Albany, NY—At a time when pharmacies nationwide are scrambling to get enough COVID-19 vaccine to meet demand, the association representing the nation’s governors has some concerns that those facilities might be getting too much vaccine or aren’t using it efficiently.

In a letter to President Joe Biden, the National Governors Association, chaired by New York Governor Andrew Cuomo with Arkansas Gov. Asa Hutchinson serving as vice-chair, discuss two concerns. One is that the COVID-19 vaccine-distribution process appears confusing because, in some cases, the federal government allocates doses to states for distribution and, in others, it directly supplies the vaccine.

“Due to the anxiety created by the demand and supply of the vaccine, it is imperative that the American people fully understand the process,” the governors write, adding, “Currently the Centers for Disease Control and Prevention (CDC) provides public information on a state and territory level as to the number of vaccines distributed to each state and the number of vaccinations performed. The CDC reporting mechanism has created unnecessary confusion. We would ask that the CDC reporting accurately reflects the reality.”

The letter was also signed by governors of Massachusetts, Maryland, Alabama, Arizona, New Mexico, Colorado, and Michigan.

Mentioned in the letter are two pharmacy programs—one that helps vaccinate residents of nursing homes and long-term care facilities (LCTF) and another that directly delivers vaccines to pharmacies selected by the federal government. The third is a program in which the federal government directly distributes vaccine to Federally Qualified health Centers (FQHC).

At the same time, state and territorial governments receive vaccine allocations for “first doses” and “second doses” from the federal government. “We appreciate transparency, accountability, and our responsibility for the administration of the first and second doses,” the letter states. “However, the federal LTCF program, federal pharmacy program, and the federal FQHC program are federally administered and beyond the states’ control.”

While one concern apparently is that states might be unfairly blamed for failure to distribute vaccine over which they have no control, the other is specific to pharmacies. The letter advises that the governors believe that “federal decisions to use pharmacies and FQHCs should be coordinated with state governments. States also allocate doses often to these same pharmacies and FQHCs. We understand the capacity of the individual entities and we know the range of the individual entities throughput and their inventory. As usual, some pharmacies and FQHCs are better suited for the task than others.”

It adds, “following the performance data on these entities is essential. We also know the need in the respective communities they serve and other efforts in the geographic vicinity. If the federal government distributes independently of the states to these same entities without state coordination and consultation, redundancy and inefficiency may very well follow.”

In a press briefing, Governor Cuomo explains the concerns this way, “If the federal government is sending to CVS, then I wouldn’t send to CVS—so I’m asking for better coordination.”

The federal program does not appear to have been affected by the governors’ objections, however. The White House announced that doses sent to pharmacy partners will double from 1 million to 2 million doses in late February.

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