Hundreds of vulnerable SC residents waiting on COVID shots months after requesting them
Hundreds of South Carolina’s most medically fragile residents remain unvaccinated months after requesting COVID-19 shots through the state’s home-based vaccination program and health officials are scrambling to shore up the floundering initiative.
Going on three months since it launched, the state Department of Health and Environmental Control’s Vaccination Homebound Project, which aims to inoculate South Carolinians unable to leave their homes due to age or chronic health conditions, has vaccinated just one-third of the residents who have requested the service, health officials said.
Nearly half of those dosed through the program got their shots only after DHEC deployed a strike team in early July to bolster the efforts of two vendors it had hired to run the project.
“Once we realized we needed to assist our two homebound vendors, we looked at the master list we were working to develop and we sent those teams out around the state where people are still waiting on vaccinations,” said Stephen White, director of DHEC’s immunization division. “We are continuing to assist the vendors and trying to get everybody vaccinated who has reached out for assistance.”
The program got off to a sluggish start because the inexperienced vendors faced challenges ramping up capacity, White said. Confusion about responsibilities and the agency’s expectations also contributed to the pace of progress.
White said the agency has been working with both contractors and expects home-based inoculations to pick up, but hasn’t ruled out seeking new or additional vaccinators better able to meet the needs of South Carolina’s home-based population.
“At the end of the day, we have to make sure that folks that are homebound have the opportunity to be vaccinated,” he said.
Vaccinating individuals who are unable to leave their homes is crucial because many are at increased risk of severe COVID-19 complications.
Not only are many home-based residents elderly or immunocompromised, they’re dependent on personal attendants for direct care and unable to avoid close contact with caregivers who may be unvaccinated.
State officials estimate there are between 11,000 and 46,000 South Carolina residents whose age or health prevents them from traveling to a health care provider for a COVID-19 shot.
Many of those people have found ways to get vaccinated outside of the state’s home-based program, but at least 899 have called DHEC’s vaccine information line seeking a shot at home since the service launched in June.
As of Thursday, only about 300 of those callers and their caregivers had received at least one vaccine dose, health officials said.
Kimberly Tissot, executive director of Able SC and an early proponent of creating a home-based COVID-19 vaccination program, said she’s been disappointed with the design and rollout of the service.
She criticized DHEC for not doing enough to bring members of South Carolina’s disability community into the fold when developing the program and said it was likely underutilized as a result.
“We were not involved in that process, nor have we been given information about it,” Tissot said. “A lot of people are still unaware of that program.”
She said it felt like DHEC had created the program solely to comply with equitable vaccine access requirements, but was not interested in ensuring its success.
“It’s almost, I feel, like more of a checked box than an actual program that is being monitored to make sure that they are reaching the population that’s unable to leave their home,” Tissot said.
DHEC spokesman Ron Aiken said both the state Department of Aging and the state Department of Disabilities and Special Needs were involved in the formation of the program.
While the state’s disabilities agency was not part of the core planning team, it has been involved in ongoing conversations about the service since November, he said.
DDSN spokesman Robb McBurney said his agency received information about the home-based vaccination service from DHEC and passed it along to providers, but didn’t know the number of agency clients who had received shots through it.
Home-based vendors lacked relevant experience
Early in the vaccine rollout, the state lacked any service to provide inoculations to vaccine-eligible residents unable to leave their homes. In late February, with frustration over the lack of home-based services mounting among disability rights advocates, DHEC partnered with Agape Care Group, a provider of hospice and palliative care, to pilot an at-home vaccination initiative in two rural Lowcountry counties with relatively high rates of home-based and hospice patients.
Agape, which volunteered its services, vaccinated 116 home-based individuals in Hampton and Jasper counties during the roughly one-month pilot. Pleased with the results of the pilot, health officials elected to expand the initiative statewide.
Sixteen companies submitted bids to administer home-based vaccinations in some or all 46 S.C. counties and in mid-May DHEC awarded H and M Labs and Welcome Pharmacy contracts to run the statewide program. Agape did not bid on the contract.
