This represents a change in strategy for the Biden administration, which heralded the Hubs as an effective tool to accelerate the country’s vaccine rollout and as a symbol of the president’s urge to give the federal government a bigger role in the pandemic response. However, the FEMA data received from POLITICO makes it clear that the pharmacy locations far outperform the stadiums, arenas and convention centers used as mass vaccination sites.
The vaccination centers, operated by FEMA and partially manned by National Guard troops and other Pentagon personnel, have only given 1.7 million doses since early February. For the past two weeks, the sites were giving about 67,000 shots a day. according to a number of internal FEMA briefing documents and records received from POLITICO. That is roughly 2.5 percent of all doses administered nationwide over the same period. This is based on data published by the Centers for Disease Control and Prevention.
For comparison: The Federal pharmacy program reported on March 11th that it administered nearly 1 million doses in a single day. Over the next four days, the program’s pharmacies administered more than 5 million more doses, according to federal vaccination data received from POLITICO.
“It’s clear that Americans are comfortable relying on their local pharmacies for the vaccine,” said a senior health official from Biden. “The retail pharmacy program will keep growing, and I think you’ll see more people walking down the block to CVS to get the shot than maybe an hour drive to the state offices to get it.”
Another senior administrative official pushed back claims that the FEMA pilot sites were too expensive and not as efficient as the retail pharmacy program, saying the two had different roles. The official said the American economy is losing billions of dollars a day as a result of the pandemic and that the mass vaccination sites are essentially paying for themselves.
FEMA did not respond to repeated requests for comment.
The federal government’s decision to increase the number of doses it sends to pharmacies comes in the wake of government races to ensure every American adult has access to a Covid-19 shot by May 1. Government officials are also aware of Biden’s goal of bringing the country closer to normal by July 4th.
While the bulk vaccination centers often operate smoothly and with minimal waiting times, federal officials have calculated that it is more tactical and far cheaper to rely on the retail pharmacies for the next several months.
Speaking to the country’s governors on March 16, Jeff Zients, the White House’s Covid-19 response coordinator, said the retail pharmacy program was fast, efficient and the dominant nongovernmental channel for vaccine distribution, two people said Knowledge of this was said on the call.
Administration officials said they haven’t gotten to the point where they plan to shut down any of the federal pilot vaccination centers. This week four more locations went into operation. A senior administration official said the additional websites would add to a “complex conundrum that ensures the maximum number of Americans can take their pictures on any given day”.
But senior officials in the White House and FEMA have raised serious questions about how long it makes sense – tax and strategic – to keep them open. That conversation has intensified over the past few days as some governors, including Florida Republican Ron Desantis, have previously and publicly opposed the website’s opening.
According to two people who are aware of these conversations, discussions about recruiting FEMA to build the sites began during the transition. The biggest concern at the time, according to these sources, was that the US had no easy way to quickly increase vaccination capacity to complement what the states were already doing.
Knowing that the vaccine supply would grow sharply in the months that followed, the Biden team was under pressure to set up the mass vaccination sites within a few weeks. And it did. During the course of each week, the federal government sealed contracts with states for the use of large buildings and sports centers.
However, with the introduction of the retail pharmacy program, it became increasingly clear that the pharmacies had more reach.
Everyone said, ‘Is it efficient? Is it inexpensive? “But I don’t think that was the main consideration,” said Craig Fugate, a former FEMA administrator in the Obama administration. “Speed was the number one priority. Do you want to do it fast or do you want to do it cheaply? Some of it is just brute force.”
The Biden team’s initial strategy for the pilot sites was not only to increase the number of doses administered daily across the country, but also to distribute the vaccine more equitably by reaching out to underserved populations. Officials say the pilot vaccination centers are achieving this goal. According to an internal FEMA memo by POLITICO in mid-March, 65 percent of the people vaccinated at the sites are “racial and ethnic minorities”.
The federal government distributes the Covid-19 vaccine through multiple channels and relies on states to carry out the majority of the vaccinations. Each state health department coordinates with the county health authorities to distribute vaccine dispensing across state sites or other local community centers and health programs. How each state distributes its doses depends largely on population and funding of public health programs.
Last week, for example, more than 16 million doses were given to states and about 5.8 million to the federal retail pharmacy program, according to an internal FEMA memo.
The programs implemented by the federal government also require significant state participation and coordination. For example, a vaccination center in New Jersey could be moved out of a local church or hospital and overseen by local officials, but could receive federal funding in the form of cash, personal protective equipment, or staff. Every location in the state that receives federal aid in some way is designated as a federal location, according to two high-ranking administrative officials.
