Updated 1/24/21; 1/28/21
Several readers wrote me this week to express frustration at the coronavirus vaccine sign-up process and, as a result, their anger with county government. I, too, was frustrated by the signup process, so I completely understand.
The anger with county government is understandable, too, but here in Florida, that anger is misplaced.
Public health governance and the relationship between state health agencies and local public health departments vary from state to state. It is important to understand the roles, responsibilities, and authorities of our federal, state, and local governments in order to properly direct our anger and place our blame.
Florida Has a Shared Public Health System
Most states have decentralized public health governance structures in which local governments are responsible for public health, according to the U.S. Centers for Disease Control and Prevention (CDC).
Florida has a shared public health governance structure. According to the Florida Department of Health:
Public Health is the foundation of Florida’s health care system. Public health services protect us from disease and injury and encourage us to change behaviors that cause poor health. The county health departments improve health status by preventing epidemics, protecting against environmental hazards, encouraging healthy behaviors, preparing for and responding to disasters, and assuring the quality and accessibility of health services. “It is the intent of the Legislature to promote, protect, maintain and improve the health and safety of all citizens and visitors of our state through a system of coordinated county health department services. (Chapter 154.001, F.S.)
Each of Florida’s 67 health departments (one in every county) is led by a state employee and enters into a contract annually with their host Board of County Commissioners. The contracts specify the services to be provided and the revenues that fund the services. The revenue sources might include state funds, county funds, federal funds, fees, Medicaid, grants, and contracts.
Collier County’s FY20-21 contract with the Florida Department of Health can be viewed HERE.
Why We Are Where We Are Today
The frustrations we are experiencing today are related to (1) vaccine supply and (2) vaccine distribution.
While the development of the COVID-19 vaccine came much faster than expected, the rollout has been slower than initially promised, and supply is not keeping up with demand. The United States population is more than 300 million people, yet as of January 22, according to the CDC, only 44.4 million COVID-19 vaccine doses have been distributed. Clearly, there is a long way to go.
On Thursday, President Biden invoked the Defense Production Act to expand the manufacturing of the vaccine, syringes, and related supplies. (See the entire Biden Plan HERE.) But the effect is unlikely to be felt before April due to lack of manufacturing capacity. (New York Times, 1/22/21)
While awaiting more manufacturing capacity, efforts to address the shortage include:
- The National Institutes of Health and Moderna are examining whether doses of the Moderna vaccine can be halved to double the supply, while scientists are looking for other ways to extend availability. (New York Times, 1/21/21)
- Last month, the FDA said that using every drop from overfilled vials of the Pfizer vaccine could boost available doses by up to 40 percent. (Politico, 12/18/20)
- Updated guidance from the CDC allows for a longer interval between the first and second vaccine dose, and the possibility in “exceptional situations” of switching from one vaccine to the other between the two doses. (Washington Post, 1/22/21)
As of January 22, according to the CDC’s COVID Data Tracker, states and localities have administered just 48 percent of the doses that the federal government has shipped to them. In Florida, that figure is 50 percent.
Based on a year “observing, traveling and speaking with dozens of people involved in the development, distribution and administration of the coronavirus vaccine” chronicled in TIME magazine:
According to local health officials, the Trump Administration’s decision to limit the federal government’s role in administering the vaccines left each state to create its own plans for locally distributing the shots and launching programs for getting them into people’s arms. That already-complicated logistical task, they say, was compounded by a lack of funds and a health care workforce already overwhelmed with COVID-19 testing, contact tracing and pandemic-control campaigns, not to mention mixed messages that left states in the dark about how many doses they could expect, and when.
Under President Biden’s vaccine plan, FEMA would operate up to 100 federally run mass vaccination sites, part of a strategy that would dramatically expand the federal government’s role in the effort to corral the pandemic. An efficient vaccine delivery system could deliver millions more shots.
Gov. DeSantis’ Explanation
CDC statistics to the contrary, Gov. Ron DeSantis insists that Florida’s problem has nothing to do with distribution and is simply one of supply. He has called Biden’s plan to involve FEMA a “big mistake.” “That’s not necessary in Florida,” he said. “All we need is more vaccine. Just get us more vaccine.” (Tampa Bay Times, 1/19/21)
A Guest Opinion I read last week in the Naples Daily News (edited below for objectivity and brevity) provides additional insight into where we are today in Florida:
- All county health departments in Florida are funded by the state. [The Governor] appoints the secretary of the Florida Department of Health, who subsequently appoints all deputy secretaries, state division directors and regional public health officials. This means the governor is ultimately responsible, statewide, for the public health functionality, coordinated response measures and crisis response apparatus.
- The governor “punting” — putting the sole responsibility on local county health departments and hospitals to administer the COVID-19 vaccine rollout — is equivalent to the governor punting in the aftermath of a major hurricane.
- The Florida Department of Health once had a $150 million budget to help county health departments fill in service gaps in their communities. That money is now mostly all depleted.
- Between 2010 and 2018, Florida cut funding for county health departments from nearly $1.1 billion to less than $960 million. The number of positions funded by the state has shriveled 27% from about 12,800 in 2010 to just over 9,300 now.
- Although Florida’s population grew by 2.4 million since 2010 — to make it the nation’s third most populous state — Florida slashed its local health departments’ staffing from 12,422 full-time equivalent workers to 9,125 in 2019.
- According to an analysis of state data, the state-run local health departments spent 41% less per resident in 2019 than in 2010, dropping from $57 to $34 after adjusting for inflation.
Is a Solution on the Way?
A significant increase in vaccine supply is unlikely for several months, so the best we can hope for is an improvement in distribution, closing the gap between doses received and doses delivered.
After chaotic first-come/first-serve vaccination events in Lee, Volusia, Citrus and other counties where seniors camped out overnight in cars and lawn chairs, the Collier County Health Department recognized the need for some kind of system for making appointments.
With no help or guidance from the state, they chose Eventbrite. It is an established system that many people are already familiar with and that is being used for the same purpose in several states and even in Britain. At the same time, Public Information Officer Kristine Hollingsworth acknowledges that “every system is going to have a flaw.”
Jared Moskowitz, Florida’s director of emergency management, said on January 14 that a statewide appointment system for COVID-19 vaccinations should be ready within weeks. As of today, however, no further information is available.
Other than that, I can find no information about what else Florida plans to do differently. We are likely to experience more of the same for months to come.
To Help You Stay Informed
In my experience, the most timely sources of information about opportunities to sign up for vaccination appointments are the enewsletters of Collier County Commissioners Andy Solis (register here) and Penny Taylor (register here). Recently, Commissioner Rick LoCastro (register here) and State Rep. Bob Rommel (register here) have also published newsletters with similar information, but how frequently and timely they will be going forward is unclear.
Call to Action
Now more than ever, it is important to let your elected officials hear from you. To comment on the federal rollout of the vaccine, contact the President, your U.S. Senators, and your Congressman. To comment on the distribution of vaccine within the state, contact the Governor, your State Senator, and your State Representative. For contact information for all of them, visit my Helpful Websites, HERE.