H and M, which has no online presence and had formed only months earlier, won the contract to vaccinate residents in every county except Greenville. It had been enrolled with the state as a COVID-19 vaccine provider since December, but had not reported administering a single dose, according to health department data.
Welcome, an independent Greenville pharmacy, won the right to administer doses exclusively in Greenville County. It had been enrolled as a provider since March, and had vaccinated eight people before receiving the home-based contract.
When asked at the time about the companies’ qualifications and ability to do the job, a DHEC spokeswoman said procurement officers had verified both vendors were in good standing and could perform all the requirements outlined in the contract.
The vendor expectations outlined in the agency’s bid solicitation included being enrolled and activated as a COVID-19 vaccine provider, adhering to the federal guidance for vaccinating home-based individuals, administering vaccines to people with an appointment within one week of receiving their request and complying with the agency’s vaccination reporting requirements.
All contractors were asked to provide a “detailed, narrative statement” to establish they were licensed or had a waiver to provide home-based medical services, were in good standing with the state and used qualified vaccinators operating under a physician’s order.
DHEC could not provide evidence that either winning vendor submitted such a statement.
In response to The State’s request for all documents submitted by home-based vendors as part of their bids, the agency tendered attestations from both H and M Labs and Welcome Pharmacy stating they were in compliance with the terms of the solicitation, but offering no actual documentation to verify their statements.
When asked about the missing documentation, a DHEC spokesman said the agency had verified both companies were vaccine providers and “confirmed in writing with each vendor that they were appropriately equipped to safely provide vaccinations as outlined in the solicitation.”
According to emails obtained under the Freedom of Information Act, the only communication between the agency and the vendors about their ability to perform the job occurred May 5 when a DHEC procurement officer asked the owner of H and M Labs to confirm within the next half-hour that the company could perform 10,370 vaccinations by Dec. 31.
“Yes, ma’am,” Tracie Blue, the company’s administrator, responded a few minutes later.
There is no record the procurement officer responded to Blue or communicated with Welcome Pharmacy about its ability to do the job.
Three months later, H and M has reported inoculating 140 home-based residents and Welcome has vaccinated between 20 and 27 individuals, health officials said.
Neither company provided DHEC information about its relevant experience, organizational structure or plan for vaccinating home-based residents. The only information either included in the documents it submitted the agency was an address, owner’s name and bid price, records show.
When contacted by a reporter in June, Blue acknowledged that vaccinating home-based residents in 45 counties was a significant undertaking but said the process was going well.
She said she wasn’t sure exactly how many people the company employed, but said H and M had yet to run into problems reaching rural residents because it had nurses “all over the state.”
Blue, a registered nurse, real estate broker and entrepreneur, said the company was formed out of a desire to aid the state’s COVID-19 vaccination efforts.
“We responded to a need,” she said. “We all have the credentials and the backgrounds to make it happen, and the hearts to see it happen, and that’s pretty much how we got it done.”
Blue asked a reporter to email her questions about H and M’s work, but did not respond to multiple emails or answer subsequent calls.
Samir Patel, the owner of Welcome Pharmacy, said in mid-June that vaccinations had been “very, very slow.” The licensed pharmacist said he’d been trying to inoculate residents on weekends, but that not many people were interested in COVID-19 shots.
“Just hand me the list (of home-based residents) and I’ll do it when I have time,” he said.
Cost was deciding factor in vendor selection
H and M Labs and Welcome Pharmacy were chosen because they bid less than other vendors.
Under the type of procurement process the agency used, called an invitation for bids, DHEC was bound by law to select the “lowest responsive and responsible bidder.”
An invitation for bids, which is the quickest way of soliciting proposals, is generally issued when there is no substantive difference between vendors. Cost, rather than quality and experience, is the overarching consideration.
H and M agreed to vaccinate home-based residents in every county for $35 a head. Welcome bid only on the Greenville County contract, but came in under H and M at $20 per person.
