A Vaccine Success Story Unfolds in an Unlikely Corner of U.S.
Doctor Sherri Young was so excited to get her first shipment of Johnson & Johnson’s Covid-19 vaccine that she loaded a cooler full of 60 doses and hopped in a colleague’s navy pickup at 9 p.m., taking off into the Charleston, West Virginia, night in search of people to inoculate.
A husband and wife in their 40s waited at a quiet bus stop, headed to a homeless shelter. They couldn’t believe their luck. Young stayed out until midnight, vaccinating six people, fewer than she hoped. Two days later, on March 5, her department set up shop at a homeless shelter and at a soup kitchen — and got the shot into 200 more arms.
“The J&J vaccine for me was like a kid at Christmas,” said Young, executive director of the Kanawha-Charleston Health Department. “This is an incredibly underserved population, an incredibly at-risk population, and we were so grateful to have access to a vaccine with one shot.”
More J&J vaccines should soon supplement the county’s 800 doses, which were part of an initial 15,500 dose shipment to the state. President Joe Biden said Wednesday that the U.S. will double its order of J&J shots, creating a total supply, including Pfizer Inc. and Moderna Inc. vaccines, large enough for 500 million people. And the next day he urged states to expand vaccine eligibility to every adult by May 1. West Virginia, a poor state that has already proven surprisingly adept at inoculating its many elderly and at-risk residents, will beat the date easily, officials say.
Kanawha County, West Virginia’s largest, quickly earmarked most of its initial allotment of J&J doses for the homeless and the homebound. The durable and easy-to-transport shot “opens us up to a part of the state that was pretty much closed to us,” said Clay Marsh, West Virginia’s Covid-19 czar and executive dean for health sciences at West Virginia University. In addition to requiring just one dose, the J&J vaccine doesn’t require freezing.
It’s the latest chapter in an unlikely success story under Marsh’s leadership. At the pandemic’s beginning, the Kaiser Family Foundation found more West Virginians were at risk of serious illness from Covid-19 than anywhere else in the country. Among adults, 49% were in the danger zone either because of advanced age or underlying conditions. The state routinely ranks among the worst for obesity, diabetes, and smoking rates. More people per capita die of opioid overdoses than in any other state.
Yet thanks to a quick repurposing of West Virginia’s National Guard, well-established local pharmacies with strong community ties, and a robust telephone hotline, the state quickly became second in per-capita inoculations, behind Alaska. It’s now in the top five for its share of fully vaccinated residents as other states have started to catch up.
Even before any vaccine was authorized, West Virginians put a challenging history to use fighting the coronavirus. The once-thriving mining industry led decades ago to a federal program on the West Virginia University campus that studies black lung disease. It has since expanded to encompass workforce safety. Early in the pandemic, the state decided to make its own personal protective equipment, with university researchers collaborating with federal counterparts to design masks. They were sewed largely by women in a state prisons, Marsh said.
By March 7, deaths in West Virginia had fallen 88% from a Jan. 10 high compared with a 46% decline nationwide, according to the Covid Tracking Project. Hospitalizations have decreased 75% in the state since a Jan. 6 peak compared to a 66% fall across the U.S.
Under Marsh, a native West Virginian who has a passion for tomes on leadership and statistics, the state has taken on vaccinating its remote towns and hamlets with almost military precision. The nerve center is the Joint Interagency Task Force headquartered in Charleston. Led by the National Guard, it includes local health departments and hospital associations, pharmacies and community medical centers.
West Virginia has a population of just 1.8 million spread out over 24,000 square miles (62,160 square kilometers). Its biggest city, Charleston, is home to just 48,000 people. The sparse population presents challenges, but also means the centralized command has little competition with local governments. The Task Force serves as West Virginia’s boots on the ground, strategizing vaccine allocation. Information is sent up to Marsh, who is overseeing the Covid-19 response, and to Governor Jim Justice, where the recommendations are put into motion.
The Task Force eschewed a federally backed program that used employees of large pharmacy chain stores to go into nursing homes to give shots. Instead, it relied on neighborhood pharmacies — and more residents and staff were vaccinated than the national average.
The state has also shown flexibility on age requirements. West Virginia is one of just five states that have made those 50 and older eligible for vaccines, according to Kaiser. (Alaska last week became the first state to open vaccinations up to anyone 16 and older.) The Task Force quickly pushed to include all those 50 and older because statistics showed that age range suffered nearly all of the state's deaths, said Major General James Hoyer, who heads the group.
Officials say the state can improve further once supplies increase. A mass clinic on March 5 in an abandoned Sears in Morgantown was equipped to give as many 8,000 shots, said Albert Wright, chief executive officer of the West Virginia University Health System. That day, it had enough vaccine for fewer than 2,000.
The Task Force is now broadening its focus to people unlikely to get a vaccine without a nudge. The goal is to vaccinate 75% of the state’s 725,000-odd people 50 and older. With the J&J shot, officials think they can get there in six weeks.
“We’ve been pushing vaccines to people, but we have hit a point where we are also going to have to pull people to vaccines,” Hoyer said.
In anticipation of its next J&J shipment, the Task Force is organizing mobile clinics. It has identified 600 miners at four different coal pits to whom they plan to offer shots during shift changes, said Joe Peal, chief of staff for the Task Force.
Community and volunteer organizations are helping identify others who might otherwise be left behind, like 1,350 grandparents taking care of young children, many whose parents died of opioid overdoses. They agreed to get vaccines if a mobile clinic came their way so they could continue to look after their grandchildren, Peal said.
Marsh is looking toward the future, hoping the state will use lessons from the pandemic to improve long-neglected health services. One early lesson, he said, is don’t underestimate West Virginia.
“Others have said that we’re not a very smart people, we’re not a very sophisticated people, we don’t have big sectors of industry,” Marsh said. “Maybe Covid demonstrated that having community, and higher service, and working together, and not fighting each other, but linking arms and looking out for each other is something that’s so foundational to us.”
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