Kansas vaccine divide: While WyCo struggles to get shots, rural county gives it away
Wyandotte County could put 20,000 Covid-19 vaccine shots in the arms of its residents a week. If only it had that many to give.
Instead, the county is getting between 2,000 and 3,000 total doses a week, with most of those going to the health department of the Unified Government of Wyandotte County/Kansas City, Kansas.
As vaccine doses trickle into the fourth largest county in Kansas, with a population of more than 165,000, health officials have prioritized, among others, school teachers, grocery store employees and food processing plant employees — those vulnerable to the worst effects of the novel coronavirus.
That leaves a few shots a week left over for those 85 or older, also at high risk, as Kansas enters phase two of its vaccine distribution plan, which allows Kansans age 65 and up to get their shots.
“That’s really small numbers,” said Juliann Van Liew, director of the UG Public Health Department. “I think from our community perspective it’s our lack of ability to provide for our 65 and older folks right now that’s particularly frustrating.”
Meanwhile, in western Kansas, the Stanton County Health Department advertised on social media a vaccination event on Thursday at the 4-H building in Johnson, Kansas.
“For any one who is 18 years old and over,” the Facebook flier read. “No appointments necessary! First Come First Served.”
That news came as a surprise to Marci Nielsen, chief adviser for Covid coordination for Gov. Laura Kelly.
“This is the first time I’m hearing about it,” Nielsen said. “It doesn’t comport with what our recommendations are.”
The health director in Stanton County, population just over 2,000, told a reporter she could not discuss vaccines.
The disparate experiences between Wyandotte County, which has three mass vaccination sites ready but struggles to get enough vaccine to administer it to its senior population, and Stanton County and its ability to invite anyone 18 years or older to get a shot, illustrates part of the difficulty facing Kansas as it tries to find its footing early on in its vaccination program.
Missouri has experienced a similar uneven distribution of the vaccine.
Data from the Centers for Disease Control and Prevention early last week placed Kansas, along with Missouri and Alabama, as the three lowest-ranking states in the number of vaccine doses given. (Kansas officials dispute the CDC’s conclusions, saying the state’s lagging ranking is attributable to delays in reporting as opposed to foot-dragging in giving out doses.)
Missouri data show that many rural counties have vaccinated at a faster pace than their urban and suburban counterparts.
In the far northwestern corner of the state, about 20 percent of Atchison County residents have received at least one dose so far. That’s more than double the rate of vaccination in St. Louis and Kansas City-area counties. On Friday, the state reported Jackson County had vaccinated about 7.1% of its residents.
Across Missouri, 9.7% of residents had received at least one shot by Friday, the state reported.
With criticism mounting, Missouri Gov. Mike Parson on Thursday rebuffed concerns that the vaccine rollout was disproportionately benefiting rural residents. State leaders said mass vaccination events held by the National Guard in rural parts of the state were meant to offset the high output of vaccines from big hospitals in Kansas City, St. Louis and Springfield.
“The idea that because I come from rural Missouri and there’s some kind of magical divide, that I’m taking care of rural Missouri more than I am urban areas is just false,” Parson told reporters.
The situation in both states may improve soon.
Kelly said on Friday that her discussions with the Biden administration indicated that Kansas should receive 90,000 doses of the vaccine this week, a doubling of what it got three weeks ago.
Missouri officials said recently that they, too, were told they would be receiving a bump this month.
A recent report in Missouri found that “vaccine deserts” — areas with limited-to-no access to the vaccine — were expanding in the state’s biggest cities despite shrinking for the rest of the state.
In Kansas, an analysis of state data shows that larger counties tend to receive fewer doses per 1,000 residents than less populated rural counties.
Johnson County, the largest county in Kansas, received the lowest number of Covid vaccine doses per capita in the state’s weekly shipment last week. Johnson County got 5,850 doses, according to KDHE data, and has 602,000 residents. That works out to 9.71 residents per 1,000 receiving a dose.
By comparison, Pawnee County, with 6,629 residents, got 500 doses, or 75.43 doses per 1,000 residents.
Sanmi Areola, director of the Johnson County Department of Health and Environment, said the county received 13.75% of the state’s overall vaccines, while its population is nearly 21 percent of the number of people who live in Kansas.
“We should be getting, in our opinion, slightly more than we are,” he said.
Public health officials in Kansas’ larger counties say they’re having a difficult time getting information from the Kansas Department of Health and Environment about how it makes decisions on where and how many vaccines to distribute.
Interviews with those health officials suggest frustration, a feeling shared with residents who aren’t sure when they can get their vaccine, that the initial distribution of vaccines has not been adequate.
“Clearly not,” Van Liew said. “Or we would have millions more people vaccinated, unfortunately.”
Counties say they’re prepared
Last fall, the Wyandotte County Health Department paid $24,442 to order ultra-deep freezers.
It wanted to prepare, knowing that trials for Covid-19 vaccines were well underway and there would be a need to store vials at temperatures far colder than the arctic air currently settling over the Midwest.
When those freezers arrived in December, they were part of a larger mass vaccination program that the Unified Government wanted to have ready to reverse the worst pandemic in more than 100 years. The UG had three locations, including the former Kmart across Interstate 635 from the old Indian Springs Mall that’s equipped to administer more than 20,000 vaccine doses a week.
With vaccines coming to Wyandotte County in a trickle, UG officials decided to keep one of the sites closed.
