The Local Strategy

The Texas vaccine allocation program overseen by DSHS has, at least until now, been unable to provide enough doses to meet local demand and need, even with rationing measures to limit eligibility to high-priority groups.

With three vaccines now authorized and available, including the new Johnson & Johnson jab that only requires one shot, and ramped-up federal efforts to get vaccines to retail pharmacies and grocers nationwide, both public and private providers eagerly anticipate large influxes of vaccine into Travis County. President Biden last week announced his goal to make all U.S. adults vaccine-eligible by May 1.

Until scarcity is no longer the norm, though, vaccine prioritization remains complicated and only partly within the control of local policymakers. There are more than 350 registered vaccine providers in Travis County, but Austin Public Health is the largest, consistently receiving 12,000 weekly doses of the two-shot Moderna vaccine since DSHS first designated it in January as one of Travis County’s two “vaccine hubs.” The other is UT Health Austin, the clinical arm of UT’s Dell Medical School, which only gets 2,000 doses a week, many of which have gone to local health care workers. These hubs were intended to serve the most people possible, outside of clinical settings, with the limited amounts of vaccine available.

As a public health agency, APH is typically a safety-net provider of vaccinations for low-income and uninsured residents (it also works to control tuberculosis and sexually transmitted infections, including HIV, for all Travis County residents). Its regular outreach efforts, such as for seasonal flu shots, do target those burdened by existing health inequities. But as a hub, APH is required by DSHS to make the COVID-19 vaccine available to all eligible residents, which now includes an array of essential workers, anyone over 50, and adults with existing conditions that increase the risk and severity of the disease. For nearly three months, APH has effectively been the only option for hundreds of thousands of vaccine-eligible Austinites who’ve been urged to not delay getting their shots, a group that DSHS is allowing to grow larger without actually providing more doses to its hubs.

In recent weeks, Travis County has coordinated weekend events at a mass drive-through vaccine site at Circuit of the Americas, which lies between Del Valle and Creedmoor, to shoulder some of the burden that had been falling on APH. The COTA drives, which also reach nearby Bastrop, Hays, and Caldwell County communities, use doses allocated to Ascension Seton and CommUnityCare, the region’s largest providers of care to the uninsured and medically underserved, and have sought to reach their patients as well as local educators and child care workers.

Recently, APH outlined two possible scenarios for the weeks ahead to Austin City Council and the Travis County Commissioners Court. If more vaccines are distributed by retail pharmacies and private health care providers as well as through the public and nonprofit agencies, 85% of Travis County (the upper threshold for herd immunity) could be vaccinated in 12 weeks, according to APH Director Stephanie Hayden-Howard. Alternatively, mass distribution events facilitated by APH, scaling up the current efforts at its sites and at COTA, could get the county to herd immunity in eight weeks. That plan could cost between $1.8 million and $2.5 million per week to cover
staffing, with an additional $400,000 per walk-up or $800,000 per drive-through per month.

Beyond those scenarios, “the strategy is really out of our hands,” Interim Health Authority Dr. Mark Escott told the Chronicle. “What we can infer from what the federal government has done is that it’s likely they [will] increase allocations to the private sector, to the pharmacies, to the clinics, to the other traditional settings where people get vaccinated, rather than … to the hub sites.” City and county leaders have concerns that scenario would continue to miss people in Eastern Crescent communities that lack those access points. But Escott thinks that path could also free up resources to concentrate on “people from low-income communities, folks that don’t have health insurance, our communities of color – those who normally depend on Austin Public Health. All of our resources can be focused on those individuals [at] smaller sites which are closer to home” – in other words, meeting people where they are, within the community, as Woody urges.

Council Member Vanessa Fuentes, whose majority-Latinx District 2 includes Del Valle and other hard-hit Southeast neighborhoods like Dove Springs, is bringing a resolution to Council on March 25 directing City Manager Spencer Cronk to find funding for mobile vaccine clinics, as well as for ongoing COVID-19 relief, and to
mount outreach programs to employers of at-risk workers to encourage support (and time off) for vaccinations.

Ideally, said Fuentes, a mobile vaccine clinic would serve walk-up patients without pre-registration through an online portal, which would address challenges APH knew it would face: “I feel like we should have been at a different place right now. We should have been more proactive and planning for vaccine distribution,” Fuentes told us. APH says it’s discussing partnerships with agencies such as Meals on Wheels Central Texas and Foundation Communities and with private vendors to implement mobile vaccine clinics.

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