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THE SHOT: Jennifer Roberts, assistant director of the pharmacy at UAMS, displays a vial of the Pfizer vaccine. Bryan Clifton, UAMS

About 49% of all people in Arkansas age 70 or older have now received at least one shot of COVID-19 vaccine, according to numbers provided by the Arkansas Department of Health on Friday.

About 22% of that age group have received their second dose as well. Both of the vaccines now being distributed in the U.S. — one manufactured by Pfizer, the other by Moderna — require two shots to be fully effective, though recent studies suggest that even a single dose may protect most people against severe illness. A single-shot vaccine, manufactured by Johnson & Johnson, was approved for emergency use by federal regulators on Saturday.

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Arkansas appears to be doing roughly as well as the national average in vaccinating seniors, though differences in states’ eligibility rules and data reporting make direct comparisons difficult. A report published Thursday by the Kaiser Family Foundation estimated that around 41% of people in the U.S. age 65 and older had received at least one dose of the vaccine as of Feb. 22. In Arkansas, those 70 and older have been eligible since Jan. 18, but ages 65-69 only became eligible on Tuesday, when Governor Hutchinson announced the state was lowering its age threshold.

Dr. Gary Wheeler, a retired infectious disease specialist and former health department official, said the state’s vaccine rollout has improved significantly since January. (Wheeler retired from the department in November but remains involved in weekly planning meetings for the vaccine program.)

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“I think particularly right at the beginning of the distribution, for the people over 70, it was a mess,” Wheeler said. “People were struggling to find out which pharmacies could give vaccines, which ones did not, how to get on [a list.]”

At first, Wheeler said, the amount of vaccine the health department supplied to pharmacies and other providers varied from week to week, leading to confusion about how many doses a provider would have on a given day. The supply has now become more stable, he said. 

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Col. Robert Ator, the retired Arkansas National Guard colonel appointed by Hutchinson to oversee vaccine distribution, said at a press conference on Tuesday that the state now “had a consistent flow of vaccine going out to our providers” each week. 

“What this has translated to is that our providers now feel comfortable scheduling appointments going out into the future,” he said. “They’re willing to set appointments out three weeks or a month in advance.”

Vaccinating seniors is critical because they are at the greatest risk of dying from COVID-19 or becoming seriously ill. Out of Arkansas’s roughly 5,400 COVID deaths since the beginning of the pandemic, more than 80% have been among people ages 65 and up.

The progress of the vaccine rollout for older Arkansans also gives a sense of how the state’s distribution system may perform in the months to come, as more groups become eligible and thousands more people seek out shots on their own. Arkansas, unlike most states, has distributed the bulk of its vaccines through a loose network of about 230 pharmacies throughout the state, along with a limited number of hospitals.

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That means there is no hotline or single point of access for vaccine seekers. Though the health department publishes a map of participating pharmacies and other providers, most older individuals must contact those places directly to track down a spot on a waiting list. The signup process varies from pharmacy to pharmacy. Some arrange their waiting lists on a first-come, first-served basis, while others give top priority to the oldest patients. Some providers ask people to register online, but others accept phone calls.

Wheeler said the lack of a hotline means people have relied on word of mouth for information on vaccines in their area.

“Personally, I think that was a terrible gap, a planning gap,” he said. He pointed to West Virginia, a state that has been widely praised for the speed of its rollout. Though West Virginia also relied widely on pharmacies to administer shots, Wheeler said, “they had a centralized line, and that helped quite a bit in terms of directing their citizens.”

At his Tuesday briefing, the governor said the state had weighed multiple options but ultimately decided a decentralized approach allowed for more flexibility and efficiency than trying to build a new system from scratch.

“If we tried to develop a centralized system, then we [the state] would be calling local pharmacies to actually make the appointments,” Hutchinson said. “It is more manageable dealing with that at the local level.” He emphasized the importance of local volunteers in helping people who wish to be vaccinated.

Often, those who need help simply turn to people they know. Jaime Alverson, a school nurse in the Little Rock School District, said she has served as an informal guide for dozens of coworkers, older family members and friends of the family in the past few weeks who have needed help setting up an appointment.

“I think the biggest problem is internet access or an inability to use the internet. Finding the information is hard,” she said. As of Saturday, the health department website listed some 30 different pharmacies and hospitals in Pulaski County that offer the vaccine, most of which have separate sign-ups for appointments. That alone creates a barrier for older people easily overwhelmed by technology, she said.

Alverson has become well acquainted with several local pharmacies’ booking systems in her role as a “vaccine doula.” She keeps eight browser tabs open on her phone, she said, and refreshes them regularly to look for new appointments that pop up as pharmacies have cancellations or receive new shipments.

“But that is not something my 72-year-old dad can figure out,” she said. “If the goal is to get the most people vaccinated and help the most people in the community, we need to make it easy.”

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On Tuesday, when Hutchinson announced the eligible age threshold was being lowered to 65, he acknowledged that many in the 70-plus category still had yet to be vaccinated.

“Some parts of the state said, ‘We’re done, we need to move on,’ ” the governor said. But other places had made less progress.

A breakdown of total adult vaccination rates by county provided by the health department on Friday showed stark disparities. (The health department said it could not yet provide county-level data on seniors.) Franklin County and Cleveland County led the state, with 19.8% of people ages 16 and up in both counties having received at least one dose. The lowest rates were in Miller County, at 3.8%, and Hempstead County, at 6.6%.

Ozark, a town of about 3,600 in Franklin County, is home to two independent pharmacies participating in the state’s vaccination program, Medi-Quik Pharmacy and Village Pharmacy. Robert Woolsey, the owner of Medi-Quik, said the inadequate supply of vaccine has been a source of constant frustration.

“We could do a lot more here,” he said. “I mean, with four pharmacists [on staff], we were prepared to give triple the amount that we’re giving right now.

“Pharmacists are trying to give this as quickly as they receive it, and the only limiting factor is the availability of the vaccine,” Woolsey said.

Village Pharmacy owner C.A. Kuykendall said the vaccine rollout has been tough on staff who must tell people they’re not yet eligible to sign up for an appointment.

“It’s very easy to sit there in line and administer the vaccine,” he said. “The difficulty is on the employees that are having to do the scheduling and saying, ‘No, you can’t get it, because you’re not in this current phase.’ ”

Kuykendall said the biggest challenge has been coordinating hundreds of appointments made online and over the phone. Because of the vaccine’s short shelf life, careful scheduling is key to avoid wasting doses. 

“In our case, we’re getting the Moderna vaccine,” he said. “There’s at least 10 doses per vial, and sometimes there’s some overfill and we can actually get [up to] 12 doses. But once you draw those from a vial, it has to be administered within six hours.” That often means calling down the pharmacy’s waiting list in search of someone who can show up on site as soon as possible.

“Toward the end of the day, if you have opened a vial and you have doses left … you give them to whoever you can find,” he said. Sometimes, those are people who otherwise would not be eligible. “So if someone hears that someone else under 70 got it, then they’re upset because they’ve been on the waiting list for weeks.”

Both Ozark pharmacists said they have thus far been able to avoid wasting any vaccine.

Except to avoid wasting doses, pharmacists and other providers generally must follow the state’s priority system, which is divided into several “phases.” The highest priority category, Phase 1-A, became eligible in December and included health care workers, first responders and the residents and staff of nursing homes and other long-term care facilities. 

The state is now working its way through a portion of Phase 1-B that includes people over age 65, along with K-12 school employees, higher education employees and child care workers. Other groups in 1-B are not yet eligible but should be next in line, including workers in grocery stores, food service, manufacturing, postal delivery and certain government jobs.

This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.