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Vaccine 'Hunger Games'

Late planning, decentralized oversight, a ‘Hunger Games’ sign-up: How Illinois has struggled more than most states rolling out the COVID-19 vaccine

Marj Leopardo is 85. Her husband, Sam, is 88. They both have health issues. And their days are now consumed with one thing: the vaccine hunt.

The Crystal Lake couple are, on paper, just the kind of people the government wants at the front of the vaccine line. But they live in a country that’s struggled with the rollout, and in a state that’s struggled more than others.

So that has meant reaching out daily to doctors’ offices, pharmacies, hospitals, the local health department. It has meant their daughter stalks websites to hunt for an elusive open appointment. And they watch others, in other suburbs and other states, snap up shots.

“It’s really taken over our lives,” Sam said Tuesday.

Added Marj: “After a while, your brain feels like mush.”

The Leopardos find themselves in the center of the widespread struggles of Illinois’ first six weeks of mass COVID-19 vaccination.

Sam, left, and Marj Leopardo at home on Feb. 3, 3021, in Crystal Lake. They're in their 80s and haven't received COVID-19 vaccines.
Sam, left, and Marj Leopardo at home on Feb. 3, 3021, in Crystal Lake. They're in their 80s and haven't received COVID-19 vaccines. (Stacey Wescott / Chicago Tribune)

The Tribune spoke to more than a dozen health officials, researchers, doctors and families, and analyzed federal, state and local datasets to try to assess a system that’s considered key to ending the pandemic but, so far, has attracted widespread frustration.

As of Friday, roughly 960,000 Illinoisans have received at least one shot — and about 270,000 of them have received both shots. But the state’s pace has ranked in the bottom third of the country for residents vaccinated, when adjusted for population sizes.

Gov. J.B. Pritzker’s administration has pointed to different metrics to argue the state is doing relatively well at vaccinating people, particularly recently. And echoing other states’ complaints, Illinois officials have blamed rollout frustrations on scarce supplies and poor planning by the Trump administration.

“To accelerate immunizations, we need our federal partners to align their efforts with ours, to help solve practical operational issues,” the state’s health director, Dr. Ngozi Ezike, testified at a virtual congressional hearing Tuesday.

Still, Illinois’ lagging vaccination numbers have become political fodder in the national finger-pointing over the slow rollout. At that same congressional hearing, a West Virginia Republican noted Illinois had used up less than 60% of vaccine it had received, compared with his home state, which had used up more than 80% by then.

“Look, Operation Warp Speed created the vaccine. It’s the job of the states to put it in people’s arms. And it seems that (some) states can’t even get that right,” said U.S. Rep. David B. McKinley.

Logistics researchers told the Tribune that the government hasn’t released the level of data needed to figure out more precisely why Illinois is lagging most states. But there are red flags in what has been released.

Illinois officials were late to try to hire outside experts to manage the rollout, then abandoned that effort to assemble their own team just weeks before the first doses showed up.

The state opened up shots to roughly a fourth of all residents, who qualified because of their ages or professions, then let a largely decentralized system figure out who’d be targeted and how fast to administer shots. There are no agreed-upon rules for what counts as successful. The state and Chicago each get shots to distribute, and they measure things differently.

Gov J.B. Pritzker gives a news briefing Jan. 27, 2021, at the drive-thru COVID-19 vaccination site set up inside of the Lake County Fairgrounds.
Gov J.B. Pritzker gives a news briefing Jan. 27, 2021, at the drive-thru COVID-19 vaccination site set up inside of the Lake County Fairgrounds. (Stacey Wescott / Chicago Tribune)

Some local health departments have been allowed to build up sizable inventories while others did their best to inject shots in arms as quickly as they arrived. While some medical providers have begun reaching out to patients, many vaccine seekers are often forced to make longshot cold calls to lists of places they’ve heard might have shots, or stalk websites that flash openings so briefly that those seeking them compare the hunt to the kill-or-be-killed plot of “The Hunger Games” books and movies.

Logistics and health experts aren’t surprised. The state entered the pandemic with an already strained public health bureaucracy and already drained state budget. Researchers said that gave Illinois little wiggle room to adjust to being dumped a massive logistical headache by the federal government. But at the same time, they say, that’s no excuse to not fix resulting problems.

