After receiving the COVID-19 vaccine this week, Jeff Moore felt a “tinge of guilt.”

He’s 58 and healthy, but his work as a senior management analyst for the San Antonio Fire Department qualified him to get the shot.

“I have an elderly relative in an assisted living facility here in town and I know she hasn’t gotten her shot yet,” Moore said. “That feeling [of guilt] went away when I started thinking about it. … Everybody who gets a vaccine is going to help everyone around them.”

The roughly 70,000 doses sent to Bexar County through Tuesday by the State of Texas won’t reach all of the estimated 150,000 health care workers and nursing home residents and staff prioritized for initial inoculations that started last month. That group is referred to as Phase 1A. This week, under orders from the state, local clinics and hospitals started giving vaccines to people 65 and older as well as people aged 16 to 65 with certain health conditions that put them at greater risk to the coronavirus (Phase 1B). 

Phase 1B includes about 60 percent of Bexar County’s population, said Colleen Bridger, the former assistant city manager who now leads the City’s COVID-19 pandemic response as incident commander.

“Even if this were the most perfectly coordinated process, there isn’t enough vaccine to give everybody in that group to get their shot right now,” Bridger said.

But Bridger said people like Moore should not feel guilty for getting the vaccine ahead of a doctor, nurse, or a family member living in a long-term care facility. “If you have an opportunity to get a COVID vaccination, take it,” she said.

Jeff Moore. Credit: Scott Ball / San Antonio Report

There are many reasons why people who aren’t in Phase 1B got an opportunity for the vaccine, she said.

“They’re a family member of somebody who’s in [Phase] 1A … or we opened a vial of vaccine and it’s going to go bad in six hours and we have four doses left. We’re going to put it in any human being that’s willing to have it, right?” Bridger said. “Because our ultimate goal is herd immunity. Herd immunity is what is going to protect the community. Yes, you’re at higher risk if you have an underlying chronic health condition but we had perfectly healthy people get COVID and die. We want to get to herd immunity as quickly as possible.”

As photos of people posing with their vaccine cards flood social media, reports of people receiving the vaccine who do not appear to fall into either Phase 1A or 1B have sparked questions about equity and efficiency in the vaccine rollout process. San Antonio Hispanic Chamber of Commerce Chairwoman Erika Gonzalez, a physician who owns an allergy practice, offered City Manager Erik Walsh a vaccine last month, according to the San Antonio Express-News, but he declined.

Some residents wonder if people are lying about having an underlying condition to get the vaccine. People aren’t asked to prove that they have a qualifying underlying condition when they sign up for a vaccination or when they appear for their appointment, University Health Chief Medical Officer Dr. Bryan Alsip said.

The state’s handling of the vaccine distribution, specifically its communication to providers, “could be better,” Alsip said Monday during a media briefing with Mayor Ron Nirenberg and Bexar County Judge Nelson Wolff this week.

“We don’t get information early enough to help us with planning,” he said. “Going forward, we really need to have some thought as to how to get the vaccines and more providers [giving them] so that we can get the immunizations available to more people.”

A shift in approach

State and federal governments agreed on a distribution plan late last year that was approved by the Centers for Disease Control. It outlined a decentralized approach that put the Texas Department of State Health Services in charge of distributing the vaccine to hundreds of hospitals, clinics, doctor’s offices, and other health providers. These facilities signed up directly with the state to receive doses.

San Antonio Metropolitan Health’s role was to help educate providers and the community, Bridger said. “We spent a lot of time in the fall getting the word out to providers: If you want to be a vaccinator, here’s what you have to do.”

The plan also outlined the different phases of the vaccine rollout that defined when different groups of people would be eligible for vaccination.

But the plan started to deviate when state and federal officials disagreed over who should qualify for a vaccine first, Bridger said. The rules surrounding that became “recommendations.” Now it’s up to local health departments.

Then in late December, Dr. John Hellerstedt, commissioner of the Texas Department of State Health Services, issued a letter to health care providers urging them to  “pivot quickly” to Phase 1B.

“We trust that you know your situation far better than we could, so we ask you to take the initiative and push forward aggressively with administering all the vaccine dose[s] you have received,” Hellerstedt wrote. “We want every dose administered, and we assure you there is more on the way.”