Almost 7,000 federal employees, including 2,000 FEMA employees and 2,000 Pentagon employees, help operate vaccination centers, according to another internal FEMA memo from POLITICO dated March 23. The National Guard has deployed approximately 30,000 National Guard personnel, including nearly 2,000 vaccines. It is unclear how many federal employees are specifically helping the federal pilot vaccination centers.
About 720,000 doses went to the 950 federally funded health service last week Centers in the US – community health facilities traditionally targeting underserved populations. Only 415,000 went to the 1,000 municipal vaccination centers operated by FEMA.
Not every pilot site is the same. The federal government classifies its bulk vaccination centers as Type 1, 2, or 3. Type 1 sites are usually located in large buildings such as stadiums or convention centers and can vaccinate 6,000 people a day. Type 2 locations like hospitals can vaccinate 3,000 people a day. And type 3 centers can vaccinate 1,000 people a day.
A second group of mass vaccination centers is largely run by state and local health partners outside the umbrella of FEMA’s pilot vaccination centers.
These other locations often receive federal funding in the form of supplies and personnel, but are largely overseen by the states. For example, New Jersey National Guard personnel are outside and inside such a location at the Atlantic City Convention Center to control the flow of people. Inside, federal vaccines, some of which bear FEMA insignia, sit on tables administering the shots. Nurses and doctors from a nearby health facility are also present to help with the vaccination.
On a normal day, the Atlantic City site distributes about 4,000 cans a day, officials said. This is more than the number of doses given at some pilot sites.
While the state-run mass vaccination centers achieve their overall grade on most days, there are differences between the locations. According to interviews with eight people who were vaccinated at one of the mass vaccination centers in the past few weeks, the New York and New Jersey locations ran relatively smoothly with minimal waiting times. Others, including those in California, Florida, and Pennsylvania, have experienced some degree of overcrowding. Some people in these areas reported having difficulty finding vaccination appointments at the sites.
And according to POLITICO’s internal FEMA data, not every location reaches its vaccination limit every day. A location in Erie, New York, hit about 80 percent of its limit for three days over the past week. Another center in Duval, Florida reported reaching just 52 percent, although vaccination rates at the site have since increased after receiving additional first doses of the Pfizer vaccine.
Other locations exceed their daily target. A mass vaccination center in Miami administered 173 percent of its target over three days last week. Similarly, one location in Dallas managed 170 percent of its target over the same period.
Senior Biden officials working on the federal government’s rollout of mass vaccination sites say the data is constantly being updated as not every agency reports their numbers on a daily basis.
Overall, despite the delay in reporting, the bulk vaccination pilot sites are still not delivering close to the number of doses in the federal retail pharmacy program. And while FEMA is in the process of opening more high-volume centers – including one in Yakima, Washington, and one in Atlanta – more and more pharmacies are starting to sell the vaccine. According to an internal FEMA briefing by POLITICO, more than 17,000 pharmacy locations began distributing the Covid-19 vaccine on March 17.
Several governors have told the White House that they are dissatisfied with the inclusion of federal site vaccination numbers in their statewide totals, arguing that they are lowering their averages. The complaints have surfaced over the past three weeks as governors continue to urge the CDC to change the way it displays vaccination rates on its publicly accessible dashboard. Two senior administrators aware of these conversations say the CDC is working on a new dashboard that will separate federal vaccination programs from state programs.
When that happens, Zients said on a recent call to governors, some state vaccination rates will fall as the retail pharmacy program will also be segregated from their totals.
As vaccinations continue to rise across the country, some senior government officials are wondering whether the money they are spending on maintaining the mass vaccination centers as well as some smaller community vaccination centers is worth it.
“We see tremendous potential in the retail pharmacy program,” said a senior health official from Biden. “More and more pharmacies register for sales every day.”
Others argue that FEMA’s pilot sites fill a large gap in vaccine adoption because they are in areas traditionally underserved. And if they did close, the federal government would lose a critical platform for delivering on its promise to ensure the Covid-19 is distributed fairly.
Given that, the cost shouldn’t necessarily prevent more FEMA pilot locations from opening, Fugate said – because the country is still in the midst of a deadly pandemic.
“When the dust settles, the critics come out and ask, ‘Why are you spending so much money doing something?'” Fugate said.
Rachel Roubein contributed to this report.