A day after state health officials announced 2,400 doses of COVID-19 vaccine expired under lax Shelby County Health Department oversight, one employee has been fired, another has retired and the drumbeat is rising for state and federal investigations.

In a press conference Wednesday, Feb. 24, Shelby County Health Department Director Alisa Haushalter admitted she considered resigning but decided her duty as a leader requires her to be “transparent about what happened.”

“It is my responsibility to be accountable for what has occurred, to elevate to the state when I knew there were wasted doses, which I did, to work closely with the state to determine what the issues were, and to resolve those issues in a systematic and organized way,” she said.

U.S. Rep. David Kustoff is seeking further investigation, which he says could rise to the federal level.

“Due to gross negligence and possible malfeasance, the executive branch of Shelby County government mishandled and wasted thousands of vaccines, ultimately failing our local community,” Kustoff said in a statement Wednesday. 

“Thankfully, the Tennessee Department of Health is working with the City of Memphis in order to achieve an efficient and effective distribution process. Without a doubt, local officials should be held accountable,” he said. “I welcome the further investigation by state authorities and possibly federal authorities into this fiasco.”

Tuesday, when the state announced its findings, it said it expected federal partners would also investigate.

Haushalter said Wednesday local efforts to break with state policy and vaccinate teachers early started the ball rolling, with thousands of doses being set aside for them.

When word spread that the Health Department was saving doses for a non-priority group, it set off more unrest in Nashville.

“Stockpiling for a later phase is not authorized,” state Health Commissioner Lisa Piercey said late Wednesday, “and this action unnecessarily prohibited high-risk elderly individuals from receiving their fair share of this limited and life-saving resource.”

When state officials told the Health Department it must wait until early March to vaccinate teachers, some 50,000 doses were on hand.

When ice and snow came, and doses were near expiration, the Health Department opened indoor sites and pushed 2,000 doses out, but it wasn’t enough, Haushalter said.

Storms and then low-water pressure compounded the situation, closing vaccination sites for 10 days.

Number of wasted doses higher than previously reported

Most of the waste happened Wednesday, Feb. 10, or Thursday, Feb. 11, Haushalter said, including a large tray of Pfizer vaccine that was thawed and expired before it could be used.

Another 700 doses were tossed Monday, Feb. 15, because they were not used in a clinic quickly set up for teachers in Shelby County Schools to get doses.

Snow and ice made getting to the board headquarters on Avery Avenue difficult. 

A variety of factors can lead to doses being lost, including that they were thawed and expired before they were used, that they were left over after clinic sessions, or they were returned after a clinic but had to be destroyed due to changes in temperature, Haushalter said.

She became aware that some 1,300 doses had expired on Saturday, Feb. 13.

The Health Department employed a contract pharmacist, Marilyn Bruce, as its director of pharmacy services. Her responsibility was to manage and prepare the vaccine inventory for injection.

Bruce lost her job. Dr. Judy Martin, head of immunization at the Health Department, retired in the fracas.

Haushalter said she was sure the mistakes were not intentional. One change that has already been identified is that more than one employee will have a key to the pharmacy to watch inventory levels.

“It is a very complicated vaccine campaign and the Pfizer vaccine particularly is very difficult to manage, temperature control, dates it can be in one type of storage and days it can be in another type of storage, and we had multiple, multiple batches coming in,” Haushalter said.

“My own belief is that trays were pulled for events that were in the future and that one tray expired without notice that we needed to get that vaccine out to the public,” she said.

When the weather hit and sites were expected to be closed for days, Haushalter halted shipments from the state on Friday, Feb. 19, to keep inventory from continuing to mount.

She alerted the state Health Department that doses were lost on Saturday, Feb. 13, and heard nothing back, she said.

“I made additional attempts throughout the week to reach Dr. (Michelle) Fiscus, (medical director of the state Health Department’s immunization program), without a returned call.”

Ultimately, Haushalter said, she called Dr. Tim Jones, medical officer for the state Health Department, to alert him to the waste. 

That call triggered the state examination of processes here, which began the night of Friday, Feb. 19, and continues.

By the end of this week, the Shelby County Health Department will have a plan to work with the state to address deficiencies in local processes. The hope, she said, is that the Health Department will again be able to receive and distribute vaccine.

City takes charge of vaccination sites, eyeing 40,000 in arms this week

For now, the City of Memphis has control of the COVID-19 vaccine and all the other vaccines the Health Department gives, including measles and influenza. The doses are being stored at Regional One.

In the interim, health partners around the city, including hospitals and clinics, will run vaccination sites within the city borders with the city government.

Baptist Memorial Hospital and Christ Community Health Services have identified sites where they could quickly expand. The question, in light of Tuesday’s shakeup at the Health Department, is how much more vaccine should they expect to get.

“We cannot know exactly how to prepare until we know what type of allocation of vaccine we will receive,” said Keith Norman, vice president of government relations for Baptist Memorial Health Care.

“We do understand from the investigation that took place, some changes are being made,” he said. “The health care partners, hospitals and other community partners will be playing a greater role.”

The decision about allocation will likely be made in a communitywide meeting of the partners, Doug McGowen, chief operating officer for the City of Memphis, said Tuesday.

In a move that was planned for weeks, Christ Community and the City of Memphis opened a drive-through site at Greater Imani Church Wednesday, with appointments to give 1,000 shots a day.

“We’re a contracted operator for the city,” said Shantelle Leatherwood, Christ Community CEO. “We are providing all the clinical services – the actual vaccination – and the city is providing support through volunteers and FEMA to help with registration and checkpoints and data entry.”

As managing partner, the city provides trailers, tents and portable toilets. It also covers Christ Community’s costs, including labor.

“We’re contracted with the city until they tell us they no longer need our services. They have basically shared with us that we need to, honestly, perform at maximum capacity over the next few weeks to backfill all the vaccinations that were scheduled last week, this week and for the next two weeks,” Leatherwood said.

She has also offered Christ Community’s clinics on South Third Street and in Hickory Hill as large sites in medically underserved areas.

“We have the space and sufficient parking to handle the load at those sites,” she said.

The challenge will be how much the partners can extend themselves.

“I think we can handle two sites at once; I’m not sure we can do three,” Leatherwood said.

For Baptist, the issue comes down to the number of doses it could get, which could rise significantly in a matter of a week. On Wednesday, the FDA said Johnson & Johnson’s one-dose vaccine appeared to meet the threshold for emergency-use authorization.

If approved, the Biden administration is prepared to roll out 3 million to 4 million doses of the J & J vaccine next week.

“If they only gave us another 100 doses or so, we’d still probably stay at the hospital,” Norman said. “But if we’re given an additional 1,000, we could probably really ramp up some services at places where it could be a convenient, easy process to assist people in a dignified manner, the way we like to serve our constituents.”

Baptist has several mass sites in mind.