‘It was literally Christmas’

When COVID-19 vaccines began arriving in Michigan two months ago, it was a lot like Christmas, Detroit Chief Operating Officer Hakim Berry said. There was excitement that the doses had arrived, of course, but it was more that the exact contents were something of a surprise.

“It was literally Christmas; you’d open up a box and be happy with what you got,” Berry said, referring to shipments of vaccine doses. “You’d get an email on Friday saying what you were getting Monday. I swear one email just said, ‘You’re getting a box.’ It literally said that.”

Berry certainly wasn’t alone in what amounted to a logistical nightmare: across the state, health and government leaders faced the launch of the largest vaccination campaign in the history of the United States. And this massive undertaking did not start smoothly. At one point, in early January, Michigan ranked as one of the worst states in terms of vaccine administration. 

That, however, has changed.

Michigan is now the eighth-best state in the country for the number of vaccine doses it has gotten into people’s arms— roughly 1.7 million — and the 10th highest for the percentage of vaccines the state has administered of those that the federal government has distributed in the state, according to the most recent data from the U.S. Centers for Disease Control and Prevention (CDC). 

As of mid-February, Michigan has administered about 74% of the 2,044,625 vaccine doses it has received. The doses that remain are either being saved for appointments that have already been scheduled or are allocated for CVS, Walgreens and the Managed Health Care Associates*, which will use them to vaccinate long-term care residents and staff, according to a spokesperson for the Michigan Department of Health and Human Services (DHHS). There also was a delay in doses arriving to Michigan this week thanks to extreme winter weather in the South.

Still, while more vaccines are reaching more people, there remains a long way to go.

About 13% of Michigan has been vaccinated and state officials want that number to get to at least 70% in order to reach herd immunity. And there just is nowhere near enough vaccine in the state right now to cover the Michiganders who are eligible to receive the vaccines, which currently spans a wide swath of the population, including those who are 65 years and older, health care and prioritized frontline workers, teachers, corrections staff, and individuals in agriculture and food processing.

“We just need vaccines,” Grand Rapids Mayor Rosalynn Bliss said. “We have tens of thousands of people on our waitlist right now. They’re just waiting. They have no idea if it’s going to be two weeks or two months [before they get the vaccine]. That’s where I continue to hear frustration. People say, ‘I want the vaccine, and I don’t know how long it’s going to be.’”

Dr. Joneigh Khaldun, Michigan’s chief medical executive and the chief deputy director for health at the MDHHS, said in an interview with the Michigan Advance that the state has the capacity to administer at least 80,000 vaccine shots per day, but does not have the supply from the federal government to do so.

“We have over 2,000 providers enrolled in our [vaccine] program, and right now we’re only able to give vaccines to about 130 of those providers,” Khaldun said. “We are not able to utilize all 2,000 of our enrolled providers because we don’t have enough vaccine.”

State officials said they’re optimistic that will change, though they concede it’s going to take more time than they, and many people waiting to be vaccinated, would like. 

With President Joe Biden’s recent announcement that his administration secured 200 million more vaccine doses for the country, 100 million of which are expected to arrive in May and the other 100 million by the end of July, and the federal government sending millions of dollars to Michigan for vaccine distribution efforts, state officials said they’re feeling optimistic that they’ll be able to significantly boost access to the vaccines in the state. 

As for when that will happen, it’s unclear. Earlier this month, state health officials said during a press conference that, based on the amount of vaccine then coming into the state, it could be October before the general public can get the vaccines. But, they emphasized, that is likely to change with any kind of an influx in vaccine doses arriving in Michigan. During a tour of Pfizer’s Portage facility Friday with Biden, CEO Albert Bourla said the company will be ramping up production and adding suppliers.

In the second week of February, Michigan received 153,300 vaccine doses, a number which increased to 278,000 total doses this week, according to the state health department. By the time the federal government has access to the 200 million doses, the amount of the vaccines allocated for Michigan is slated to jump significantly higher.

“I expect us to continue to increase our rate of vaccinations; we’ve continued to improve week by week since we started,” Khaldun said.

