting before then. The first phase included only health care workers and long-term care facility residents.
In Illinois, 447,348 vaccine doses had been administered as of Friday, at least 45% of the doses Illinois received, according to the state health department. A total of 345,678 people had been given at least one shot, equaling about 2.7% of the state’s population.
Chicago had administered at least 44.8% of its 229,950 doses as of Thursday, according to city data. In total, 66,602 Chicago residents have gotten at least the first dose, amounting to 2.5% of the city’s population.
State and city leaders have said more doses are needed from the federal government to speed up vaccinations. The Trump administration said Jan. 12 that it would no longer hold back vaccines for second doses, and President-elect Joe Biden has also promised to release available doses.
But a limited number of available doses isn’t the only reason more Illinois residents haven’t been vaccinated. There also has been criticism about the distribution effort, and hurdles including hesitancy among some health care workers and logistical issues.
It’s unclear how much those challenges will dog the program’s expansion.
In preparation for the next phase, the state, hospital systems and health departments are setting up mass vaccination sites, getting ready to comb through electronic medical records and working with employers to find those who should get the shots next. Gov. J.B. Pritzker said Jan. 11 that some local health departments would be allowed to move onto the next phase of vaccinations early if they had “substantially” completed the first phase.
But Pritzker has cautioned that many in the next phase may still have to wait.
“We’re all anxious to get vaccinated, but in these next few weeks, at least, patience is our watchword,” Pritzker said during a news conference Friday.
First phase limitations
One issue during the first phase has been that health systems could only vaccinate health care workers. If they couldn’t inoculate enough health care workers quickly, they didn’t want to hold on to doses that others might be able to use.
As a result, a number of Chicago-area hospital systems have declined offers of additional vaccine shipments in recent weeks.
The week of Christmas, Edward-Elmhurst Health turned down an offer of Moderna vaccines, when many of its workers were off for the holidays. The system had just received a big shipment before the holidays and was expecting another one after Christmas.
“Why would I have something sit in a refrigerator for a month when someone else could be administering it in another location?” said Mary Lou Mastro, president and CEO of the health system, which has hospitals in Elmhurst and Naperville.
Hospitals can vaccinate only so many people a day. Administering the vaccines is more labor-intensive than flu shots. Those receiving vaccinations have to be scheduled for second doses, the Pfizer vaccines need ultracold storage or must be administered within days, and people are generally observed for at least 15 minutes after each vaccination in case of an immediate adverse reaction. Plus, people can’t wait in crowded lines for vaccinations because of the contagious nature of COVID-19.
NorthShore University HealthSystem, which has six hospitals in the city and suburbs, said no thanks to a batch of doses earlier this month because it was busy administering second doses to employees, said Jeff Thiel, its assistant vice president for pharmacy.
Amita Health, which has 19 hospitals in Illinois, was in the midst of vaccinating 15,000 workers with the Pfizer vaccine in December when it was asked if it was ready for Moderna vaccines, said Dr. Michael Kelleher, who leads Amita Health’s COVID-19 vaccine steering committee. At that point, it was not.
The state estimates there are 850,000 health care workers and long-term care residents eligible for the first round of vaccinations, so that would equate to roughly 41% of them receiving at least one inoculation and nearly 12% getting both doses so far.
In long-term care facilities, where vaccinations are being done through a federal partnership with pharmacies, just 21% of allocated doses have been administered, according to state data.
Of doses controlled by state and local health departments, about 54% of available doses have been used.
Pritzker said Friday that he expects hundreds of additional vaccination sites to open in coming weeks, including at retail pharmacies, state-run sites, hospitals, urgent care clinics, doctors’ offices and large employers, as the state moves into the next phase. But he said, “Patience will be required in these first weeks of phase 1b because vaccine supplies are just extremely limited.”
Tracking the progress of vaccinations in Illinois can be difficult. The state was one of the last to post vaccination data online, and it’s not offering the demographic data released by other states.
Also missing: details of where the vaccine is being distributed within Illinois, and what those places have done with the shots. In some states, such as Michigan and South Carolina, health departments provide online details for citizens to track how many doses have been given and where.
The Tribune has filed Freedom of Information Act requests for such data with the Chicago and state health departments, which oversee distribution of shots. Both have said they need more time to consider what, if any, records to provide.
Overcoming vaccine hesitancy
Another challenge in the first phase was that many people were hesitant to get the vaccine — an issue that’s likely to carry over to the next phase as seniors and essential workers become eligible.
Dr. Allison Arwady, Chicago Department of Public Health commissioner, has said she was surprised by the number of inpatient health care workers who haven’t wanted to get vaccinated. That hesitancy was more prevalent among support staff and Black and Latino employees, leading her department to ask hospitals to do a second round of sign-ups if needed.
Some health care workers at area health systems have held off on getting vaccinated because they already had COVID-19. The CDC recommends that people who’ve already had COVID-19 get vaccinated, saying it’s unknown how long a person is immune from the illness after getting sick.
