Oregon is lagging behind most states in its COVID-19 vaccination rate. The first Oregonians — health care workers and residents and staff of nursing homes — started getting their vaccines a few weeks ago.

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At the time, state officials said they wanted to vaccinate 100,000 people by the end of December, but less than a third actually got a dose. The numbers have risen since then. But still, according to state data, only about a quarter of the doses that have been shipped to Oregon have been administered.

Oregon Health Authority Director Patrick Allen appeared on OPB’s “Think Out Loud” to talk with host Dave Miller about why the pace is so slow and what’s being done to speed it up. Here are highlights, which have been edited for brevity.

Dave Miller: What has gone wrong?

Patrick Allen: I wouldn’t necessarily say anything’s gone wrong. I would say that what’s happening is, around in Oregon, across the country and around the world, people are unhappy with what is a slow ramp-up. There are some things we knew would happen. And then some things we didn’t expect.

We’ve talked a lot about the cold storage requirements. And that’s certainly an issue. But you’ve also now got a known risk of allergic reaction to the vaccine. And so people need to wait after they’ve received a shot to be observed to make sure they don’t have that happen.

Oregon Health Authority director Patrick Allen, at a press conference Monday, March 16, 2020.

Oregon Health Authority director Patrick Allen, at a press conference Monday, March 16, 2020.

Kaylee Domzalski / OPB

We know there are side effects that, in a small percentage of cases, could be severe enough for someone to want to take a day off work. So the hospital intensive care units and emergency departments are scheduling people before their day off for a weekend or those sorts of things, and then all of this needs to be done while still maintaining social distancing. So it can’t work like many of us remember, lining up in the school cafeteria when we were kids to get vaccines.

Miller: Right now Oregon is 36th out of 50 states in terms of per capita vaccination and near the bottom 40-something in terms of the percentage of delivered vaccine doses that have actually ended up in people’s arms. So everybody is dealing with the same challenges. But we’re doing worse in terms of these important metrics.

Allen: I think you have to put that in context for where we are in the rollout. Right now it’s like looking at the fifth block of a marathon and trying to assess how the race is going. It’s just way too early for that to be a meaningful measure.

What I want to do is be able to continue to build up that percentage of people who get vaccinated and continue to increase the pace that we’re vaccinating people out.

Miller: Pfizer has said that you can store the vaccine with dry ice and coolers, meaning you don’t need to take it out of the delivery boxes and put it into expensive and, in some places, rare freezers. Does that make it easier to keep the vaccine cold without a lot of infrastructure?

Allen: It will keep for up to 30 days in its shipping container, as long as you add dry ice pellets to it. The Moderna vaccine is a little more forgiving. You can keep it in a plain old refrigerator for 30 days.

The challenge with the Pfizer vaccine is kind of the very last mile. The smallest quantity that can come out of a container is 200 doses, and those 200 doses will keep for five days. And so you have to be careful to know that you’re going to be able to use those 200 doses over those five days. And so we’re a little bit limited in how rural you could get, how small you can get, how many people are signed up to get the doses.

Related: Oregon’s COVID-19 vaccine rollout still behind schedule as authorities try to pick up the pace

Miller: It seemed like a big deal a few weeks ago when we learned that Oregon and other states were going to be getting fewer doses than what the feds had originally announced. But given that the majority of doses that have been delivered haven’t been administered, is it fair to say that that has not really proved to be a major issue?

Allen: We’re in kind of this weird place where we both have too much vaccine and not enough vaccine. If we had 4 million doses ready to go, we could open up the usual kinds of channels that we use to give the flu vaccine, and we wouldn’t have to worry about prioritizing.

But because we’re prioritizing people, we add yet more complexity to how the vaccine gets administered and it causes this, “who goes next?” kind of a backlog.

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Miller: Can you give us the basic outlines of what is a recent policy shift that followed the governor’s call to speed things up?

