AUSTIN — Amid widespread confusion and criticism of Texas’ rollout of COVID-19 vaccines, state leaders are urgently telling hospitals and other providers who have received shipments to move down the pecking order of priority populations.

Get the doses you have into people’s arms before vaccines spoil and must be discarded, Gov. Greg Abbott and state health commissioner Dr. John Hellerstedt urged providers late Tuesday.

That means some elderly and sick Texans will get vaccinated before the state completes the job of immunizing the top-priority cohort — health care workers and residents of long-term care facilities.

On Wednesday, Dr. Peter Hotez, a vaccine scientist at Baylor College of Medicine in Houston, said Texas and the federal government have made the process too complicated — and need to consider setting up tents in larger cities and just running as many people through them as possible.

For the state to achieve herd immunity by the middle of 2021, it’ll need to vaccinate nearly 1 million people a week — and so far, officially, it’s only gotten shots to just more than 200,000 people, Hotez said in an interview.

Texas and federal agencies relied too much on pharmacy chains that lack the capacity to do mass vaccinations, while being “really fussy on who to vaccinate and when,” he said.

Needed: Less ‘hand-wringing’

“What I want to see is a system in place where we can vaccinate large cohorts of people quickly with very simple straightforward rules that don’t require a lot of interpretation and hand-wringing,” Hotez said. “I’m just not seeing that yet, and in fairness to Texas I’m not seeing it in any state.”

Texas is reeling from a surge of the virus, with a record number of new confirmed cases on Tuesday — 26,990. For the third consecutive day, the state on Wednesday achieved a new high for coronavirus patients hospitalized — 11,992. More than 27,000 Texans have died during the pandemic — or more than the entire population of Colleyville.

For more than a week, Hellerstedt and the Department of State Health Services have quietly fretted over anecdotal reports that some of the hospitals, doctors’ offices, clinics and other providers that agreed to administer COVID-19 vaccine — and got some of the first batches shipped by Pfizer Inc. and Moderna Inc. — were moving slowly.

Vaccinators are supposed to enter recipients’ names, dates of birth, addresses, gender, race or ethnicity and the vaccine manufacturer, lot number and date of administration in ImmTrac2, the state’s immunization registry, within 24 hours after they give a shot to someone.

But, as Hellerstedt wrote in a memo to participating providers on Dec. 23, “It has come to our attention ... that there may be unnecessary delays in administering all allocated vaccines and reporting those administered doses” using ImmTrac2.

“The time to vaccinate willing individuals is now,” he wrote.

Hellerstedt referred to his department’s labels for priority groups — Phase 1A, or health care workers and long-term care facility residents; and Phase 1B, Texans who are 65 or older or who have one or more of nine chronic medical conditions such as heart conditions or obesity.

‘Pivot again’

“Once all readily available and willing members of the primary Phase 1A priority populations have been served — including 1A persons outside your facility — we urge you to pivot quickly and begin providing vaccine to as many readily available and willing Phase 1B persons as possible,” he wrote.

“There is no need to ensure all of your 1A group has been vaccinated before starting 1B vaccinations,” he said.

“If, in a given situation, all readily available and willing 1A and 1B persons have been served, we urge you to pivot again and provide vaccine to any additional available and willing persons, regardless of their priority designation. Every shot administered matters.”

But shipment delays because of parcel services’ crushing loads over the Christmas holiday, the need to replace a smaller number of shipments because temperatures may have reached impermissibly high levels and new-user errors and state miscues involving ImmTrac2 have suppressed public reporting of shots given, department spokeswoman Lara Anton said.

While the department’s COVID-19 vaccination dashboard on Wednesday showed 205,463 people in the state have been vaccinated with at least one dose, out of 678,925 doses received by vaccinators, the actual number of shots administered is higher, Anton said.

Just more than 144,000 doses of Moderna vaccine in 421 shipments that were supposed to arrive last week — week two of the effort — didn’t arrive until Monday or Tuesday of this week because of holiday-shipment delays, she said.

Another 4,300 Moderna doses in an additional five shipments experienced a “temperature excursion,” or a reading of too much heat for the vaccine to stay viable, she said. They had to be replaced, Anton said.

Together, that meant 32% of the 460,500 Moderna doses that were slated to arrive in week two didn’t arrive until week three.

User errors, state miscues

On Thursday, about 75,000 more doses administered will show up on the dashboard, reflecting ImmTrac2 inputting and processing problems, Anton said. Of those, 48,000 doses weren’t reported because of something the department failed to do and 27,000 doses were omitted from dashboard totals because providers used incorrect organization codes, she said.

The department is hosting a webinar for providers on Thursday, she said. It hopes reporting will run more smoothly from now on, she said.

On Tuesday, both Abbott and Hellerstedt went public with demands for a quicker pace to vaccinations.

“A significant portion of vaccines distributed across Texas might be sitting on hospital shelves as opposed to being given to vulnerable Texans,” the Republican governor tweeted. “The state urges vaccine providers to quickly provide all shots. We get plenty more each week. Always voluntary.”

In a news release, Hellerstedt said, “All providers that have received COVID-19 vaccine must immediately vaccinate healthcare workers, Texans over the age of 65, and people with medical conditions that put them at a greater risk of severe disease or death from COVID-19. No vaccine should be kept in reserve.”

‘Not sitting on vaccine’

Spokeswomen for the Texas Hospital Association and the Texas Pharmacy Association said their members who’ve received batches aren’t dawdling.

“As an industry, we are certainly not sitting on vaccine,” Carrie Williams, spokeswoman for the hospital group, said in an email. “Vaccine is not sitting on hospital shelves.”