Others are taking a wait-and-see approach.
At Memorial Health System in Central Illinois, about 65% of employees have said they want to be vaccinated, said Charles Callahan, president of the system’s hospital group. He’s noticed some young women, in particular, holding back, possibly because they are pregnant or planning to have children soon and are worried about the effects of the vaccine. Experts say vaccines should be offered to pregnant and lactating women, and they believe they’re unlikely to put them at risk, but the vaccines have not been studied in pregnant women.
Vaccine hesitancy might be more pronounced outside of health care, among those eligible for shots in the next phase. About 27% of nearly 1,700 adults surveyed in late November and early December said they would probably or definitely not get vaccinated, according to a Kaiser Family Foundation survey.
Hospitals have worked to engage with employees who don’t want the shots, said Dr. Susan Bleasdale, acting chief quality officer and medical director for infection prevention at University of Illinois Hospital and Health Sciences System. That’s meant holding town halls and asking those who are vaccinated to be examples for their co-workers.
Experts say about 70% of the population must have immunity to the illness before “herd immunity” is reached.
“I think you have to be working in a lot of different directions,” Bleasdale said. “You need to make it available to next group, and circle back.”
Vaccinating another 3.2 million people
In the next phase, state and local leaders say getting more doses is essential to speeding the pace of inoculations.
“We are frustrated by the federal government’s response to COVID-19 overall, but particularly the vaccine rollout, which has not delivered on its promises,” Chicago Mayor Lori Lightfoot said in a Thursday news conference. “We must accelerate the number of first doses that we are receiving on a weekly basis so we can get those doses into people’s arms.”
President-elect Joe Biden has promised to ramp up vaccinations, with a goal of vaccinating 100 million people in his first 100 days in office. Pritzker said Friday he’s encouraged by Biden’s plans.
But experts say a more cohesive distribution plan also is needed.
A lack of federal oversight in vaccine distribution has created problems, said Dr. Sadiya Khan, an epidemiologist and assistant professor at Northwestern University’s Feinberg School of Medicine. Although she does not advocate for a “one-size-fits-all” approach, she said injections have been hampered because local public health departments have been left to coordinate everything themselves — and with insufficient budgets.
In Illinois, some hospital systems have been working with four or five local health departments to obtain vaccines.
“There is a bit of (an) every county and every state for themselves approach happening right now,” Khan said.
Pritzker said Friday the state’s vaccine administration plan will coordinate Illinois’ 97 local health departments.
Some states have been doing better than Illinois, according to data from the Centers for Disease Control and Prevention. In Illinois, at least 42% of total vaccines received had been administered, as of Thursday, according to the CDC.
In West Virginia, that figure was 74% and in Wisconsin, 34%. As with the figures published by the state, there’s a lag time between when vaccine administrations are performed and when they’re reported, meaning the actual percentages are likely higher.
State and local leaders hope to see those numbers grow as Illinois opens vaccinations to 3.2 million seniors and essential workers in coming days.
In this next phase, the state, hospitals, employers and local health departments will work together to get people vaccinated.
Starting Jan. 25, sites led by the National Guard as well as some Walgreens, CVS Health and Jewel-Osco pharmacies across the state will begin vaccinating those eligible under the next phase, with pharmacy vaccinations by appointment, Pritzker said Friday. The state also plans to launch a website in coming days where people can find vaccination sites near them.
A number of hospital systems plan to use their electronic medical records to find and contact patients who are 65 and older, when it’s their turn to make appointments to get vaccinated.
University of Chicago Medicine has said it plans to begin vaccinating some of its own patients in the coming days, focusing first on inpatients and South Side residents who are 75 and older, using any leftover doses that had been allocated for health care workers. It has said it plans to notify patients through MyChart and phone calls when they’re eligible, and a lottery will be used to decide the order of appointments.
Some health systems, such as Loyola Medicine, are getting lists of first responders from their county health departments so they can reach out to police and firefighters to get vaccinated.
In Chicago, Arwady has said the next phase will be by appointment and promised it won’t turn into a “come one, come all, whoever can get in line” situation, which has led to long lines in states such as Florida. The majority of people will sign up through health care providers or employers. But patience will be needed as people are prioritized by age, risk factors and more.
“There’s not going to be enough vaccine for everybody at the beginning,” Arwady said about the next phase. “I want to be really clear about that.”
Lightfoot said Thursday that she expected the city to have a total of six mass vaccination sites up and running within days that could eventually serve seniors.
In the west suburbs, Edward-Elmhurst has been working to determine sites for mass vaccinations, Mastro said. Edward-Elmhurst had initially thought it would be responsible only for vaccinating its own workers. Now that the system is taking a larger role, it has to prepare for that.
“For as little infrastructure that was in place or guidance on distribution, people are really pulling together and trying to do the right thing,” Mastro said. “I think everybody wants to get this done.”
Chicago Tribune’s Dan Petrella contributed.
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