Prioritizing health care workers while simultaneously opening up vaccines for most of the city seem to be at odds, Bridger said. “[But] I see it as ‘yes and.’ So we want to make sure that everybody who’s at risk of serious complications from COVID gets vaccinated as quickly as possible. And we want to make sure that we achieve herd immunity in our community as quickly as possible.”

It’s unclear why the plan was adjusted or why it wasn’t communicated to local officials sooner, but the sudden timeline adjustment may have been the result of political pressure to vaccinate as many people as possible by the end of the year.

On Dec. 22, Gov. Greg Abbott said 1.4 million health care workers and vulnerable Texans were set to receive the vaccine by the end of 2020, but by Dec. 29, State data showed that fewer than 137,000 people had been vaccinated with at least one of the two required doses.

On Thursday, the state health department announced that it will shift away from the decentralized model – in which all providers were given doses based on their size – to a “mass vaccination model,” in which entities that have the capacity to vaccinate more than 100,000 people will get even more doses.

“Large and small sites around Texas will receive a total of about 200,000 doses of vaccine next week,” according to an agency press release. That will be the last week the state is required to reserve doses to vaccinate residents and staff of long-term care facilities, freeing up more vaccine for use in other settings in the future.

The City is ramping up coordination with area hospitals and pharmacies, including H-E-B and CVS Pharmacy, for such events in City facilities such as the Alamodome starting early next week, Bridger said.

A press conference is hosted by the City of San Antonio during which Alamodome and Valero Alamo Bowl officials highlight safety precautions ahead of the socially-distanced bowl game. Photos taken on December 28, 2020.
Facilities such as the Alamodome would administer anywhere from 500 to more than 1,000 doses per day. Credit: Bonnie Arbittier / San Antonio Report

These facilities would administer anywhere from 500 to more than 1,000 doses per day, she said. The University Health System’s operation at Wonderland of the Americas Mall administers roughly 1,400 per day.

Injecting equity

While most residents who qualify for a vaccine were frustrated to find that appointments at clinics and hospitals were completely booked, others were able to find a vaccine through word-of-mouth or on social media.

Robert Salcido is executive director of the Pride Center San Antonio and community outreach and engagement manager with Equality Texas, which advocate for LGBTQ rights and services. Salcido worries that San Antonio’s most vulnerable residents might not be able to get access to the vaccine in a timely manner.

“San Antonio having one of the biggest digital divides in the country – that automatically is inequitable for somebody who does not have internet access, or does not have a computer or a smartphone at home” to register online for appointments, Salcido said.

Beyond awareness, there are other hurdles for low-income families, including transportation to a vaccination facility, he said.

Inequitable distribution of the vaccine is “a legitimate concern,” Bridger said. “I literally have not had a single conversation about COVID vaccination that does not have an equity component to it.”

The City – in partnership with health providers – plans to roll out information about the vaccine much the way it did coronavirus testing, Bridger said.

When the vaccine is more widely available, mass vaccination events will take place in near historically disadvantaged neighborhoods across Bexar County and mobile units can be deployed there, she said. The City has already developed an equity score map that shows where these areas are.

The City and local providers are starting to get a firm grasp on how to roll out the vaccine, Bridger said. “I’m confident saying it’s way better than last week.”

Even if Bexar County had 2 million vaccines today, she said, “it still takes us a long time to vaccinate 2 million people. I have no doubt that there will be enough vaccine for everybody to be vaccinated by the fall.

“So somebody who has an opportunity right now [to get a vaccine] should grab it and somebody who doesn’t have an opportunity right now can rest easy, knowing that there will be another opportunity for them to be vaccinated.”

Salcido was infected with COVID-19 for six weeks last year and received the vaccine on Tuesday. He has diabetes, one of several conditions that increase the risks of COVID-19. He doesn’t understand the science behind the vaccine – and has questions about how it works, but he ultimately set that aside in the interest of ending the pandemic.

“At the end of the day, scientists are there for a reason, and I trust their judgment,” he said.

Disclosure: Dr. Erika Gonzalez serves on the San Antonio Report’s board of directors.

Iris Dimmick

Senior Reporter Iris Dimmick covers public policy pertaining to social issues, ranging from affordable housing and economic disparity to policing reform and workforce development. Contact her at iris@sareport.org