Some state lawmakers say many Missourians are feeling left out of the state’s coronavirus vaccine efforts. The Missouri House Committee on Health and Mental Health Policy held a public hearing this week to hear from state officials about Missouri’s vaccination plan and the state ranking low in the rate at which citizens are getting immunized.

Robert Knodell, the governor’s deputy chief of staff, says the state has vaccinated 7% of its population.

“Which if you look at the latest data from Kansas, they are at 6.6%. If you look at Illinois, they are at 6.8%. If you look at Iowa, they are at 6.3%. So, we’re seeing some good progress,” says Knodell.

According to state data, Missouri has completed 632,213 total doses.

More than half of the state’s weekly doses of COVID-19 vaccine will be going to larger hospitals in each region of Missouri this month. Another 23% will go to mass vaccination events, and 8% each will go to local public health departments, federally qualified health centers, and other community providers. The state Department of Health and Senior Services (DHSS) says the hospitals chosen were based upon the ability to complete 5,000 vaccinations per week.

Representative Cyndi Buchheit-Courtway, R-Festus, says citizens in her rural district are struggling to find vaccine.

“What are we supposed to tell our constituents who live mostly in a rural area that can’t do 5,000 doses a week obviously,” she asks. “They’re feeling like they are being forgotten in this. They’ll call their health department, or their hospital and they’re told to call their health department. Their health department says they don’t have any doses. They call the county next to them. Their county next to them is saying ‘You don’t live here. So, we can’t vaccinate you.’”

DHSS Director, Dr. Randall Williams, says the state is addressing the vaccine need in rural communities. Several high volume coronavirus vaccination events are being held this week throughout the state.

“That is one of the primary reasons the governor activated the National Guard,” says Williams. “They can go into those regions that don’t have a fixed structure like a big hospital or maybe not even have a Wal-Mart or an independent pharmacy. That is why we are doing nine of those sites every week.”

Adam Crumbliss, the director of the Missouri Division of Community and Public Health, says vaccine has been delivered to nearly every zip code throughout the state.

“When folks are looking and they are thinking that their community is being left out, when you look at the data and the distribution that we see so far, there are some places where we’re a little off the point. At one point in time early on, it was 91% of the zip codes in Missouri had individuals that have been vaccinated. My understanding, and I have not seen the data this week, but that’s increased even further,” he says.

The vaccine, which the state does not touch, goes directly to the providers. The Pfizer drug comes in allotments of 975 doses. For the smaller health systems, dividing up those doses takes more work. But Williams says the state is putting in the extra work to reach all regions of the state.

According to Crumbliss, cold storage of the vaccine has been a logistical challenge.

“If you have 975 doses that have to be maintained at ultra-cold storage of -70 degrees, there are some communities where that was just not an option. What we tried to do in our initial allocations, was to identify first a primary storage location structure where we knew we knew we had facilities in Missouri that could handle that level of storage. That predominantly fell in line with your major research institutions in the higher education capacity as well as the high throughput healthcare systems,” he says. “There were some other locations in the state of Missouri that had those capacities, but they were few and far between. And the reason for that is because not everybody has a -70 degree freezer with space sitting around in their facility. They’re not cheap. They’re not easy to get. There was a run, essentially, in the market on some of those ultra-cold storage units. So, for those that felt like they wanted to make the investment, they couldn’t. For them, it was a matter of ‘I can’t do 975 doses of a single tray of Pfizer. So, I would have to do Moderna for my distribution.’”

Representative LaDonna Appelbaum, D-St. Louis, cites St. Louis County Council Chair Lisa Clancy saying the county has received 4,875 total vaccine doses so far. Williams says the state has a much different figure.

“We’ve had 87,000 doses in St. Louis County – primary doses,” he says. “The very first case in Missouri was in St. Louis County. We are incredibly sensitive to St. Louis County. If you look at the very early part of the epidemic in Missouri, St. Louis County was literally the epicenter of the disease. In that area, there are large healthcare systems that are designated – BJC, SSM, and others that we will want Spring (Schmidt) and Sam (Page) to coordinate with to supplement the vaccine they are getting every week going forward. In addition, we expect as contingent on getting vaccine, the large healthcare system that are getting vaccine every week, work with Spring and Sam to vaccinate especially those most vulnerable areas that we know are at higher risk of morbidity and mortality.”

Representative Patty Lewis, D-Kansas City, says Jackson County did not received its first portion of vaccine last week.

“Just want to echo what the vice chair said rural feeling forgotten,” says Lewis. “I’m here to tell you that urban feels forgotten, too.”

Crumbliss says Truman Medical Center in Kansas City is one of the state’s largest recipients of vaccine. He says he can talk to Truman about working with the county to distribute vaccine.

Missouri health care workers are allowed to get their coronavirus vaccination, but actually getting one could be another story. Representative Michael O’Donnell, R- St. Louis County, says the workers are now competing for the vaccine with those 65 years and older and citizens with certain health conditions.