Allen: Let me give you a couple of really simple examples. Frontline health care workers in hospitals are in the first group. Home health care workers are in a later group. Residents in nursing homes are in the first group. People who live in other kinds of assisted living facilities are in a later group. Our expectation was to go first through group one, then group two, then group three, then group four. We’ve decided, now that we really have gotten most of the way through group one, is to get them to all go at the same time.

So (we’re going) from just giving shots to people in nursing homes to giving people shots in all those assisted living facilities. We’re working in partnership with hospitals and with local public health to begin opening up clinics that will give shots to all kinds of health care workers.

Miller: The governor called for a rate of 12,000 shots a day. Right now it’s 3,000 or 4,000 or 5,000 shots a day. How much authority does the Oregon Health Authority have to actually meet that goal?

Allen: Yeah, I don’t know that it’s a question of authority as much as it is facilitation. We’ve got vaccine that is now at local public health offices and clinics. It’s at local firehouses and emergency services providers. It’s at hospitals. What we need to do now is to facilitate hooking up populations that are eligible to be vaccinated with these sites.

Miller: Who is next on the priority list after the health care workers of various kinds and people who live or work in various kinds of care facilities?

Allen: Next come education workers. the governor identified education as a critical workforce and she really wanted to be able to focus on opening schools, and so she indicated that they would go next. We will consider them the first group of Phase 1 b.

Related: Gov. Kate Brown wants Oregon kids back on campus Feb. 15, but many teachers won’t be vaccinated by then

And when we talk about education workers, we’re not just talking about teachers. We’re talking about instructional assistants and nutrition workers and bus drivers. There are about 75,000 public and private education employees across the state. And that would be the next group that will go.

Miller: A panel of the Centers for Disease Control and Prevention looked at the data, in particular death rates, and they decided that people 75 over should be next in line to receive the vaccine. That was their recommendation. In Oregon, people over the age of 70 make up less than 20% of the population, but about 77% of all COVID-19 deaths. How can the state justify prioritizing teachers over the demographic group that is by far associated with the highest risk of death from this virus?

Allen: By prioritizing long-term care, you address the most impacted — not just by age, but also by setting — of where those deaths are coming. It’s not necessarily just age, but also that living setting that indicates your risk. And so by prioritizing those people higher than the CDC did, we address that directly.

Miller: Still, many thousands of older Oregonians are very susceptible to the virus and not living in long-term care facilities. What is the argument for why they should wait behind a 42-year-old teacher who is much less likely to die from COVID-19 than the 82-year-old?

Allen: Well, because we’re asking the educational workforce to come back into work and be in contact with lots of people. Now we think that can be done safely with masks and social distancing and all the guidance that has been provided to schools.

But we’re asking them to take an enhanced risk, that someone who is a senior is often able to better shelter themselves from.

Miller: It seems to me that not prioritizing the vaccination of older Oregonians who are not in congregate care facilities will lead to more Oregonians dying. Do you think I’m wrong about that assumption?

Allen: The fact that we don’t have enough doses to vaccinate everybody in the space of time that we do with the flu vaccine means that any kind of prioritization, any kind of time schedule that it’s going to take means that people will continue to get sick. Some of them will continue to be seriously ill, and some of them will die.

That’s why throughout this vaccination process, we need to do the things that we’ve done really successfully in Oregon to protect people by wearing masks and washing your hands and avoiding large groups. That stuff will need to continue. And that’s what’s helped us achieve the fourth-lowest fatality rate in the country.

Miller: How concerned are you about people who are either skeptical or fully opposed to getting vaccinated?

Allen: I continue to be very concerned about that. We have focus groups and surveys in the field right now to continue to refine our messaging and communications. To try to overcome that. There’s been some encouraging developments in national survey data. I’ve seen where before the vaccine was real, you saw numbers that looked like 40% or 50% of people potentially were vaccine-hesitant. Now that it’s actually here, that seems to have dropped. But I think it continues to be a serious concern.

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