“Every day that a dose of vaccine is not in somebody’s arm is a day that person is exposed to COVID,” said Hani Mahmassani, who directs Northwestern University’s Transportation Center and has been commissioned by the National Science Foundation to help study logistical woes from the rollout.
“So at the end of the day,” he said, “it’s a matter of life and death, and every day counts in this fight.”


How bad is Illinois?

On a tour of a Champaign vaccination site Wednesday, Pritzker praised the state’s mass vaccination effort.

“We’re actually doing quite well,” he said. “We’re reaching new heights. I just announced a record today. We had I think three record days or four record days last week.”

For sure, the number of daily doses are generally increasing, recently topping 70,000 per day in the state.

But that’s only one way to look at the data. States were always expecting to get better as the process moved on. And when comparing Illinois’ figures with other states, its performance appears far murkier.

As of Friday, out of 50 states and the District of Columbia, Illinois ranked 45th in the rate of shots each state has injected, when adjusted for population.

The Pritzker administration counters that the state so far has gotten less vaccine, per resident, than most others. And that’s true. The state ranks 34th, per capita, in doses provided by the federal government. (Illinois congressmen recently asked federal officials why. So did the Tribune. They didn’t offer an immediate response.)

That still wouldn’t explain another ranking — 41st — for the percent of vaccine received that’s been injected into residents. In essence, even if Illinois has gotten a smaller share of vaccine than it deserves, it’s injected a smaller percentage of its share than most states.

Illinois officials say such figures don’t reflect an accurate score card for judging bigger states facing more complexities in delivery across urban and rural areas. After all, Illinois is the sixth-most populated state.

Still, even focusing on the six largest states, Illinois ranks second-worst at the rate of getting doses into arms. The difference in rate isn’t huge, but If Illinois, at 57%, had kept pace with Texas, at 66%, it would have meant nearly another 180,000 shots delivered into Illinoisans by now.

The lackluster rankings help provide the context of stories of frustrated residents seeking help for themselves or loved ones that qualify for early vaccination. And they compound the concerns of others waiting in the next tier, such as Rachel Dvorkin of Kane County.

The 58-year-old said she has several comorbidities and health problems that put her at a higher risk for contracting COVID-19. She’s watched friends get sick from it and heard of her neighbors dying from it, as she waits her turn.

“It seems that it’s working much better in some other states that also have many more doses than Illinois does,” she said.

What happened?

The national problems have been well documented, with the Trump administration pushing much of the distribution challenges to the states without much money or guidance.

Those who study vaccine logistics say that every state was stuck trying to build out its own system, with already overworked staffers using glitchy software to manage a complicated rollout of delicate, frozen vials of vaccines.

And in Illinois, there’s one more caveat: Chicago handles its own doses, directly from the federal government. The rest of the state, including the suburbs, is overseen by the state health department. Among other things, it means additional coordination because people living in the suburbs might work in the city, or vice versa, and get doses at either place.

Granted, none of this was a shock. States were warned about logistical challenges well before the first vaccines were shipped out before Christmas.

And some places were predicted to have real problems, like West Virginia, with a far older, more remote population. Yet, that state became a national model in vaccine delivery, which included enlisting its National Guard to game-plan distribution as early as November.

That same month, in Illinois, the state health department hadn’t even settled on who would run its operation. The department put out a request for proposals, a process often described by its initials, RFP. In questions accompanying the RFP, the state said it was seeking an outside firm for “high level planning, strategy, managing and oversight” of the effort.

Illinois wasn’t alone in seeking such help, said Julie Swann, an engineering professor at North Carolina State University who researches health care logistics. The surprise? It took Illinois so long to do it.

“When I heard there was this RFP out, I thought, ‘Oh my gosh — they should have been doing this in August and September,’” Swann told the Tribune.

Ultimately, the state abandoned the idea of seeking an outside firm to manage the project, and instead grouped four newly hired staffers with an agency deputy director and consultants already working with the department.

The Pritzker administration declined to make its lead vaccination coordinator available for an interview.

Pritzker spokeswoman Emily Bittner told the Tribune in an emailed statement Tuesday that the late setup hasn’t hampered the vaccination effort.

