As New Jersey begins the fifth week of its massive COVID-19 vaccine program, state officials have blamed shipping conundrums, workforce limitations and reporting delays for what has seemed to be the slow pace of the initial rollout.
The federal government is responsible for shipping the coronavirus vaccines to providers in each state, including more than 572,000 doses sent to New Jersey as of last Thursday, according to tracking by the U.S. Centers for Disease Control and Prevention (CDC). As of Friday, more than 175,500 vaccines had been administered (7,400 of them second doses), according to the state, which hopes to immunize 4.7 million people, or 70% of those eligible.
To expedite the process, state officials took initial steps to recruit additional vaccinators, putting out a call for volunteer help early last week. It has overseen the creation of more than 200 immunization sites, including the first two of six “megasites,” which launched Friday.
But it is not clear why New Jersey is not receiving timely reports from these distribution sites. The state vaccination plan, which the state Department of Health updated in mid-December, calls for all vaccine distribution clinics to be enrolled in the state’s existing immunization information system and for data — including demographic information — to be uploaded every 24 hours. All participating vaccine sites are registered and using the system, the DOH said Friday, but some have struggled to report data in a timely manner.
State regulation may be complicating compliance
Despite the federal and state requirements for daily uploads of this data, New Jersey’s own rules may complicate compliance among the vaccine providers. According to the COVID-19 vaccine plan it submitted to the CDC, the state’s current regulation includes a “30-day window” to report data via the state’s system.
DOH communications director Donna Leusner said the 30-day reporting timeline pertains to the state’s other vaccination programs, while COVID-19 vaccinators must adhere to the tighter CDC turnaround time. That said, the state COVID-19 vaccine plan indicates New Jersey’s standing regulation “creates an incongruity with the 24-hour standard established under the CDC Provider Agreement for COVID-19 vaccination.” The plan also notes some vaccine providers have raised concerns about the feasibility of reporting immunization data every day.
“There is no question, I just had a conversation just as I was leaving the office, there is a significant amount of underreporting” of vaccine administration, Gov. Phil Murphy said on Wednesday, declining to name the provider group he had talked to. “I think this is what every American state is going through, frankly. But there is no question, no question that that number is undercounting the amount of shots that have been actually delivered. And by the way, that will smooth out over time. There’s just no question about that.”
The state vaccination plan, which stretches 190 pages with charts and references, highlights the importance of tracking delivery, storage and administration of vaccines manufactured by Pfizer and Moderna, which received emergency approval from the federal government late last year. And those administering the vaccine must report on their work for the state to ensure sites are working efficiently and doses aren’t being wasted, as well as assuring those most at risk do get immunized.
“To bolster the overall pandemic response, the State will link vaccination coverage reporting to the broader set of pandemic response measures, including disease progression and surveillance, healthcare capacity, and public health interventions,” the plan reads. “Mapping of vaccine administration will take place to provide visualization of vaccine coverage for the state by provider type, vaccine type, and population type.”
Leusner said the state expects to make public a dashboard with dosage and demographic vaccination data sometime this week.
The plan repeatedly notes the importance of incorporating lessons learned from the state’s response to the H1N1 flu variant in 2009 in its COVID-19 vaccine strategy. “Without proper accounting, patient safety issues may arise if a consumer receives doses from two different novel vaccines. Inconsistent reporting was a key barrier to the H1N1 response.”
At that time, New Jersey received 2.59 million doses of H1N1 vaccine from the federal government but only 1.11 million doses were recorded as being given by March 2010, the DOH reported. One in 10 of these entries did not list the county of the vaccine recipient; one-third lacked the municipality.
“The NJDOH has focused efforts to address gaps noted during 2009 H1N1,” the plan reads, adding that it is also “developing systems to account for vaccines on a dose-for-dose basis.” The state has also asked the federal government to provide additional help with the tracking and reporting systems, the plan notes.
Getting the full picture
Last week, Murphy and DOH Commissioner Judy Persichilli said delays in getting data from vaccine providers left the state — and therefore the public – without a full picture of the program’s success to date. Since March, as many as 589,000 New Jerseyans have been diagnosed with COVID-19, including some 20,000 likely to have died as a result.
Persichilli said Wednesday the count was also depressed by delays in uptake during the holidays, when eligible health care workers may have been less eager to get vaccinated in case they experienced side effects, as well as ongoing “vaccine hesitancy” in general. “Putting that all together, we believe that the numbers that are showing up in our systems are definitely under reported,” she said, suggesting that more than twice as many immunizations had been performed at nursing homes and other long-term care sites than were formally reported to the state.
When asked Friday, representatives for Hackensack Meridian Health and RWJ Barnabas Health, the two largest health care systems in the state, did not report problems with the state’s data management system at the dozens of sites they are running.
Dr. Puthenmadam Radhakrishnan, a pediatrician who co-chairs the New Jersey Immunization Network, said the organization is not directly involved with the rollout but has been regularly briefed by the state and pleased with the rollout to date. “The (state’s reporting) system is a well tried system that has been working well for the routine immunizations that we had been providing prior to the epidemic so it was a natural platform to start using here,” he said.
However, there were few adult providers enrolled — vaccine programs traditionally focus largely on children — so the state held webinars to familiarize them with the system, Radhakrishnan noted.
“Overall I think New Jersey (put) itself in a good position in being able to roll out the process on day 1,” Radhakrishnan said. “We have not heard of any hiccups” or delays, he said, save the time it takes to manually input the figures. “Although there is a lag in the administration of the vaccines it seems like a good flow through at this time,” he added.
Tracking immunization data
According to the state’s COVID-19 vaccine plan, all sites administering inoculations were to enroll in the New Jersey Immunization Information System (NJIIS), a database launched in 1997 to track immunization information for children and adults. Even before the coronavirus, the system was accessible to more than 12,000 provider sites and contained records for some 4.7 million patients. The state’s technology team is working on upgrades to expand capacity, as well.
NJIIS is designed to securely store vaccine recipients’ name, age, address, race and ethnicity; the CDC also requires all COVID-19 vaccine providers to record nearly two-dozen data points — including details on the lot, series and expiration data on each vial — and has ordered this information to be reported daily.
“These are standard data elements that have been used across vaccines administered in New Jersey,” the vaccine plan notes, and it stresses how vaccine distribution sites must prioritize this tracking and reporting process so that data can be incorporated into the state’s larger public information campaign around vaccination.
In November, Murphy signed an executive order designed to encourage individuals to allow their information to be included in the NJIIS, although they can still opt out. “The change is aimed at maximizing efficacy and efficiency,” the plan says of this revision.