JEFFERSON — The subject of a report from N.C. Watchdog Reporting Network — a consortium of investigative media outlets — it was recently confirmed that AppHealthCare and the Ashe County Health Department had distributed unauthorized vaccinations throughout the county. In response to that story, AppHealthCare conducted an interview with Ashe Post & Times on Feb. 12.
Health Director Jennifer Greene and Director of Communications & Compliance Melissa Bracey disclosed to the Ashe Post & Times, sister newspaper to The Blowing Rocket, that AppHealthCare had launched an internal investigation based on a complaint.
“We did discover that there was some use of vaccine that did not follow our typical protocols, but it was not done in a way maliciously, it was provided because we actually have to throw away doses if they are not used within a certain amount of time,” Greene said.
Since AppHealthCare self-reported its concern to the North Carolina Department of Health and Human Services, the regional health department will not be penalized. According to Greene, AppHealthCare has identified protocol shortcomings and NCDHHS has provided the organization with support.
“As vaccine providers, we are all faced with an ethical dilemma here. I am on the side of, we do not want to waste a dose. I would much rather tell you 13 people got a vaccine versus 13 doses were thrown in the trash that could’ve protected people,” Greene said.
According to Greene, the internal investigation involved interviewing staff and reviewing protocols. As a result, officials discovered flaws in the structure of vaccine distribution and have made improvements. These improvements include the addition of staff.
Greene confirmed that 13 doses went to individuals who are not currently in the designated phase. Currently, healthcare workers and people older than the age of 65 are the only ones authorized to receive the vaccine. Forty doses total were given outside of AppHealthCare’s typical protocols and were not given on-site at their vaccination clinics. Twenty-seven of those doses were administered to people who otherwise qualified for the current phase, Greene said.
“Our team really wanted to make sure that they didn’t throw away and waste any doses,” Greene said. “At the end of the day, they didn’t waste anything; they put shots in arms.”
Greene said AppHealthCare staff is aware that its communities are experiencing increasing stress and anxiety surrounding the need to get more people vaccinated. The small allotment of doses issued to rural communities, such as Ashe, leads to extensive waitlists.
AppHealthCare discovered they needed a separate system for managing broken appointments, Greene said. In the beginning, Greene said their protocols were not as strong due to little time to prepare and organize vaccine distributions.
“Part of the pressure that we’re under is if we don’t administer all the doses that we get that week on time, plus all the second doses on time and get them all documented, we risk losing doses that come to us the next week,” said Greene.
Greene added that the state can cut back on the allocation if things are not documented clearly and if all of the first doses were not administered. There have been a lot of factors outside of AppHealthCare’s control as a vaccination provider due to logistical challenges and strict timelines, according to Greene.
The Moderna vaccine is labeled for 10 doses, but sometimes 11 doses can be drawn from the vial. To ensure extra doses are not wasted, AppHealthCare has a separate staff member who is responsible for managing “no show” appointments. It is the duty of this appointed staff member to utilize the vaccine interest list, in chronological order and fill any open vaccine slots.
“We’ve given 3,180 shots in Ashe County alone. Across our district, we are pushing nearly 10,000 doses of vaccine,” said Greene.
Vaccine distributions have been inconsistent each week. AppHealthCare can receive 200 one week and 700 the next. The vaccine comes frozen and is thawed upon arrival. Once the vial is broken and it is drawn up into a syringe, it can only last for six hours before it has to be thrown away.
She added that she feels their staff is doing their best and they care about the immunity of the community.
She also identified the major issues or challenges that staff at AppHealthCare is experiencing concerning vaccine distribution scheduling.
The call volume of both outgoing and incoming calls has been overwhelming. According to Greene, a team of approximately 30 people are working on scheduling appointments and responding to calls 24/7.
Scheduling of appointments has also been a challenge because a fair portion of individuals age 65 and older are not as familiar with technology as the younger generations. Greene said in order to notify individuals on the waitlist that it is their turn to be vaccinated, they either call or provide a link via email.
“We are doing our best to try and put all of the upfront work so that we make it an easy, seamless process for the community at the end,” Greene said. “And there are some times if it comes to the very end of a clinic, we are not going to throw it away. We are going to do everything we possibly can to use interest lists, to walk through the groups that are currently approved, but we are not going to throw the dose away because that seems just wrong.”
Greene also disclosed that the week of Feb. 15 AppHealthCare will receive 700 extra doses in addition to their regular shipment of 200 doses. This will amount to a total of 900 first doses.
The next challenge for AppHealthCare is to navigate having a small number of doses while dealing with increased demand for vaccinations.
In a media brief on Feb. 10, Gov. Roy Cooper announced that teachers, child care center employees and school support staff will be eligible to receive the COVID-19 vaccine starting on Feb. 24, in phase 3 of the state vaccination schedule.
Group 3 is set to begin receiving vaccinations on March 10. In this category, everyone who physically goes to work will be eligible for their first doses. This includes farm workers, first responders, restaurant employees, grocery store workers and many others.
To sign up for a vaccination, visit AppHealthCare’s website to fill out the interest form at https://www.apphealthcare.com/covid-19-vaccinations/.
The follow up on Ashe County High School’s mass vaccination event which occurred on Jan. 23, will take place on Feb. 20.