When Danielle Campoamor’s son Samuel was only about four weeks old in late 2018, he contracted respiratory syncytial virus (RSV), the most frequent cause of hospitalizations among infants in the United States, and landed in the neonatal intensive care unit at New York-Presbyterian Brooklyn Methodist Hospital.
Four years later, during what public health officials called a “tripledemic” of RSV, Covid and the flu, Samuel was again placed in an intensive care unit.
While the severe impact of the virus did not leave the younger of her two sons with any chronic health issues, for Campoamor, a journalist, it was “traumatic to watch him struggling to breathe.
“It’s just definitely something that doesn’t leave you, and so when we were first able to get the vaccine as adults, we signed up right away and then of course when they became available to my kids, we made sure that they got vaccinated,” said Campoamor, who lives in Brooklyn. “The moment that there is a new [Covid vaccine], we sign up.”
Unfortunately, Campoamor was one among many people in the United States in recent weeks who were unable to schedule an appointment to receive the latest Covid vaccine; had their appointments canceled; or were informed by insurance companies that they would not cover the cost of the shot.
Public health experts attribute the hurdles to this being the first time that private companies, rather than the US government, has handled the purchase and distribution of Covid vaccine doses.
“The whole system was, in a sense, very centralized, and now Covid-19 vaccines are being provided to the commercial market much like other vaccines, and because it is the first time that this is occurring, there have been some hiccups,” said Jennifer Kates, a senior vice-president at KFF, formerly the Kaiser Family Foundation.
By the end of 2022, the federal government had spent $30bn on Covid vaccines, according to KFF.
In September of that year, the Biden administration announced it no longer had money to cover the cost of the vaccines. Congress did not authorize additional spending for Covid vaccine purchase and distribution, which meant that when federal health officials authorized a new Covid vaccine in September, insurers or individuals had to pay to get the shot.
While Medicare, Medicaid and most private insurers cover the cost of the vaccinations, some people were told during the initial rollout that they would have to pay for it, Kates said.
Some insurers blamed the difficulties on issues with billing codes.
Kates said: “The coding that is needed for these vaccines was available in August and so this wasn’t something that dropped on them the day that the vaccines were recommended. That is another thing that could have been potentially avoided.”
Some pharmacies did not initially have sufficient vaccine supply because they did not know what the demand for it would be, according to Sara Rosenbaum, a health law and policy professor at George Washington University.
Corporations “fear that vaccines will sit around on their shelves unused”, Rosenbaum said. “When it was clear that we were going to need a new kind of vaccine … there was sort of this wait-and-see approach because people resist vaccines, so now you end up with this vicious cycle of people coming in looking for the vaccine, only to discover that they can’t have it.”
Spokespeople for CVS and Walgreens, two of the largest US pharmacy chains, blamed canceled appointments on supply chain issues.
“We are aware of isolated incidences at a small number of locations where appointments had to be rescheduled due to delays in supply,” a Walgreens spokesperson told the Associated Press last month.
Matt Blanchette, a CVS spokesperson, told media last month that “due to delivery delays from our wholesalers, some appointments may be rescheduled”.
Moderna and Pfizer, Covid vaccine manufacturers, told the Associated Press that they had sufficient supply and had delivered millions of doses.
On 25 September, CVS informed Kates, of KFF, that it had canceled her vaccination appointment scheduled the following day. That was a problem for her because she was about to travel for a conference, and then her parents, who are in their late 70s and early 80s, were coming to visit her in Washington DC.
Now she will not be able to get it before they come and will use precautions such as Covid testing and masks to avoid infecting them.
“It was too bad that the timing didn’t work out; it was disappointing,” she said.
Still, she said, when you’re switching from a public to a private system, “there’s bound to be challenges that arise”.
Rosenbaum said: “We have such a poor track record in public health in the United States … The moment the emergency was over, we forgot the basic lesson of vaccines, which is do not wait for private companies to order this stuff. Get it to where it’s needed.”
A group of insurers stated in a letter to Xavier Becerra, the US health secretary, late last month that issues with billing had been “largely, if not completely, resolved and are not limiting patient access to vaccine”.
But parents still say that they are having trouble finding the vaccine for their children, according to news reports.
Kates said she expects that Covid vaccine rollouts will start to look like ones for the flu vaccine.
“This should not be like this for the next one, but there is always a surprise out there,” she said.
Campoamor, the journalist, said she had been able to get her sons vaccinated but Rite-Aid canceled her 22 September vaccination appointment and said she would have to wait a month for a new appointment. She then made an appointment with Walgreens but that too was canceled because of flooding in New York.
On Twitter, she wrote of the canceled appointment and flooding: “This is fine. Everything’s fine. Totally normal. Nothing to see here.”