Early woes

When those first doses arrived in mid-December, state and local health officials quickly handed them out to hospitals across the state to begin the process of vaccinating their workers. They were set to be the first ripples in waves that would wash over other health care workers in group 1a, then ultimately the other waves, starting with the 1b group of seniors and front-line essential workers.

But there was early debate about how loosely to define who qualified for shots, mixed with surprise that sizable numbers of hospital workers were hesitant to be among the first to have them injected. Willing doctors and nurses who didn’t work for hospitals were often left to scramble for shots, such as Dr. Inbar Kirson, whose Northbrook practice includes COVID testing.

She said five health departments told her she’d wait a month or more. Then she caught a Dec. 30 social media post of a friend, a funeral director, who’d gotten his shot at an Orland Park Jewel-Osco. He gave her the web link to make an appointment. She trekked 2½ hours down and back the next day for her first shot. She knows others in health care are still waiting.

“It should have been pretty quick for every hospital to get their employees vaccinated and move onto” other health care workers, she said. “And that just didn’t happen.”

And records show there were also major delays in the other portion of 1a: long-term care residents.

Unlike with other parts of the vaccination program, the federal government set up a special partnership with pharmacies, mainly Walgreens and CVS, to directly visit long-term facilities in each state. The city’s health commissioner, Dr. Allison Arwady, said it was supposed to be “plug and play,” requiring little effort from local officials.

But then there were notable delays, particularly in Illinois, with the pharmacies and the state blaming each other. State and local officials had to push pharmacies and help coordinate with facilities, while those batches of shots sat unused.

“It’s a huge amount of our vaccine, and we have not been pleased to not see it fully used,” Arwady said.

Still, by Jan. 8, when CDC first published state-by-state data, Illinois’ rankings appeared in the middle tier of states: 30th in the rate of doses administered, per resident, and 25th in the percent of its shots that had been delivered into arms.

Then other states got better, faster, than Illinois.

It’s unclear exactly just why Illinois couldn’t keep pace. But officials offer some possibilities.

Bittner, the Pritzker spokeswoman, suggested one reason was because the state waited a week later to expand vaccinations to the 1b group, and states that had done it sooner were able to boost their numbers quicker.

Another suspected reason: the continued troubles in the long-term care vaccination process, which affected Illinois more than most states. West Virginia, the only state to handle its own long-term care program, expected to finish second shots on all residents who want them by Saturday.

Illinois doesn’t expect its first shots to get into all willing arms in long-term care until Feb. 15. But the state did announce Wednesday that it will take surplus shots in the federal program and use them for others.

One more possibility: As the city and state roll out vaccinations to more clinics, those clinics are doing shots fast enough but struggling to record them quickly enough in the state’s dataset.

“In some cases, there’s an issue of providers not using their vaccines,” Arwardy said. “But in a lot of cases, they actually are doing a very good job of using their vaccine. But still, in terms of some of that tech reporting, it’s not fully there.”

Health officials said they’ve ruled out one possibility: wasted doses. As of Tuesday, the state reported 412 doses wasted for a variety of reasons, such as vials broken or left open too long. Chicago reported one facility had a freezer break down, costing about 150 doses.

While frustrating, the figures are too small to make a dent in rankings.

Supply chain

That leaves one more, obvious possibility: It’s simply taking providers longer to put shots into arms in Illinois than elsewhere.

Understanding that requires peering deep into supply chain, experts said, to figure out the holdups. But that supply chain is largely hidden from public view.

The Tribune on Dec. 31 filed open records requests with both Illinois and Chicago health officials for detailed breakdowns on shipments of doses sent to each provider and what they’d done with them. Neither the city nor state has responded with adequate records within the law’s required time frame.

Arwady told the Tribune the city was uneasy releasing such information because it may not be accurate if clinics distributed doses but failed to properly record it. The city did, however, release less detailed data to the Tribune. Even when looking at doses not tied to the long-term care program, the data shows varying rates of success.

Logistics experts say the goal should be for providers to use up all their vaccine within the week of receiving it and, in places with built-up surplus, to eat into that too at the same time. Arwady said that’s the city’s goal, too, but recognizing the challenges of the work, Chicago sets a minimum goal of 85%. Even that can be a struggle.

