A vial of the Moderna vaccine for COVID-19 distributed in Hennepin County in December 2020. Credit: Christine T. Nguyen | MPR News

The email arrived at Sahan Journal on Wednesday afternoon, January 20. Scores of extra doses of COVID-19 vaccines were available for people in the East African, Hmong, and Latino communities—right now! In south Minneapolis! Could we help tell our readers?

If only it were so simple. 

Last week, I ventured to tell what in a perfect world would be a simple story: explaining how people in our communities can get vaccinated against COVID-19. But the task turned out to be more difficult and complicated than we all bargained for. 

You’d think we’d be prepared by now. I’ve been reporting about COVID-19 for Sahan Journal since last spring. Two vaccines got approved in December as safe for the public. Tens of millions of doses have been produced and distributed to the government and medical providers. I have high-speed internet, several public health sources, and a spouse who works as a medical doctor.  

But after many days of reporting, the picture is still muddy. So if you’re still confused about where and when and how to get a COVID-19 vaccine, you’re not alone. In this story, after all of the mess, I hope to provide some examples about confusing information, some clarity about the current situation, and a window into what’s coming next. 

Let’s start with the obvious question: Who is currently eligible for a COVID-19 vaccine? Right now, the state is vaccinating people who fall into the 1A category created by the federal Centers for Disease Control and Prevention. 

People who live in group homes, nursing homes, and assisted living facilities fall into this category. So do people who work in health care. 

Those who fall into 1A shouldn’t have to go on a hunt for a vaccine, according to Kris Ehresmann, director of infectious disease, epidemiology, prevention, and control at the Minnesota Department of Health. People’s  employers or health providers, she told me, should be contacting them. 

So far, Minnesota has given at least one shot to around 247,000 people, covering less than 5 percent of the state’s population. (Just 1 percent of Minnesotans have received two doses.) This lackluster performance (for administering first shots) ranks 43rd among the 50 states—well below most of the country, according to the New York Times

Vaccine pilot programs add new categories of people—and multiply the confusion

Now is where the confusion comes in. The state recently expanded vaccine availability beyond the populations I just mentioned in the 1A category (older people in nursing homes and health care workers) through limited pilot programs to give an additional 12,000 doses. 

These newly eligible Minnesotans include some teachers and child care employees, who should be hearing about vaccine availability directly from their employers, Ehresmann said.

But more notably, the state launched a pilot program earlier this week to anyone aged 65 and over. This pilot program was a way for the state to test out and prepare for mass vaccination drives once more vaccines become available, Ehresmann said. The idea is that soon the state will move to vaccinate category 1B (which will include senior citizens over the age of 75 and frontline essential workers like firefighters, police officers, and bus drivers). 

Under this program, people can register for appointments online at a state website or over the  phone. But within seconds of going live last Tuesday, the state website crashed. Later that day, state officials told reporters people had flocked to the website at the rate of 10,000 unique hits per second.

As you can imagine, available appointments through this portal filled up instantly. Sahan Journal’s senior editor, Mark Porubcansky, found out the hard way. 

“Being of the age to actually make use of this, I was one of the 10K hits per second,” Porubcansky told staff on our message board around 2 p.m. that day. “Now in a ‘waiting room,’ where I’ve been for more than an hour.”

One of the challenges, Ehresmann noted, is how eager some people are to get vaccinated. Minnesota is home to more than 900,000 people who are 65 and older, and only about 55,000 had received at least one shot as of last Thursday, the date of most recent data available by press time. In other words, many people are going to have to wait weeks to get vaccinated, she said.

For people who believe they are eligible for a vaccine but are not sure, Ehresmann recommended they try to register through the state website or hotline. 

“Otherwise it’s just going through health providers, and providers will call,” she said. “If a health system has a vaccine, they will call their patients to let them know.” 

Vaccine available now! Come get it! (Or not.) 

That suggested procedure sounds straightforward enough—even with the likely delays. 

But it turns out vaccine availability is not quite as simple as this. A day after I spoke with Ehresmann, the head of Axis Medical Center, a clinic in south Minneapolis that mostly serves East African patients, sent a frantic email to Sahan Journal and our editor Mukhtar Ibrahim. 

“Axis is being granted a lot of COVID-19 vaccines for dispensing to our community,” Tedd James, Axis’s CEO, wrote in the email. “We are looking for every avenue to help in publicizing that they are available and the importance of being vaccinated.” 