As the vaccination process continues, and as more doses are sent to the state, everyone from health and government officials to academics and civic activists said it’s crucial to identify the vaccination barriers that have existed, and continue to exist, in order to vaccinate as many Michiganders as efficiently, and as equitably, as possible.

What went wrong — and what’s changed? 

Much of the struggle in connecting people with the vaccines at the beginning of the distribution efforts in Michigan was rooted in “figuring out the logistics,” Khaldun said.

“This is the most massive vaccination effort the United States has ever undergone, and it’s taken time for people to improve their operation,” Khaldun said. 

As for specifically how Michigan went from hovering around the bottom of the country in administering the vaccines to surfacing near the top is a messily complex version of government officials, health departments, hospitals and others “figuring out the logistics.” 

And, for nearly everyone we interviewed, large chunks of that answer continue to be pieced together in a narrative that encompasses frustration over the former Trump administration, changes to the state’s vaccine allocation algorithm, the haze surrounding data about the vaccines, and equitably administering the vaccines to Black and Latino residents, who were hit disproportionately hard by the pandemic.

Some elected officials cited the difficulties in trying to launch the rollout of the vaccines under an unresponsive Trump administration focused almost entirely on the results of the 2020 election and often aggressively opposed to even recognizing the ongoing pandemic or providing clear, or truthful, information about what to expect with vaccine distribution. 

You may remember, for example, when then-U.S. Health and Human Services Secretary Alex Azar said in January that the federal government would be releasing a reserve of doses that had been held for the second shots of the vaccine — but that reserve never existed in the first place.

“Since the Biden administration has come in, there’s more federal information and conversation about the urgency of getting more vaccines and getting them out into local communities,” said Bliss, the mayor of Grand Rapids. “Up until the Biden administration, we didn’t hear a whole lot from D.C. The air was sucked out of the room with this belief that the election wasn’t fair. The Trump administration was so obsessed with the election that from November through Jan. 19 very little was shared [about the vaccines].”

“I appreciate that now at least we have a consistent message coming out of D.C.,” Bliss continued. “I’ve been on calls with the White House staff talking about the needs of cities, so I feel they are proactively reaching out and trying to identify barriers to accessing the vaccine.”

Khaldun, who was recently chosen to serve on Biden’s COVID-19 health equity task force, also said the transition from the Trump administration to the Biden White House has paved the way for a smoother vaccine distribution process.

“It was challenging when there were announcements from the previous White House administration that did not seem to be consistent or true [about the vaccines], but moving forward I’ve been quite pleased with my engagement with the Biden administration,” Khaldun said. “I’m pleased with the transparency and consistency.” 

With a Trump White House almost singularly focused on the false claims that the election had been “stolen,” there was a profound lack of communication from the federal government to states about basic details regarding the vaccines, such as how many doses would arrive and which vaccine — Pfizer or Moderna — would be coming, local government and health officials said. That, in turn, meant Michigan’s health departments and hospitals, two of the main entities that have been distributing the vaccines, also did not receive that information, creating a series of logistical nightmares for them. 

In Detroit, for example, Berry explained that city officials didn’t know if they’d be receiving the Pfizer or the Moderna vaccine in the beginning, leaving them to “expedite our request for ultra-cold freezers,” in case they were receiving the Pfizer vaccine, which has to be stored at extremely low temperatures. This lack of basic information about how much vaccine was coming and which vaccine it would be was occurring while officials across the state scrambled to figure out where people would go to get their shots and the individuals who would physically be administering that vaccine, among a slew of other logistics.

As more vaccines arrived from the federal government, and as the state changed its algorithm for allocating the vaccines — at first, it was based on requests from health departments and hospitals and is now based on population and what’s called the “Social Vulnerability Index” — the distribution process has become increasingly stable, Berry said. 

For its first shipment of vaccines in mid-December, the city of Detroit’s health department received 2,000 Moderna vaccine doses. By the end of January, that increased to about 15,000 doses. A couple weeks later, that number jumped again, this time to 20,000 doses for the week of Feb. 14, according to state data. 

“I’m not holding my breath yet, and I won’t say everything’s 100% smooth, but it’s steady,” Berry said. 