Pharmacy association chief executive Debbie Garza said that while supply is limited, “Texas pharmacies are working diligently to vaccinate health care workers and the most vulnerable Texans in Phase 1A and the recently authorized Phase 1B. Pharmacies are administering their allocated vaccine doses very quickly.”

Despite Garza’s comment about Phase 1B Texans who are 65 or older or who have chronic conditions, Anton, the department spokeswoman, said vaccinators still are supposed to try first to finish giving shots to front-line health care workers and residents of nursing homes and other congregate-care settings for the elderly and disabled.

The department hasn’t yet tried to define another group high on most experts’ list — non-health care workers who perform essential jobs, such as food production, distribution and preparation, delivery services and utility workers.

A panel advising Hellerstedt “is discussing it,” Anton said. However, “1B is a really large group,” she said, referring to how there are millions of elderly Texans and nonelderly state residents with chronic conditions.

One provider group peeved

Owners of freestanding emergency rooms criticized the department’s rollout of vaccine.

Rhonda Sandel of Houston, president of the National Association of Freestanding Emergency Centers, and Dr. Eric McLaughlin, a board member for the state counterpart, said in interviews that the department should have asked providers as they enrolled to estimate take-up rates among their employees so it didn’t overship based on raw numbers of workers.

The department also should have asked providers to submit a backup plan for distributing extra unused doses and made it more clear to providers that they could administer unused doses to people with lower priority, if that’s what it required to avoid spoilage.

“The state got it very wrong,” Sandel said.

Although Texas is unique in licensing and regulating the centers, the department used cookie-cutter provider lists from the federal Centers for Disease Control and Prevention in designing application forms for vaccinators, she said. Freestanding ERs didn’t fit any of the categories and were reluctant to apply as a hospital or private medical practice, Sandel said. That was especially the case because applications included formal attestations that providers would follow all state rules, she recounted.

“They forgot that we are an integral part of the emergency management disaster response system throughout the state,” Sandel said. “They dropped the ball.”

McLaughlin, whose Elite Care chain includes a facility in Plano, said only a handful of the nearly 200 freestanding ERs got vaccines, even though they average about 50 employees each. The doctors and nurses at such facilities have come into contact with thousands of of infected patients, he said.

“It makes me wonder, do we have the right people in charge of allocation and accountability when they completely fail to recognize one of the largest segments of health care in taking care of front-line COVID cases?” McLauglin said.

The department’s Anton did not immediately provide a response to Sandel and McLaughlin.

No call-ins accepted

As confusion reigned over who can now get shots, leaders at Parkland Memorial Hospital in Dallas, like counterparts at many hospitals across the state, said on Wednesday that they were besieged with calls.

“Parkland Health & Hospital System wants to clarify that it is not distributing COVID-19 vaccine to the general public at this time,” spokeswoman Catherine Bradley said in an email.

“We are vaccinating persons who meet the criteria under category 1A,” Bradley said. “Next week, we will begin vaccinating a list of established Parkland patients who have been pre-identified as the most vulnerable should they contract COVID-19. But we are not currently accepting call-ins for vaccines from the general public or people who are not on our pre-determined list of prioritized patients.”

San Antonio-based H-E-B Grocery Co. has received COVID-19 vaccine shipments at many of its stores’ pharmacies. But it’s saving those for health care workers.

“There is some confusion based on updates from TX Dept of State Health Services,” H-E-B tweeted Wednesday. “While some providers may be offering it to those in [Phase] 1B, we are not yet in this phase as we are still receiving shipments. We will continue to offer vaccine to the healthcare worker group at this time.”

Christy Lara, spokeswoman for Albertsons, which has Tom Thumb and Randalls pharmacies that have received vaccines, said in an email that it too will follow state guidance and concentrate for now on administering shots to front-line health care workers.

“We will continue to follow the allocation guidance from” the department, Lara said.

Another dashboard

Also on Wednesday, the Texas Division of Emergency Management launched a vaccine reporting system that is different and separate from the state health department’s.

Division spokesman Seth Christensen said the new site will improve “transparency”' and help inform the public about where vaccines — and “therapeutics,” such as monoclonal antibodies — are available. The confusion so far hasn’t really been about amounts of doses shipped but numbers of shots administered, he noted.

Hotez, the Baylor College of Medicine vaccine scientist, though, scoffed at the notion that the state needs more tracking systems.

“Dashboards? I don’t want to see dashboards,” he said. “I want to see tent cities go up where we have the capacity of vaccinating 1 million Texans a week.”

Texas is relying almost solely on vaccines, not other public health measures, to end the pandemic and return residents to normal life and commerce, Hotez noted.

“I’m just looking at the scope of this thing and it’s massive,” he said. “Remember, we don’t have a plan B, right? There’s been no COVID-19 containment to speak of, right? The governor said no lockdowns. So we’ve got the surges on our ICUs. The only plan that’s in place is to vaccinate.”

Paraphrasing a tweet he sent Wednesday, Hotez said of the delays, “These are not bottles of cabernet sauvignon. They don’t need to age. We need to get them out.”

SLOW GOING

Only a minuscule share of North Texans have gotten the COVID-19 vaccine shot, according to state figures.

While Dallas County’s 15,528 doses administered ranks second in the state only behind Harris County’s 28,400, it makes up only 0.77% of the county’s population that is 16 years of age or older.

In Tarrant County, 0.68% of its population 16 years old or older has received the first shot of the vaccine.

Trailing were Collin County at 0.65% and Denton at 0.44%.

In Dallas County, 10,440 residents in the 16-49 age range have received the first dose. Only 3,987 residents in the 50-65 range have gotten the dose. For residents 65-79 the number is 963, and it drops to 133 for Dallas County residents 80 years of age and older.