As states are pressured to get shots into arms more quickly, some governors and public health officials are rerouting COVID-19 vaccine doses earmarked for assisted living communities and nursing homes back to states.

The governments of Maine, Michigan, Minnesota, Oklahoma and Utah are redirecting or reserving doses originally meant for long-term care facilities until those facilities use up the doses they have on hand, according to Politico

The news outlet reported that Utah is halting new shipments to long-term care facilities and is redistributing shots to local health departments and other providers, saying federal allocations were too high. Minnesota is rerouting doses to teachers and childcare providers, who are newly eligible for vaccination. Maine is moving doses to hospitals and independent pharmacies, and Michigan is steering shots to other providers.

Ohio Gov. Mike DeWine tweeted Tuesday that because not all long-term care residents and staff are choosing to receive the vaccine through the federal vaccination program, the state will redirect about 77,000 of those unused doses over the next two weeks to the community. He also said that, starting Feb. 8, the state will be taking vaccines directly into affordable senior housing locations, where several thousand older Ohioans live.

State officials insist that their moves won’t interfere with the federal program to vaccinate assisted living community and nursing home residents. In fact, CVS and Walgreens, as well as the federal Centers for Disease Control and Prevention, are working with states, in some cases, to redistribute an oversupply of vaccine.

Watching and waiting

But assisted living providers and other residential care communities recently reported lagging rates of vaccinations, with many residents having yet to receive — or be scheduled for — their first vaccine, even as the federal government announced an expansion of the vaccination rollout.

CVS Health and Walgreens said this week that it will be mid-February until they complete first-dose vaccinations in assisted living communities that selected the companies as their vaccine providers, although both already have finished administering first doses in skilled nursing facilities.

A LeadingAge spokeswoman said the organization is monitoring states’ decisions and primarily wants to ensure that older adults and their caregivers are prioritized “because they haven’t been throughout the pandemic.”

“If these reallocations mean that residents and workers in nursing homes and assisted living are not prioritized, that would be concerning,” she said, adding that millions of older adults who do not live in those settings also are vulnerable, as are their caretakers, and need vaccination.

The American Health Care Association / National Center for Assisted Living similarly encouraged prioritization of senior living and skilled nursing settings for vaccinations. A spokesperson said that the organizations’ efforts continue to focus on combating vaccine hesitancy and increasing vaccine uptake through the #GetVaccinated campaign.

“We strongly encourage governors to continue to prioritize long-term care residents and staff and ensure they have enough vaccine for this population before offering vaccines to other lower-priority groups,” the spokesperson said. “If their allocation allows them to do both in tandem, we understand their decision.”

Based on the results of a recent member survey, Argentum said that delays in distributing and administering vaccines to senior living communities are continuing to put residents and caregivers in jeopardy. Reasons for those delays include wide variances in state rollouts, challenges with scheduling clinics through the federal Pharmacy Partnership for Long-Term Care Program, and changing prioritization guidelines.

Maggie Elehwany, Argentum’s senior vice president of public affairs, said that association executives are meeting with congressional delegations from across the country to share their concerns.

“Our priorities continue to be that all senior congregate care settings be prioritized for COVID-19 vaccines; that adequate supplies be held in reserve for second doses; and that vaccines be administered to all residents, regardless of care level, and staff in a senior living community,” she said. 

American Seniors Housing Association President David Schless said that although the federal long-term care vaccination program has experienced “fits and starts, and is not moving necessarily as quickly as we would all like to see,” it is progressing.

Schless said ASHA’s focus remains on advocating for vaccination for independent living residents and encouraging senior living staff members to get vaccinated.

“I am going to remain optimistic,” he said. “I think we’ll see the supply of the vaccine pick up, hopefully, in the coming weeks, which will be helpful for all of us. But, certainly, we want to see these communities get these clinics scheduled so residents and staff can get back to some sense of normalcy.

Overestimating doses

Monday, CVS Health and Walgreens announced they had completed the administration of the first round of COVID-19 vaccine doses to skilled nursing facilities across the country, with second doses expected to be completed within four weeks. 

Tuesday, Walgreens noted that it had provided more than 1.3 million COVID-19 vaccinations to people at long-term care facilities and other vulnerable populations and announced that it will complete first-dose vaccinations in assisted living and other long-term care facilities by mid-February.

States, as well as a Walgreens spokesperson, said that facilities overestimated the number of doses needed “due to fluctuations in occupancy levels and the impact of vaccine hesitancy.”

A Walgreens corporate spokesperson told McKnight’s Senior Living that in many cases, long-term care facilities overestimated the number of doses needed due to fluctuations in occupancy levels and the effects of vaccine hesitancy. A CDC spokesperson added that the ability to get six doses from the Pfizer five-dose vials also created a surplus at some sites.

“In states or jurisdictions where the number of vaccines needed for the long-term care program is trending lower than what facilities initially requested, we are working with states and jurisdictions to determine how they would like to reallocate those vaccines, which may include expanding vaccinations to additional prioritized individuals in our stores or returning vaccine to the state to administer according to their needs,” the spokesperson said. “We are working hand-in-hand with states to achieve the shared goal of vaccinating our most vulnerable populations as quickly as possible.”

The CDC required states and jurisdictions to “allocate ample vaccine supply” during the initial weeks of the long-term care pharmacy program to support on-site vaccination clinics and avoid interruptions or delays, a CDC spokesperson told McKnight’s Senior Living. At the same time, the agency encouraged jurisdictions to collaborate with pharmacy partners on strategies to prevent “vaccine wastage.”

“Now that pharmacies have made substantial progress in efforts to bring vaccination directly to the more than 70,000 long-term care facilities nationwide — and more information on uptake in facilities enrolled in the program has provided us with a better grasp of how much supply is needed to finish vaccinating these medically fragile residents and the frontline staff caring for them — we are working with pharmacy and jurisdictional partners to adjust, or temporarily pause, some of those allocations where appropriate,” the spokesperson said. 

A CVS spokesperson said that allocations were based on bed counts multiplied by two to account for staff members. But with occupancy down and low staff uptake, pharmacies had more vaccine doses than were needed during initial vaccinations.

“We want shots in arms as urgently as the states do, so we’re proactively asking that they ‘reclaim’ allocation we won’t need, or defer making more allocations for the time being,” the CVS spokesperson told McKnight’s Senior Living. “Where we do have ‘excess doses’ in our stores, they’re being repurposed for other long-term care facility visits [such as second and third clinics.]”