The county’s readiness has been frustrated by a slow and opaque response from Kansas government, which is responsible for allocating doses of vaccine it receives from the federal government.
In some cases, the state is approaching Wyandotte County with vaccine tasks it has already completed.
“The fact that right now that it’s February and now the state is asking us if we need some sort of system for registering and scheduling people, that shouldn’t be how it is, right?” Van Liew said. “We have already now invested hundreds of thousands of dollars into the technology we need because we couldn’t wait until February to do that kind of work.”
Pawnee County health officer Cheryl Hoebrecht, whose county had the highest per capita rate of vaccine doses last week, has a sunnier outlook.
Hoebrect said the list of people wanting a vaccine is lengthy, but said the county gets by with what it receives from the state.
“Do we wish we had more? Well, yeah,” Hoebrecht said. “The more we have the more we have to give. We’re not stressed with the amount we are getting.”
In Lane County, nearly 300 residents have received at least one vaccine dose, said county health department director Arlene Doll. That’s not a huge number, but in one of Kansas’ least populated counties with about 1,500 residents, it represents nearly 20% of those who live in Lane County.
At the current pace, Doll hopes to have everyone on the county’s waiting list vaccinated in the next week or two.
“When you know everybody in your county it’s easier,” she said. “We feel very fortunate.”
She said she could but has not requested more than the weekly 100 doses sent by the state. The only nurse in the health department, Doll said she would struggle to give more than that amount in a week.
The health department is reserving its first doses for those who live or work in Lane County.
“To me, you’ve got to protect your own,” Doll said.
That includes folks like the UPS driver who lives out of the county. Doll said she offered the vaccine to him, because he’s in and out of local businesses five days a week.
Still, Lane County gets plenty of requests. People with some connection, whether they used to live there or own local property, have tried to get on the waiting list. Doll said one man in his 70s called from Newton, more than three hours away. He was apparently trying to call every local health department across the state to secure a shot for himself and his wife.
“I feel like people are desperate,” Doll said. “KDHE is telling them to call the smaller surrounding counties where they live because they may be able to get their dose quicker than they can in bigger counties. I’ve had more than one person tell me that when they call in.”
KDHE doesn’t publicize its formula for how it allocates the vaccinations it receives from the federal government to different parts of the state. It provides a summary instead.
“The number one is per capita...for the allocation,” said KDHE secretary Lee Norman at a press briefing last week. “But there’s other metrics. There’s some counties that in terms of the social determinants of health that have worse health outcomes and nutritional status and the like that have weighted a little bit higher.”
Another complication is how vaccines are packaged. The Moderna vaccine, which arrives in little pallets of 100 doses each, tends to go to rural counties because it does not require as deep a freeze as the Pfizer vaccine.
That means the state can’t parcel out doses with precision.
Norman said if a smaller county needs 240 doses, it might get 300 because the shipment of vaccines can’t be broken up. The next week, it might get 200 to even things out.
Nielsen, the governor’s adviser, said the KDHE formula also takes into account vulnerable people who are likelier to die from a Covid infection, as well as how willing counties are to accept vaccines.
Nielsen said she understood concerns from people in larger counties — she lives in Douglas County — who have anxiety about getting the vaccine.
“I guess the first thing I would say is remember there’s a shortage, so that’s the big problem is not everybody is going to get vaccine,” Nielsen said. “Even the way a county might choose to prioritize their vaccine could potentially impact what their inventory is at any point in time.”
Targeting high-risk communities
Wyandotte County shares many of the characteristics reflected in KDHE’s prioritization plan. It’s one of the largest counties, it’s been battered by Covid infections, it is ready to administer large numbers of vaccines and it has areas that are densely populated with low-income and minority populations that are most vulnerable to the coronavirus.
The slow distribution of vaccine to the county has meant public health officials initially prioritized certain professions like health care, education, postal workers and child care providers — all jobs that tend to skew white and middle- to upper-middle class.
Mindful of unequal distribution of the vaccine, Van Liew said the county plans to target three zip codes it has identified as the most vulnerable to the coronavirus, based on the rates of infection and the number of residents who lack health insurance coverage, an indicator of income and health outcomes.
“There are portions and people in our community who by the nature of where they live and their employment situation and their comorbidities are at higher risk so it is our job as a health department to figure out who those people are and to get the vaccine to them,” Van Liew said.
Those zip codes are:
66101 — generally downtown Kansas City, Kansas, east of 10th Street between Fairfax and Armourdale.
66102 — a long stretch from 10th Street west to College Parkway, between Parallel Parkway and Interstate 70.
66105 — Armourdale.
The county worked on its own social vulnerability index, a way to identify not only who is likely to get the coronavirus, but to go further and identify who was also likely to die if they got it. Among those likelier to die were those who had less access to health care and lower income to manage if they had an infection.
Jason Glenn, an assistant professor at the University of Kansas Medical Center’s department of history and philosophy of medicine, said that, for example, in healthcare emergency room and family doctors have a high risk of contracting the coronavirus, but also have a lower risk of dying.
“So your lowest wage earners, like your CNAs (certified nursing assistant), your orderlies and whatnot, those folks had a much higher vulnerability of mortality if they were exposed to the virus,” Glenn said. “There’s a number of reasons behind that: The lower the income you make, the more likely you are to be a person of color, and the more likely you also are to have any of the comorbid conditions that Covid likes to eat up.”
The Star’s Katie Bernard contributed to this report.
This story was originally published February 14, 2021 at 5:00 AM.