Axis staffers had notified its eligible patients that their vaccines were ready and waiting for them—just as Ehresmann said. But on Wednesday, the first day administering the new doses, only about 10 percent of the patients whom the clinic called actually made appointments, James told me. 

Many clinic patients expressed hesitancy and a desire to wait things out a little longer. Axis had done its own outreach to encourage patients, showcasing how its doctors and staff were getting vaccinated. With more than 16 million doses already given across the country, both COVID-19 vaccines have proven to be safe. But those efforts to install full confidence in the vaccine—and book appointments—had amounted to little so far, James said. 

Axis is one of Minnesota’s 17 federally qualified health care centers, a designation that means they serve marginalized populations—often people with no health insurance. Ninety-five percent of Axis patients, for example, are East African, and 4 percent are Hmong or Latino. 

These dedicated Minnesota clinics had successfully lobbied the state to receive a large shipment of available vaccines to serve their patients, who are being infected with the virus at higher levels than the general population. For Axis, that meant 300 vaccines last week and an expected 300 more this week. 

For a time, it seemed like the clinic had a supply of vaccines, a list of eligible patients—and not enough appointments scheduled. 

That’s when things got a little crazy. Word got out that Axis had available vaccines, and people who weren’t existing patients started bombarding the clinic with calls requesting appointments. Because the state instructed all FQHCs to prioritize their patients, Axis staffers either put these callers on a waitlist or turned people away. 

“We’ve had people calling from Arden Hills, people calling from Minnetonka,” said Jonathan James, an epidemiologist at Axis. “We’ve had to say, ‘Your normal care provider should be making sure you’re getting it.’ Our priority is to serve the patients that are in this community that we already have. But that doesn’t mean we’re blind to the idea that there are certain people who are part of these communities that have never registered as a patient and never come in.” 

By the end of the day, another problem arose. The Moderna vaccine, the one Axis is using, comes in vials that contain enough of the serum for 10 doses. The vaccine arrives at the clinic in a frozen form. Once it’s thawed, health care workers have roughly six hours before it spoils.  

By the end of the day Wednesday, with just a half hour to go before expiration, Axis had leftover serum nearing expiration. With every scheduled appointment done for the day, the staff scrambled to get the remaining vaccine into arms before it went bad.

“When you get to 5:30 p.m. and you have some left, that forces a decision,” Jonathan James, the epidemiologist, said. “Do you throw it away? Or do you find someone to give it to?”

Luckily, Axis contacted an eligible woman on the waiting list who was able to come in at the last minute, preventing the vaccine from going to waste. 

Contradictory advice about calling your clinic

Jonathan James expressed confidence that things would get less messy in the days and weeks to come. He also said he believed that hesitancy will drop as more people from Axis’s target communities get the vaccine and tell friends and family about it. 

But he did offer a piece of advice that contradicted MDH: People who believe they are eligible and are part of the communities Axis serves should call Axis directly and ask for appointments. That group might be people from the Somali, Oromo, Hmong, and Latino communities. 

Not all of the state’s federally qualified health centers appeared to be in the same position. Sara Bolnick, director of advancement at Community–University Health Care Center in Minneapolis, said her clinic also received a similar number of vaccines this week and wasn’t having trouble scheduling shots with existing patients. 

Ehresmann blamed part of the mess on how the now-former Trump administration publicized the vaccine rollout. As recently as January 12, then-Health and Human Services Secretary Alex Azar announced he would release to states a stockpile of additional vaccines. Four days later, the department admitted those vaccine doses did not actually exist. 

“He set up this expectation,” Ehresmann said.  

Ehresmann and other public health officials say better federal guidance on vaccines under the new Biden administration should soon help the situation.

Bottom line: For everyone outside of 1A—elderly people in care facilities and first-line medical providers—vaccine distribution is chaotic at best right now. You could spend your day bombarding clinics with calls trying to be one of the lucky few who gets a stray dose that’s being given out to avoid wastage. But this isn’t the recommended approach. 

If Sahan Journal gets another email that changes the rules, I’ll let you know ASAP.

Joey Peters is a reporter for Sahan Journal. He has been a journalist for 15 years. Before joining Sahan Journal, he worked for close to a decade in New Mexico, where his reporting prompted the resignation...