Outside Spokane, vaccine hesitancy and oversupply challenge the region's ability to stick with a phased approach

Ferry County Health staff pick up the Pfizer vaccine from North Valley Hospital. - COURTESY OF FERRY COUNTY HEALTH
Courtesy of Ferry County Health
Ferry County Health staff pick up the Pfizer vaccine from North Valley Hospital.

Spokane County currently has a vaccine supply problem. Appointment windows run out within hours. Older folks eager for their turn are told they'll need to wait another week.

But Whitman County, just south of Spokane, doesn't have that problem, health officials say. Since Washington opened vaccine eligibility to those 65 and older, or 50 and older in multigenerational households, Whitman County was able to put shots in their arms quickly.

"We've moved through that population just about completely," says Chris Skidmore, director of Whitman County Public Health. "We've given vaccines to about everyone who wanted it."

In contrast to more urban areas like Spokane, rural Eastern Washington has at times had more vaccine doses than health officials know what to do with. Whitman County was forced to send its excess doses elsewhere rather than move onto the next phase of Washington's vaccine plan. In northeast Washington, some teachers were able to get the vaccine early when health officials had an overabundance of supply. In North Idaho, Kootenai Health hospital says it opened some vaccine appointments to those outside Idaho's current eligibility requirements to avoid throwing doses away.

Vaccine hesitancy — especially among Republicans — has certainly factored into the oversupply of doses in these areas, health officials say. But it's not just that. Eastern Washington counties have reported being sent an unexpected amount of doses, either for reasons the state hasn't explained or because other providers in the county asked for vaccine shipments concurrently.

The state, meanwhile, has maintained that Washingtonians in the current phase — a population making up the vast majority of COVID-19 deaths — should be vaccinated first. That means counties with excess supply will receive fewer doses or they must ship those doses to other counties.

But rural counties aren't satisfied.

"We understand larger counties take longer to move through the 65 and older group, but we have farmworkers and others who need to be vaccinated," says Karen Potts, community health director in Adams County. "It's hard to sit and wait."

In December, the Northeast Tri-County Health District — covering Stevens, Ferry and Pend Oreille counties — received nearly 1,200 doses of the Pfizer vaccine. Based on a survey of medical providers in the area, the health district came up with a list of 870 people who wanted the vaccine, says Matt Schanz, administrator for the health district.

"We told the Department of Health that we felt like we had adequate supplies to meet the eligible population. We said don't send us anymore, this is going to be all we need," Schanz says.

But then hospitals in northeast Washington started receiving vaccines.

"So all of the sudden we had this surplus. We couldn't get rid of the doses we had," Schanz says.

The state hadn't announced that people 65 and older were eligible at that time, in early January, and Schanz says his health district didn't know what the state planned. It didn't help that just about 50 percent of first responders refused to take the vaccine, Schanz says. But they had to get rid of the vaccine doses, so they started vaccinating people they thought would be next: teachers and other workers in congregate settings.

The state DOH says it's an "extremely rare occurrence" for a county to receive too many vaccine doses. But the same thing happened weeks later, in Whitman County.

Whitman has a population of about 48,500, but a large percentage of those are college students from Washington State University. Only about 5,000 people are 65 and older. Yet a few weeks ago, Whitman County received about 9,000 vaccine doses in a single week, Skidmore says. It would have more than covered everyone in the current vaccine phase.

"It was a good problem to have, but we weren't prepared for that much," he says.

Whitman County tried to inoculate those who would qualify in the next phase, which would include teachers 50 and older. But the state stepped in.

"When the state got wind of that, they called us and said, 'Don't do that,'" Skidmore says. "So we backed off and never went through with it."

Whitman sent extra doses over to neighboring counties, including Spokane. The Department of Health, in an email to the Inlander, didn't explain why such a large allocation went to Whitman County. It named a handful of factors, like "equity" and "partner input," but declined to give any specifics.

Skidmore says he never got a good explanation why they were sent extra doses.

"It boggles my mind how they sent us 9,000 in a single week," he says.

In North Idaho, vaccine hesitancy may be causing vaccine clinics to give doses to people who shouldn't be eligible. Only about 37 percent of people 65 and older have been vaccinated with just one dose, Panhandle Health District says. Yet already, Kootenai Health is having a hard time filling appointments.

Andrea Nagel, a spokeswoman for Kootenai Health, says they experienced "several no shows" for scheduled appointments recently.

"We do believe that the demand by those 65 and up who desire vaccination is slowing down," she says, though she added that inclement weather played a role, too.

Kootenai made "multiple attempts to fill these appointments with the appropriate groups," she says, but had to give doses to people who didn't fall under an eligible tier in Idaho. That included some family members of Kootenai Health employees.

Rural Eastern Washington counties have problems filling vaccine appointments, too. That's why they've asked the state for some help.

"We need flexibility," says Aaron Edwards, CEO of Ferry County Hospital.

The Ferry County Hospital, surrounded by mountains, is hours away from a big city.

"We feel like we're probably the most isolated community hospital in this state," Edwards says.

He says vaccine hesitancy was an issue at first, but more people are coming around to getting the vaccine as they see others get it. A bigger problem, which they share with other rural counties, is meeting the state's requirement to use 95 percent of its vaccine supply in a week.

When Ferry County Hospital holds a vaccine clinic, it takes significant staffing resources to run it smoothly and efficiently, he says. It's worth it if 100 people show up in a day, he says, but not when it's only 20, as is often the case. Edwards says that on those slow days, it doesn't mean there isn't demand, only that it can be difficult to get the word out to folks in rural areas, or they may be slow to come around to getting vaccinated. If they want to use 95 percent of their vaccine, then, they would have to give it to people not eligible.

Edwards says he's asking the state this: Either relax the 95 percent rule, or let rural counties give doses out to the next phase in order to fill their days out.

"Not that we want to cheat and get ahead, but I don't want to have allocation taken away because I can't get it out in seven days," he says.

That could mean, however, that rural areas get more vaccines than urban areas, per capita. Edwards says this would be justified, given that rural areas are "known to be sicker, more unhealthy, poorer and also underserved." He argues that if rural areas are protected, then those residents won't be using hospitals in Spokane.

The state has rejected this strategy, arguing that it would mean people in rural areas have a better chance of getting vaccinated than more urban areas. In an email to the Inlander, the Department of Health says it is trying to guarantee that eligible communities receive the vaccine. That may mean now allocating more doses to more populous counties.

The state has said that the next phase of its vaccine plan won't open until roughly half of people eligible in the first tier had their shots.

"This statewide approach ensures everyone who is eligible has equal access to the vaccine no matter where they live," DOH says. "Any vaccine that gets into our state helps protect us all by building community immunity." ♦

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About The Author

Wilson Criscione

Wilson Criscione, born and raised in Spokane, is an Inlander staff writer covering education and social services in the Inland Northwest.