Like other governors nationwide, Gov. JB Pritzker has recently taken to criticizing a slower-than-anticipated COVID-19 vaccination effort at Illinois’ long-term care facilities by pharmacy giants CVS and Walgreens.
The companies last fall entered into a federal partnership under the Trump administration aimed at administering vaccines to long-term care facilities beginning in late December.
But last week and this week, Pritzker joined a chorus of governors bemoaning both the program’s slowness and alleging it has trapped viable vaccine doses in the process.
“That program has gone exceedingly slow,” Pritzker said Monday. “All the vaccinations that are necessary for that entire group have been taken out already of our allotment and they sit on shelves because that federal pharmacy partnership is so slow at the job.”
The governor made similar comments on Friday, saying he was “very troubled” by the program’s slow pace, and admonished the companies to “accelerate the pace of vaccines to our most vulnerable residents.”
But CVS is pushing back on Pritzker’s comments, claiming it was the state that made the choice to not “activate” the vaccination programs in half of its long-term care facilities until Monday of this week, thus slowing its own program.
Long-term care facilities are split into two broad categories: skilled nursing facilities and assisted living facilities. The CVS/Walgreens vaccination program began at Illinois skilled nursing facilities on Dec. 28, along with most other states. But only Illinois, Wisconsin and the city of Philadelphia had “activation” dates for the vaccination program in its assisted living facilities on Jan. 25 — the latest in the nation.
According to CVS and Walgreens data, 17 other states, the District of Columbia and the city of Chicago had activation dates for their assisted living facilities concurrent with their activation dates in late December. Other states staggered their activation dates for assisted living facilities through January.
But the Pritzker administration and CVS disagree on which entity set that late activation date.
“As made clear by regularly updated data CVS Health makes publicly available, most states chose activation dates for assisted living and other facilities – meaning, when CVS Pharmacy teams could first visit – well into January,” CVS said in a defensive press release Tuesday.
Walgreens and CVS' daily spreadsheets also stipulate the activation dates were chosen by states in plans submitted to the Centers for Disease Control before the program began.
Pritzker spokeswoman Jordan Abudayyeh maintained the pharmacies were in charge of the scheduling, and an Illinois Department of Public Health spokeswoman told the Chicago Tribune last week also said it was Walgreens and CVS who set the timing.
“If they could have made it through the (skilled nursing facilities) sooner, they could begin vaccination clinics at other (long-term care) facilities sooner,” the spokeswoman is quoted as saying.
Both vaccines currently on the market require two doses three or four weeks apart. In order to achieve full vaccination status in nursing homes, the pharmacies must travel to long-term care facilities three separate times in order to make sure all residents and staff get the chance to receive both the initial and booster shots.
CVS and Walgreens have already made it through their first round of vaccinations in all Illinois skilled nursing facilities. According to CVS data, 49% of the nursing homes CVS has partnered with in Illinois have also received their second dose visits, which is about average among states, whose second visit status ranges widely. Walgreens does not give a percentage for skilled nursing facilities, but says that out of the 269 nursing homes they’re partnered with, they have 102 additional clinics scheduled for the next seven days.
Despite the Jan. 25 official activation date, Walgreens said it was able to begin vaccinations at Illinois assisted living facilities in mid-January “based on further direction from the Illinois Department of Public Health and CDC,” according to spokeswoman Kelli Teno, as the pharmacy was able to “pull forward vaccinations in these facilities.”
As a result, Walgreens has made first visits to 50% of Illinois assisted living facilities. CVS has visited 8% (40) of the 516 assisted living facilities it’s partnered with in Illinois since Monday.
Pritzker last week said he’s received assurances from Walgreens and CVS that the pharmacies will make their first visits to all assisted living facilities in Illinois by Feb. 15. Even so, the state pulled its four veterans homes and congregate care facilities operating under the Department of Human Services out of the program due to its pace.
Abudayyeh said the administration is focused on moving forward and getting long-term care facility residents vaccinated as quickly as possible.
Beyond the pace of the rollout, Pritzker is also not alone among governors criticizing the Walgreens/CVS vaccination program for requiring states give up some of their federal vaccine allocation up front in order to give it to the pharmacy partnership.
The federal partnership, accepted by all states but West Virginia, means that for each shipment of vaccine given to states and large cities, those jurisdictions must reserve a certain amount for the Walgreens/CVS program. But that’s left thousands of doses unused so far in the 30 days the program has been active in Illinois.
IDPH says that out of 537,050 vaccine doses allotted for long-term care facilities, only 110,403 had actually been administered as of Monday, according to the state’s provisional data.
“[The doses] sit on shelves because that federal pharmacy partnership is so slow at the job,” Pritzker said Monday.
CVS, however, says states like Illinois overestimated their long-term care facility populations, and insists vaccine allotment is not an accurate depiction of the program.
“Think of it like a paycheck: it’s like getting a lump sum payment, versus a weekly paycheck,” a Midwest spokesman for CVS said in an email to NPR Illinois. “Pharmacies under the CDC get ‘paid’ weekly in vaccines to administer to partner long-term care facilities, whereas the health centers are getting it in lump sums.”
The spokesman said health centers “are spending their entire supply, but we only receive it weekly and therefore spend it weekly — even though our annual salaries are being posted. As we move 5 weeks into the program, we have been paid 5 weeks of our total salary of vaccines.”
But some states have moved to recoup vaccine doses allocated to the Walgreens/CVS partnership for use among the population eligible for vaccines in Phase 1B, which began Monday in Illinois. This phase includes frontline essential workers like teachers and daycare employees, grocery store workers, first responders, postal workers, public transit employees, corrections staff and inmates and those in manufacturing and agriculture, as well as seniors 65 and older.
According to reporting from POLITICO, states like Oklahoma, Utah and Minnesota, Michigan and Maine have decided to go this route, and other states are considering it.
Utah, for example, is halting new shipments for long-term care facilities this week — instead redistributing nearly 9,000 doses to local health departments, according to POLITICO. Minnesota is reallocating 30,000 doses from the CVS/Walgreens partnership and distributing them to teachers and childcare providers instead.
CVS has also pointed to reluctance among nursing home staff as one reason vaccine doses allocated for long-term care facilities have gone unused. In a CNN interview Monday, CVS Chief Medical Officer Dr. Troy Brennan said 40% to 50% of long-term care facility staff has refused vaccines on the pharmacy’s first visit to sites.
CVS’ Midwest spokesman said the same for Illinois.
“Based on feedback from our teams in the field we’re seeing more vaccine hesitancy among long-term care facility staff when compared with residents,” the spokesman said.
Walgreens has reportedly said the vaccination refusal rate in nursing homes it’s visited across the U.S. is even higher.
Pritzker on Friday said his administration is aware of the phenomenon and has reached out to union representatives for better collaboration on vaccine education efforts.