Vaccine Distribution Data in Long-Term-Care Facilities Needs to Be Public

Nearly a month after COVID-19 vaccine distribution began, it’s still impossible for the public and the media to track the rollout of vaccines in nursing homes, assisted living facilities, and other long-term-care facilities in most states. But last week, South Carolina began publishing the data they receive from the federal government on vaccinations in long-term-care facilities. This is the first facility-level vaccination data we’ve seen from a US state, and it’s a crucial step in transparency around vaccine distribution to these most vulnerable populations. We believe that this facility-level data likely exists for every US state, which means that it could be published by every state. But in most states, the details of vaccine rollouts across the country’s LTCs remain closely guarded.

To say that the pandemic’s toll on LTC residents has been disproportionate severely understates the case. Less than 1 percent of US residents live in long-term-care facilities, but deaths among LTC staff and residents—which our research suggests are overwhelmingly among residents—make up at least 37% of the nation’s total COVID-19 deaths. As of January 7, 2021, more than 133,000 COVID-19 deaths were reported among residents and staff of LTCs. Some states don’t report these deaths as LTC deaths unless they take place within an LTC facility, rather than in a hospital, so even this number doesn’t fully capture the reality of the pandemic’s effects on our most vulnerable.

Both long-term-care residents and the healthcare workers who staff LTC facilities were prioritized in Phase 1a of the CDC’s vaccine distribution. However, while vaccine data is readily available across 49 states and territories, our team has found vaccine data for LTCs from only seven states: Arkansas, Illinois, Kentucky, Michigan, South Carolina, Tennessee, and Texas. Given the devastating numbers of deaths we’ve seen in LTCs, we believe that releasing information on vaccination rollouts in LTCs should be a priority in every state. 

What South Carolina has released

South Carolina’s recent release of vaccination data is the most detailed we’ve seen yet. It provides the facility name, pharmacy distributor, vaccine type, and the number of residents and staff vaccinated. The data released by South Carolina can be used to examine which facilities are receiving the first vaccine distributions. Based on our analysis on January 10, 2021, one third of the South Carolina LTC facilities that administered initial vaccine doses currently have ongoing outbreaks. Additionally, 14 out of the 20 facilities that experienced the highest cases and deaths throughout the pandemic had vaccinations this week—and this is exactly the kind of information that local communities deserve access to. 

The facility-level data comes to South Carolina from the federal government, and may need additional cleaning, quality checks, or explanation before it’s ready for wide use. In this report, 39 facilities are listed as having more resident vaccines than available resident beds, with 14 of those reporting between two and six times as many resident vaccinations than available beds. Whether this reflects reporting errors, definition gaps, or something else remains to be seen, but we urge caution in using the data in its current form without confirming the figures with facilities. On their vaccine dashboard, the South Carolina Department of Health and Environmental Control makes it clear that they don’t manage this data and that it is reported through the federal Tiberius database. In a drop-down menu above the spreadsheet is a note from the state health department that reads, “The data within these spreadsheets are approximate and provisional. VAMS and Tiberius are new federal reporting databases, and as vaccine providers become more familiar with them, we expect the accuracy of the data to improve.” 

Where LTC vaccine data comes from

Most LTC vaccines in the US are distributed via the federal Pharmacy Partnership for Long-Term Care Program, through which pharmacies—primarily CVS and Walgreens, but also several regional pharmacies—store the vaccines, deliver and administer them at facilities, and report them to the CDC. West Virginia is the only state to not participate in the pharmacy program, opting for their own program.

According to available federal data as of January 14, 2021, 1,084,177 initial doses of vaccines have been administered to residents and staff via the Pharmacy Program—about 11 percent of all vaccines administered in the United States. Currently, the only data available from the CDC about this federal program is the number of total vaccines distributed and total vaccines administered, but interestingly, CVS recently began releasing its own LTC vaccine dataset. The CVS data segments their distribution data by jurisdiction (state and city) and by facility type—skilled nursing facilities, which are federally regulated by the Center for Medicaid and Medicare Services; and assisted living and other LTC facilities, which are regulated by states—but doesn’t include facility-level details. According to Rebekah Pajak, a senior manager of pharmacy communications at Walgreens, the participating Walgreens pharmacies are also currently reporting all the data associated with the vaccines they administer in LTC facilities to the CDC, and the company is “exploring a path to make this same information available externally.”

Government agencies should release facility-level data about vaccines in LTCs now

We need to know how vaccines are being distributed, administered and completed, and, ultimately, know if our most vulnerable populations are being protected. In the coming weeks, we hope to see the same level of granular information that South Carolina reports on LTC vaccinations released by the federal government and by other states.