Others, like Bliss, said some of the difficulties in distributing the vaccines came when Gov. Gretchen Whitmer announced at the beginning of January that anyone over the age of 65 was eligible to be vaccinated, instead of 75 and over as was originally expected. That announcement meant about 1 million more people — Michiganders between the ages of 65 and 74 — were eligible for the vaccines. 

Many of those individuals then began requesting the vaccine from local health departments and hospitals, which were unprepared for this wave of applicants, according to Bliss and health officials from throughout the state who spoke about the matter anonymously. Because so many more people are eligible than are able to receive the vaccines, a deep sense of frustration built, Bliss and the health officials said. 

“The hiccup was when the governor announced anyone over the age of 65 was eligible, and I’m not sure our health departments and hospitals had enough time to plan for the influx of people wanting the vaccination,” Bliss said. 

But things are turning around, the Grand Rapids mayor said.

“Now, there’s a really seamless process when it comes to signing up for the vaccine; they have all the information on the website, and the county, Mercy and Spectrum Health are coordinating their efforts,” Bliss said, referring to efforts by Kent County and the two hospital systems to open a vaccine clinic at the massive DeVos Center in downtown Grand Rapids at the end of January.

“Now that the downtown clinic is up and running, they’ve been able to streamline things,” Bliss said.

Christopher Bendekgey, community clinical services division director for the Kent County Health Department, agreed that the distribution process is steadying.

“I think a lot of the panic has subsided because people are starting to get into a vaccination queue, and they’re getting registered,” Bendekgey said. “I think there’s still some frustration on how to get the vaccination or where to go to get the vaccine.”

There definitely remains frustration for those 65 and over who haven’t yet gotten the vaccine, said Jackie O’Connor, the executive director of the Area Agency on Aging of Western Michigan, which works with seniors in Allegan, Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Newaygo and Osceola counties. O’Connor also said a technological divide has presented problems for older Michigan residents. 

“[The vaccine] is only accessible for seniors who are tech savvy and seniors who are willing to drive; there are older adults who don’t drive,” O’Connor said. “You can sign up for vaccines online and do some phone calls, but they have to be persistent, and that’s only going to be a certain small group of older adults who do that.”

“If you’ve got an adult who’s willing to go online or call, maybe there’s only 250 vaccinations on the end of that call and there are thousands calling,” O’Connor continued. “That’s where the frustration comes about.”

So far, 35.4% of Michigan residents who are 75 years old and over have gotten their first vaccine shot, and 29.3% of those between the ages of 65 and 74 have done the same, according to DHHS. Michigan State Long Term Care Ombudsman Salli Pung said she has been pleased to see the numbers of seniors being vaccinated increase in recent weeks. The Michigan State Long Term Care Ombudsman Program advocates for people living in licensed long-term care homes, including nursing homes, homes for the aged and adult foster care homes.

“In the greater Lansing area, Sparrow Health System opened the drive-through clinic, which opened up vaccine opportunities for many,” Pung wrote in an email.

But, like O’Connor, Pung emphasized that seniors continue to face steep barriers to accessing the vaccines.

“We are hearing concerns [about] people living in the community getting access to appointments for the vaccine, especially those that rely on public transportation,” Pung wrote. “We also have concern for people living in the community that have mobility or healthcare needs that would make traveling out of the home difficult due to the wait times and observation periods [when getting the vaccine shot].”

State officials hope to better connect seniors — especially marginalized seniors — with the vaccines by allocating a portion of Michigan’s vaccine supply to 41 health clinics that work with low-income residents over the age of 65. The clinics, known as “federally qualified health centers,” are located in both rural and urban areas of the state.

‘It was crystal clear we were the only African Americans in line’

When Adrian Walker, a community leader in Flint, took his 85-year-old grandmother to get her vaccine in North Flint, a predominantly Black neighborhood, they noticed they “were the only African Americans in line at that specific time,” Walker said. 

It immediately raised questions of equity and the vaccines for Walker.

“Given where a vaccine site is located, you wonder if there have been conversations about reserving vaccines for residents in the community where we’re located,” he said. 

“The [vaccine] rollout has been challenging, but I’m hopeful the state and county’s approach will be equitable, especially when you talk about Black and Brown communities who have been impacted disproportionately by the pandemic,” Walker continued. 