Taking out long-term care shots not controlled by the Chicago health department, city data shows providers in the city have increasingly struggled to meet that threshold, with average weekly usage rates hovering closer to 80% collectively. Arwady said her department is pushing to improve efforts at struggling providers and, ultimately, redirecting new shipments to places that can deliver them faster.

A state spokeswoman did not respond to a question about why the state wouldn’t provide the detailed information. But on Monday the state did release some data that looks at the problem a different way, by snapshots of inventory at the county level. By comparing that with the average number of shots injected in each place in a day, the figures can show how many days’ supplies are on hand.

Taking out long-term care shots, the data shows a statewide average of about a six-day supply, based on how quickly shots are being injected.

But there are wide variations, particularly with concerns there won’t be enough second shots coming to cover those given first doses.

In Will County, for example, state data released Monday suggested the county and its providers were sitting on less than four days’ supply at that time, based on how much they had and how quickly they’d been injecting it.

Health department spokesman Steve Brandy said county officials were told not to worry about second shots, and to get doses out the door as quickly as possible. So that’s what they’ve done, surviving some “ticklish points” where the county had to be careful how it delved out shots to ensure it could cover second doses due in days.

“Of course, we need to do better,” he said. “Of course, Illinois as a state has to do better. And we’re hoping for a better, more consistent vaccine supply.”

Compare that with Sangamon County, where Springfield, the seat of Illinois government, is located. There, state inventory data shows about a two-week supply for the county health department and its providers collectively, based on their daily average of shots given.

The county department put out a statement Tuesday saying its portion of shots was actually a 20-day supply. Why hold back so much? Officials cited unpredictable shipments “until just recently.” And while it’s begun to expand its program, the county said it was limiting that expansion “until the second dose supply becomes more reliable.”

The state told the Tribune that it approved shipments of all second doses on time and warned it may hold back more shipments to the county if the pace isn’t picked up.

The state health department has already done that once with doses originally earmarked for Cook County but sent instead to faster-paced Adams and Champaign counties.

Still, the state has yet to impose more precise rules on how quickly doses should be given.


In the nation’s fast-evolving responses to vaccination, there remains a lot of unknowns that could affect whether Illinois’ slower rollout carries a significant cost to residents or is merely a footnote in the pandemic.

The Biden administration has promised to send even more doses to states, with better federal coordination, while also stepping up direct shipments to pharmacies. The state itself is standing up more mass vaccination sites with the National Guard. And other vaccines are expected to be approved to boost supplies even more.

At the same time, health officials say it’s a race to vaccinate the most vulnerable before new, more contagious mutations of the virus take hold, which themselves appear to limit some vaccine effectiveness.

For now, Illinois is left with lagging rankings among states and a wide disparity in who’s gotten shots where. It can vary from roughly 1 in 5 residents on Illinois’ western edge to 1 in 35 on its southern tip. In between are the big population centers — Chicago, suburban Cook and DuPage counties — at roughly 1 in 15 residents, and Lake and Will counties, at roughly 1 in 19..

The decentralized process means teachers in and around Deerfield, the corporate home to Walgreens, got access to a special program by the pharmacy, but Chicago Public Schools couldn’t get all of its teachers vaccinated for at least a month, a delay that’s fueled weeks of bitter contract talks over resuming in-person classes.

One suburban school superintendent told the Tribune it’s created a world where success is fueled by “inside connections,” calling it “everything wrong about this rollout.”

There’s also divide between those comfortable lining up online appointments and those not. One grassroots group of health care workers, Illinois Medical Professionals Action Collaborative Team, called for a statewide sign-up and lottery system to help assign slots for shots while ensuring they’re distributed equitably.

For now, the hunt continues for people like the Leopardos.

They’ve been “ultra-quarantining” for the pandemic, said their daughter, Liz Driscoll. That means ordering groceries online, attending church and book clubs remotely, and struggling to clean their northwest suburban duplex on their own.

Driscoll said she lives in Ohio, where she’s watched an “orderly” process there that slowly opened first to the oldest ages, then tiered down week by week.

“It feels like my parents are in the Hunger Games against 3 million people, many of whom are younger, less at risk and more computer savvy than they are,” she said.

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