Missouri Gov. Mike Parson and his administration have said more details will be coming sometime this week about the next phase of vaccinations against COVID-19 - for people over the age of 65, people ages 18-64 who have underlying health conditions, first responders and essential workers.
In the meantime, state health director Dr. Randall Williams said the only thing limiting Missouri's pace of vaccination is the supply it's receiving.
The state is currently focused on vaccinating health care workers - including private and family doctors who do not have practices at hospitals - and Williams said that will also help the health care system deal with any possible new surge in cases due to the spread of more contagious variants of the coronavirus that causes COVID-19.
Details of phase 1B coming
Though Parson touted last week that "Missouri is still ahead of the majority of states on our vaccine distribution plan," he acknowledged, "we know that many Missourians are still wondering when they will be able to receive COVID-19 vaccine."
He said the state had so far administered more than 105,000 doses, not including those administered by retail pharmacy chains CVS and Walgreens in a partnership with long-term care facilities to vaccinate their residents and staff.
The vaccination of health care workers and people who live or work at long-term care facilities is all part of the state's 1A phase of vaccine distribution.
Phase 1B will be for people older than 65, people ages 18-64 who have underlying health conditions, first responders and essential workers.
Parson's administration has not yet given an exact timeline of when phase 1A will shift into 1B, but Parson last week said: "We anticipate receiving an adequate supply of vaccines by the end of January to complete phase 1A."
He added: "Once we feel we are close to completing phase 1A, then phase 1B will begin. This is a gradual and ongoing process, and we will continue to communicate with the public about phases and vaccine availability."
Parson encouraged Missourians to visit mostopscovid.com for the latest updates.
Williams said he knew people have many more questions other than timing - how people will know if they're eligible to receive a vaccine in phase 1B, how eligible people will be tiered, how the phase will be rolled out, how people will know where to go to get their vaccine.
He promised more information would be coming this week.
Williams did tell Central Missouri Newspapers that long lines of people waiting to receive vaccine - as have been seen in other states - should be avoidable.
"The straightforward way (to avoid lines) is just make appointments. That's what you do. You make an appointment to get your vaccine, so that you don't have to wait around. I don't understand what places like Florida, that I see these pictures from, don't understand about that. Why wouldn't you just make appointments?"
He added, however, "I haven't inquired enough to know why what would seem obvious to me isn't going on there."
Approximately 3 million Missourians will be included in phase 1B, including a million people older than 65.
Supply stream
When asked by a reporter last week what may be needed to get vaccines out faster, Williams said, "If we had three times as much vaccine, we would be able to get it out. So, really, right now in Missouri, the rate-limiting step is simply that (supply) of how much vaccine we get."
He did not yet know how the state would use a new supply of billions of dollars of federal money for vaccine distribution.
Speaking with Central Missouri Newspapers last week, Williams said Missouri is getting approximately 70,000 first doses of vaccines each week.
Parson said the state expected last week to receive approximately 73,000 doses - 37,000 from Pfizer and 36,000 from Moderna.
Williams said the Moderna doses currently go toward the federal partnership between long-term care facilities and retail pharmacies, but the state should be through that allotment by Jan. 18 - at which point, the doses would be freed up and under the state's control to be steered to vaccinating more health care workers.
In the meantime, Williams said the state controls neither the distribution nor reporting of doses allocated to the partnership.
The state only determines what amount of vaccines out of its weekly allocation goes toward the partnership.
Williams said there's no set number or guarantee of how many vaccine doses the state gets each week.
Allocations by the federal government are based on a state's share of the national population, so Missouri gets 2 percent.
While the U.S. population is a fairly stable number week to week, the exact allocation of vaccine still depends on the available supply. Williams said the state does not know what the denominator is - how many doses Missouri is getting 2 percent of. "Is it 2 percent of 50 million doses, or 2 percent of 30 million doses?"
Therefore, Williams said, he couldn't say when the state will move from phase 1A to 1B, because that "would imply I know exactly how much vaccine we're getting in the next three weeks."
He did hope to have phase 1B completed by mid-April.
Another variable will be any changes in the federal government's plans. President-elect Joe Biden has promised a better handling of the pandemic, including the speed of vaccine distribution, and the Associated Press on Friday reported Biden had pledged to release most available vaccine doses - rather than holding back quantities of second doses - in order to accelerate the shipment of first doses.
Pfizer and Moderna's vaccines have to be delivered in separate doses, spaced weeks apart, to offer maximum protection against COVID-19.
Speaking a few days ahead of Biden's announcement on speeding up delivery of doses, Williams said he did not foresee any big changes in how the federal government would be handling things a month into the future.
"I can't point to any objective evidence of something (the incoming Biden administration has) said of either why it's going to be better or how it's going to be better."
Williams did say the Biden team had been in communication with the state health department, asking questions including how many vaccines Missouri was getting and how many were being distributed.
He said the state is not hoarding vaccines, has the capacity to immediately vaccinate with what its supplies are, and can re-calibrate its distribution timelines as more vaccines become available - such as possibly from AstraZeneca or Johnson & Johnson in the weeks ahead.
Challenges remain in phase 1A
Vaccinating even just health care workers still presents some ongoing challenges, and the state may be in a race against time with the spread of more contagious variants of coronavirus, including one from the United Kingdom that's 50 percent more contagious and has already been found in multiple states and dozens of countries.
Williams said the state's health lab tests 500 COVID-19 samples a day - what he said is a representative sample of the entire state of Missouri, where 15,000 COVID-19 tests are done each day - and starting the week before last, the lab began checking every sample every day to see if the U.K. variant was present.
"We also went back to November and looked at old samples," and did not find any samples that were of the new variants, Williams said. He added the lab will look for the variant every day going forward.
If or when a more contagious variant is found in Missouri, it would not really change much. People infected with the variants do not have different symptoms, and public health guidelines would be the same - and would need to be abided by more than ever.
Asked if the state is helping to prepare hospitals for another possible surge in COVID-19 cases, given the more infectious variants spreading in the country and around the world, Williams cited the vaccinations of health care workers, the vaccinations at long-term care facilities - which account for a third or half of deaths - and the state's contract to bring in health care workers from out of state.
"We're doing all those things with the idea of trying to make sure that we protect our most vulnerable citizens and we protect our frontline health care workers and hospitals' capacity," he said.
Vaccinating thousands of health care workers at large, centralized hospital campuses is one thing, but Williams said it will be more challenging to vaccinate health care workers at "the trailing edge" of the industry, "who don't practice at a hospital, who are a private family doctor," or who don't have hospital privileges, "but they want their staff vaccinated."
He said the state is "absolutely committed" to also vaccinating those health care workers, "but we don't want to pretend that it's not more challenging."
In terms of people's willingness to get a COVID-19 vaccine, Williams said, anecdotally, 67-70 percent of health care workers and people who live or work at long-term care facilities have opted to get a vaccine when offered, adding, "We don't have exact numbers."
Given 45 percent of people get flu shots, and that the COVID-19 vaccines are new, Williams was impressed.
"We're incredibly encouraged by that. I don't think anybody thought it was going to be 100 percent," he said. "We think 67 (percent) - we're very appreciative."
He added: "We know based on national studies that as we went into this two months ago, the projection was that 50 percent of people would get the vaccine, 20 percent wouldn't, and 30 percent would be on the fence."
Can the willingness of health care workers to receive a vaccine be extrapolated to other populations of people?
"We'll have to wait and see," he said.