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South University nursing student Kimberly Pham prepares to administer the Moderna COVID-19 vaccine to central Texans lined up at a drive-through clinic on Jan. 21. (Bob Daemmrich)

For two weeks in January, Donna Snyder had one focus: finding a COVID-19 vaccine appointment. The 69-year-old, who lives near Lake Travis, scoured newspaper pages, watched the news and tuned in to city press conferences. She signed up for waitlists in Austin, Fredericksburg and Waco, as well as in Collin and Williamson counties.

"It became my full-time job," she told Austonia.

On Jan. 22, Snyder received an email from Family Hospital Systems, a provider in Williamson County, alerting her that appointments were available. "I signed up that day," she said. Within 90 minutes, she had received her first shot. Her second appointment is scheduled for this week.

Although Snyder was "totally impressed" with the FHS system, she remains frustrated with Austin Public Health. "I am utterly angry and a thousand times disappointed at how poor the Austin process is," she said. "As far as Austin goes, I still need a vaccine."

Nearly three months into the vaccine rollout, Austinites continue to face long waitlists mired by technical glitches and report concerns about scheduling their second dose appointments. The fundamental problem is inadequate supply: with this week's allocation, Travis County will have received 233,515 initial doses, or enough to vaccinate 47% of residents who are currently eligible. (Nearly half of Travis County residents 16 and older fall into groups 1A and 1B, according to Texas Department of State Health Services data.) But Snyder and many other residents say that poor communication is making a stressful process worse.

"I would like an explanation for why the city of Austin, with all of the extraordinarily brilliant tech people in this town … why they screwed it up so bad," she said.

A decentralized process

DSHS established a number of vaccine hubs—including Austin Public Health—in mid-January, shifting its distribution strategy to focus on these sites in an effort to simplify the sign-up process and funnel doses to those providers capable of vaccinating 100,000 people or more. Shortly after, APH debuted its vaccine waitlist, through which it schedules appointments. Since Jan. 11, APH has received 12,000 doses weekly.

More than 306,000 people have registered through APH, with more than 229,000 meeting the current eligibility criteria. Of those, approximately 194,000—or 85%—are still waiting for an appointment. The department does not open up appointment slots until it receives doses from the state in an attempt to avoid cancellations. but this leads to limits the notice APH can provide and often leads to a stressful rush, users told Austonia.

"The vaccine supply is the rate-limiting step in getting everybody vaccinated and getting people protected," Austin-Travis County Deputy Medical Director Dr. Jason Pickett said during a Friday press conference.

But users also report problems using the waitlist. City staff are continuously working on improvements, including registering people who showed up in the early days of the rollout without an appointment and require a second dose and sifting through users who created multiple accounts with different email addresses, APH leadership said at the same event. "We are seeing things run so much better," Director Stephanie Hayden-Howard added.

The department also established a new queuing system last week: when first dose appointments are available for scheduling, registrants will be added to a queue and receive a place in line with an estimated wait time until they are at the front of the line; at that point, they will have 10 minutes to make an appointment.

Some Austinites have compared APH's waitlist to Williamson County's centralized model, which opened on Feb. 8 and currently has around 190,000 registrants. Public Affairs Manager Connie Odom said the county developed the centralized model so that residents didn't have to register on multiple lists. The central list allows users to update their information and remove themselves if they make an appointment elsewhere. "I think that puts people's minds at ease," she said.

APH does not have such a centralized system. "Since the vaccine distribution and allocation process is very decentralized, it is incredibly difficult to make a single, centralized waitlist that encompasses the availability of hundreds of providers, all of which have different processes for registration," a spokesperson wrote in an email to Austonia.

DSHS has allocated more vaccines to more providers in Travis County than in Williamson County, reflecting differences in population. Although the centralized waitlist is a welcome improvement to some, it is not a panacea.

Hank Ewert, 69, lives in the Brentwood neighborhood and secured a vaccine appointment last week through the Williamson County waitlist. When he arrived at the scheduled time, he and the others in line with him were told their appointments had been rescheduled due to shipping delays caused by the winter storm. "You can't fault them for canceling the vaccinations if there's no vaccine," he said. "But I think they should have texted everyone."

Ewert is worried that the delay may mean it's another month before he is able to get his first shot. He and his wife are now looking for an appointment elsewhere. "I would not mind having two appointments set up at one time," he said. "I know it's going to improve as more and more vaccine gets distributed, but right now the whole availability system seems so fragile that it seems best to try everything."

The second dose shuffle

Another common complaint from eligible Austinites is the waiting game between their first and second shots.

Genevieve McKinster, 81, lives in a senior community in North Austin and received her first shot through APH on Jan. 27. There was a glitch—when she arrived for her 11 a.m. appointment; she was told her appointment wasn't in the system—but luckily she had printed out her appointment details and brought it with her. "I cried when I got my first shot," she said. "I wanted it so bad."

Now McKinster is back where she started, anxiously awaiting a confirmation email for her second appointment. She said she probably spends two to three hours a day checking her inbox and spam folder for an update. "I just don't trust them to email me," she said.

Tilak Khetrapals, 81, feels the same way. The South Austin resident received his first shot on Jan. 20 from APH's Delco Activity Center vaccine site. Nearly six weeks later, he's still waiting to hear about his second dose. "They're not communicating," he said. "That is the problem."

Like many providers, APH is reaching out to patients directly to schedule second dose appointments. Although Pfizer and Moderna recommend three and four weeks between doses, respectively, the Centers for Disease Control and Prevention says the second shot may be administered up to six weeks later.

Although APH generally does not allow for walk-ups, people who received their first dose through the department and have not received information about their second dose within the 42-day period may show up at any APH vaccine site, present their vaccine card and receive a second dose.

Deirdre Strand, 65, lives in South Austin and registered for a vaccine through APH, Austin Regional Clinic and Williamson County, where she ultimately was able to secure an appointment on Feb. 3. "It was an absolutely easy, breezy, very coordinated procedure," she said.

Although Strand has not yet heard about her second shot, she has stopped looking for alternative sites. "I'm not going to spend my entire day waiting to sign up for things and put myself on another waiting list when I truly have been blessed to get my first shot," she said. But she also has a backup plan. If she doesn't hear back from Williamson County about her second shot, she plans to show up at the site where she received her first dose this week. "All I can think of is they must be able to give me my second shot that day," she said.


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