Additionally, the Flint resident said he witnessed the barriers his grandmother faced as a senior citizen.

“I’m tech savvy, so I could go on the computer, sign her up and get her in line for her appointment, but unfortunately a lot of seniors don’t have someone like that to do that for them,” Walker said. “There’s a technology gap. My grandmother’s friends are calling me to sign them up. There’s a phone number listed on the website [about the vaccines], but a lot of them don’t have computers. My grandmother has a flip phone. And the number they list is busy a lot of the time.”

So far, the state has not released data about racial inequities and the vaccines, but, nationally, Blacks, who make up 13.4% of the United States’ population, constitute just 5.4% of vaccine recipients, according to the CDC.

Lynn Sutfin, a DHHS spokesperson, wrote in an email that “initial reports indicate Michigan’s data will be similar to other states across the nation.” She noted the state would soon begin reporting information about race/ethnicity and vaccine administration “in the near future.”

That Michigan, and states nationwide, “do not have a great data collections systems that give us” an in-depth look at racial inequities in the distribution of the vaccines is a major issue with the rollout,  said Dr. Debra Furr-Holden, the associate dean for public health integration at Michigan State University and the director of the Flint Center for Health Equity Solutions. 

As states prepared to receive the vaccines, the federal government should have mandated an equitable rollout of the doses — that it didn’t happen means that Black and Brown Americans are once again subjected to systemic racism and marginalization in health care. And, those major gaps in data are barring government and health officials, as well as researchers, from being able to address the inequities, Furr-Holden said.  

“It would not surprise me if once we unpack the data we see inequities and disparities in who’s actually getting the vaccine injected into their arm across many of our disparate populations — gender minorities, sexual minorities, racial/ethnic minorities, rural populations,” Furr-Holden said. “This is deeply embedded in our nation’s DNA, and it’s nothing we can solve with a quick surface level fix. The mandate for equity has to be there.” 

In addition to collecting data on racial inequities, Furr-Holden said the state, and country, must provide “institutional and systemic support for people getting vaccinated.” 

For example, Furr-Holden knows of health care workers in Genesee County, where Flint is located, who did not get the vaccine as soon as they were eligible — not because they were hesitant to do so but because their employers wouldn’t give them a day off to get the vaccine.  

“Many of the health care workers I spoke to said, ‘If I had been given the day off, I would’ve gotten the vaccine,’” Furr-Holden said. 

If the federal government mandated there be an equity component to vaccine distribution and administration, employers could be directed to provide paid days off for employees to get their shots, Furr-Holden said. Now, however, anyone who was eligible to get their vaccine in December or January but didn’t — for such reasons as they couldn’t afford to take the day off — and now would like to, are placed at the bottom of the waitlist, Furr-Holden noted. 

“The wait list in my county is over 30,000 people and is growing by 2,000 people a day,” she said. “We have people who were a no [to getting the vaccine], but who’ve now become a yes, and now they’re 30,000 people back in line.” 

Sutfin, of DHHS, said the state health department will soon release data on race/ethnicity and vaccine administration, and she noted the state also has a number of equity initiatives in its vaccination program. 

“Community outreach and engagement programs are underway with beauty shops, Black fraternities and sororities, faith-based leaders, minority small business owners, homeless shelters, and others who can help share” information about the vaccines with “minority communities,” Sutfin wrote.

Khaldun also emphasized the state is focusing its efforts on “Michiganders having equitable access to vaccines.”

“We don’t want anyone to have to go more than 20 minutes to get to a vaccination site, and that’s really, really important,” she said during a Feb. 5 press conference. 

In addition to partnering with local institutions and the Michigan National Guard to create and operate “mass vaccination sites in each emergency preparedness region,” Khaldun emphasized the state is working with smaller facilities, such as pharmacies, casinos, barber shops, and more and more to make sure anyone who wants a vaccine will have access to it. 

“We’re looking to ensure there are zero disparities among populations receiving the vaccine and that people have access to the vaccine,” Khaldun said.

This story has been updated with DHHS information on where vaccines are allocated.