“There’s a lot of other people, whether you have got a surgery center, an outpatient surgery center, or like I said dentists. I feel like those people have been kind of thrown into the masses now. We’re discussing here how difficult it is for people. Those people are treating patients daily. They are in people’s faces all day,” he says.

Dr. Williams says the state had to make tough decisions about who would get the vaccinations first.

“Certainly, we have great appreciation for our dentists for lots of reasons. Lots of times they treat pain. If that pain isn’t taken care of, people go to the ER. So, people don’t always appreciate just how much they contribute to the overall healthcare system,” says Williams. “I certainly understand their concerns. I also hear it from morticians. I hear it from opticians. I hear it from optometrists who are in the face of people. But back in December, our priority was clearly people involved in acute care of sick patients.”

Representative Kimberly-Ann Collins, D-St. Louis, says in-home health care agencies have not been prioritized the way they should be.

“I have a total number of 26 home health care agencies in my district – in-home health care,” says Collins. “None of those agencies – not one, not a single soul, not a business owner – has been reached out to from the state.”

Crumbliss says his office is working with the Division of Senior of Disability Services to reach those businesses.

“Local public health agencies often are doing the work for populations that others can’t reach. I agree that that’s got to be a population of where we continue to work with our partners at the local public health agencies and empower them to reach out to those communities,” he says.

Missouri’s homeless population is not yet allowed to get vaccinated. Collins says Missouri’s homeless should not be in phase two of the state’s vaccination priority list. Missouri is currently vaccinating people in different tiers of phase one.

“We do have pop-up shelters in the city of St. Louis and our pop-up shelters do have limited space for sleeping,” she says. “So, we have individuals who are sharing cots. We have individuals who are sharing blankets and that’s the same thing outside when you are sleeping outside. You are huddling up.”

Dr. Williams acknowledged her argument.

“Excellent point, especially this time of year when it’s so cold,” he says. “You bring up an interesting point that now you have a risk factor that’s defined kind of by your circumstances – it’s not age. It’s not heart disease. So, it’s an excellent point. Your normal mechanisms of communications aren’t going to work with homeless people. You can’t do that. We really rely on our community partners, our hospitals and local health departments, who consistently work with those populations because they often end up in the emergency room when things happen. I think they are excellent points and I think we need to double down on our efforts to help that particular population.”

Collins goes on to say certain state prisoners should be moved up in the priority list.

“Inmates who are a part of the (Missouri) Vocational Enterprise Program, those inmates who are working for free – free labor. Convict leasing is still legal in the United States of America under the 13th Amendment of the Constitution. So, inmates who are producing free labor, who are building chairs, making masks, doing whatever, wouldn’t you agree in their work under the state, wouldn’t you agree that they should be under phase 1, tier 3, because they are basically government workers not getting paid. And this is a genuine question,” she says.

Williams says he has not addressed that issue.

“I mean, that would be another thing that I would think would go through equity through our committee, he says.

Karen Pojmann, spokesperson for the Missouri Department of Corrections, says the inmates don’t get paid much, but they do get paid.

“They also earn Department of Labor apprenticeship certification through MVE jobs. And it isn’t convict leasing; they don’t do work for private companies,” she says.

Representative Doug Clemens, D-St. Ann, says Missouri’s prisons are a coronavirus “hotbed”.

“The positive cases inside and around a prison are pretty staggering,” he says.

Crumbliss says the Missouri Department of Corrections maintains it is doing consistently better than its peer organizations around the country at combatting coronavirus transmission within its institutions. He credits the early intervention and education with prisoners and staff.

Clemons says he has been in touch with correctional officers.

“I wonder if maybe you could add them into the distribution committee as just a reach out and talk to these officers,” he says. “They feel that they’ve been underprovided for in terms of protective wear and in terms of guidance. We have guards walking around infected, sick, a couple have actually passed on. Please interact with these folks.”

Pojmann says 0.4% of the offender population is affected by COVID-19 and most facilities have 0-4 active cases.

“The only prisons with more than four cases are the reception and diagnostic centers, where COVID-positive offenders are being sent from county jails, a situation that, unfortunately, is out of our control,” says Pojmann.

Missouri’s prison population consists of about 23,000 inmates.

In early December, the department began installing 1,400 ionization generators in air handling systems within the prison system.

“Since then, the number of active COVID-19 cases has dropped by more than 80%, which is prettying exciting,” she says.

According to Pojmann, the agency is testing the wastewater at all locations. She says COVID-19 in wastewater has declined at nearly every facility to undetectable levels.

Pojmann says the department has started vaccinating staff, and all of its facilities are ready to start vaccinating offenders in Phase 1B-Tier 2 (over 65 and/or with serious medical conditions) as soon as a supply is available; more than one-third of offenders are eligible in this tier. A vaccination event is being held Monday for staff at Algoa Correctional Center, Jefferson City Correctional Center, Probation and Parole offices in Jefferson City, and maybe for some in the central office.

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