All but two of the other vendors that submitted bids, including some national companies with extensive COVID-19 testing and vaccination experience, proposed charging $100 per person or greater, bid documents show.
“The award was made to the lowest priced offer for each county where the offeror met all the required specifications, where the offeror was also in good standing,” spokeswoman Laura Renwick said.
Despite cost weighing so heavily in the vendors’ selection, DHEC has not yet paid either company for vaccinating home-based residents, officials said.
While the vendors may seek reimbursement from the agency at the awarded rate, they also can bill private insurance or the U.S. Health Resources and Services Administration to recoup costs.
Thus far, only H and M has submitted an invoice to the agency, Aiken said.
The company reported providing 206 vaccines, which at a rate of $35 per vaccination comes to $7,210. DHEC has not paid the invoice because it has not been able to account for nine of the doses H and M reported administering.
The company is working to reconcile their records and will resubmit an invoice once the root cause of the discrepancy is identified, Aiken said.
DHEC was not tracking home-based vaccinations
Until recently, neither home-based vendor was sharing vaccination information with DHEC and an agency spokesman said last month the state did not know how many residents had been vaccinated through the program because vendors were not required to report that information.
H and M has since started voluntarily providing the agency periodic operational updates, including vaccination data, at DHEC’s request, but Welcome still does not share that information, Aiken said.
As a result, the agency estimates the company’s at-home vaccination totals based on the information it enters into the Statewide Immunization Online Network, or SIMON.
Because DHEC cannot independently track home-based vaccinations, it relies on the vendors to provide accurate information about the number of people they’ve inoculated and tries to cross-check those figures with the number of people who call the state’s vaccination line seeking shots.
The agency also conducts customer service outreach to home-based callers to gather information about their experience with the program.
H and M’s vaccination reporting, in particular, has contained numerous anomalies that are under review.
On multiple occasions, the vendor reported administering Moderna doses in intervals that do not conform with the manufacturer’s emergency use authorization, according to state vaccine allocation data.
People who get the Moderna vaccine should return for a second dose four weeks after their first shot, but H and M reported providing second doses to patients within a day or two of first doses on at least four occasions, data shows.
Aiken confirmed DHEC was looking into the anomalies and had been working with H and M to address its reporting issues, but did not say whether the company had administered doses improperly or simply entered vaccination data into the system incorrectly.
DHEC may replace vendors, rebid contracts
While state health officials said they meet weekly with H and M to discuss steps the company is taking to build capacity and believe both vendors are committed to improving their performance, DHEC is actively considering soliciting new vaccinators to take over the home-based program.
The agency notified H and M this week that if it didn’t start inoculating at least 100 home-based individuals a week it would terminate the contract, Aiken said.
He said H and M had a new leader who is confident in his ability to meet the agency’s expectations, and then some.
Patel, the owner of Welcome Pharmacy, said Thursday he was still vaccinating home-based residents here and there and wanted to continue working with DHEC’s program, but could no longer commit to inoculating all the people the agency was referring him.
“It’s just too much work for me,” he said.
Aiken said DHEC was in the process of reevaluating its relationship with Welcome Pharmacy and exploring other vendor options for Greenville County.
If DHEC does end up soliciting new home-based vaccinators, it will issue a request for proposals rather than an invitation for bids to ensure that quality, rather than cost dictates the vendor selection, White said.
Issuing a request for proposals would allow DHEC to review the operational plans of all prospective vendors before they’re hired to ensure they can meet the agency’s needs.
“This is a life or death situation for people who are homebound and at risk, and so it is imperative that as a state agency we do our due diligence on monitoring vendor performance and evaluating it on a daily, weekly, monthly basis to make sure that we can identify any deficiencies and cure them,” Aiken said. “It would be wonderful if every vendor performed above expectations, but that’s not the real world.”
This story was originally published August 27, 2021 at 5:00 AM with the headline "Hundreds of vulnerable SC residents waiting on COVID shots months after requesting them."