Alabama vaccine distribution worst in the nation

Frank McPhillips

Today’s guest columnist is Frank McPhillips.

When a deadly pandemic collides with exponential growth, the result is frightening. We have reached that point in Alabama, and we must speed up the distribution of vaccines.  

During October, roughly 30,000 Alabamians contracted COVID-19. By November, the number rose to 42,500 in one month. In December, the number of cases more than doubled to 111,000. And, January’s cases are rising even faster than December’s.

As of this writing (January 12), more than 400,000 Alabamians have contracted the virus since the first official case on March 12, and the death toll stands at 5,347. It’s not easy to comprehend the magnitude of 400,000 cases. That is virtually equivalent to every man, woman and child living in Mobile County, our second most populous county. No other state with our population has witnessed nearly so many cases. 

More cases inevitably result in more hospitalizations, and more hospitalizations lead to more deaths, especially when all the ICU’s are full. On January 11, Alabama recorded 3,088 hospitalizations, the highest level ever, and twice the number of patients in Alabama hospitals in July, when the State battled its worst outbreak before now.

Intensive care units in Alabama are now averaging 94% occupancy, according to official figures released by the Department of Health & Human Services. In the Birmingham area, the ICU occupancy rates at Medical West, Brookwood, UAB Hospital and St. Vincent’s are all running at or above 94%, while those in all hospitals serving Mobile, Huntsville and Montgomery top 96%. 

Meanwhile, amid great fanfare, Alabama received its first shipment of the Pfizer vaccine on December 15, the very day we crossed the 300,000 case threshold. In the intervening 28 days, the State has seen 108,000 new infections but only 87,000 inoculations, according to the State Health Department’s vaccine dashboard.

It is clear the State’s vaccine distribution program so far is abysmal. We have administered 1,775 doses per 100,000 population, the lowest per capita rate in the nation. West Virginia has administered 3.5 times Alabama’s doses on a per capita basis. After four weeks, it should be unacceptable that only 1.7% of Alabama’s population has been vaccinated. At that rate, it would take over three years to reach 80% herd immunity. 

Why is the vaccine roll out so slow? One reason could be a rigid adherence to the CDC-recommended tiered distribution plan. In the first tier are 300,000 front line medical personnel and nursing home residents, followed by seniors over 75 and specified essential workers, then seniors aged 65-74 and additional essential workers, and lastly, the general population. 

The tiered system may be more equitable, but what happens when, as in the case of Clay County Hospital, 90 of 200 high-risk medical personnel elect not to take the vaccine (despite the hospital being overrun with COVID patients, oxygen running low, and beds being added to the ICU)? How long must we wait on those in the first tier before moving on to the next tier, and so on?

To speed things up, the State Health Department announced last week that the State will open up vaccinations to 75 year olds and older, while continuing to vaccinate eligible first-tier eligible recipients. Within hours after setting up a statewide appointments hotline, the Health Department shut it down because 1.1 million calls flooded the line. Hospitals around the State were overwhelmed with calls from residents desperate to receive the vaccine. 

There are roughly 300,000 healthcare workers in the State and 350,000 people age 75 and older who qualify for the vaccine. At the current pace of vaccination, an essential worker (like a teacher) or a 65-74 year old with preexisting conditions would not be eligible for vaccination until September, at the earliest. Just this morning, Secretary of H.H.S. Alex Azar, reversed his earlier recommendation, urging states to open up vaccinations to seniors aged 65 and older.

A second reason for the slow roll out is that officials have been holding back enough doses to ensure a second booster shot for those who received the first dose. This policy also may be changing, as Secretary Azar, under pressure from the incoming Biden Administration, urged states to release all doses currently sitting in warehouses because of growing confidence that second doses can be provided by ongoing production. It also helps that new vaccines (Johnson & Johnson and AstraZeneca) are on the horizon. 

Alabama is not the only state confronting distribution problems, but it is among the worst. According to data released by the CDC, our State is dead last in the nation in terms of the percentage of vaccines received by the State that have been injected into peoples’ arms (only 23.4%). The State Health Department, whose dashboard was updated last night to show a 32% distribution rate, would take issue with that ranking, but even ADPH would concede Alabama is in the bottom quartile. 

People are justifiably angry that our public officials are so ill-equipped to deliver the vaccines after having months to prepare. I don’t pretend to have all the answers, but let’s be clear: there are only two ways to immunize the population – by infection or vaccination. At an average of 1 death for every 75 cases in our State (400K cases and 5,334 deaths), unless the State recognizes the urgency and dramatically picks up the pace of vaccination, tens of thousands more Alabamians are likely to die.

Frank McPhillips is a recently retired attorney, devoted husband to Louise and father of three adult sons. Frank graduated with honors from Harvard College and the University of Virginia Law School, and practiced law for over 35 years at Maynard, Cooper & Gale. He currently serves on the boards of numerous nonprofit organizations, including Advent Episcopal School, Impact America and the National Multiple Sclerosis Society. To receive Frank’s free daily Alabama COVID Newsletter, sign up at

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David Sher is the founder and publisher of ComebackTown.  He’s past Chairman of the Birmingham Regional Chamber of Commerce (BBA), Operation New Birmingham (REV Birmingham), and the City Action Partnership (CAP).

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10 thoughts on “Alabama vaccine distribution worst in the nation”

  1. We live in a low tax, low service state dominated by a political party that doesn’t believe that government works, and when elected, “proves” it. The article points out one of the consequences when we face a crisis.

  2. One thought that I have as a nurse is, perhaps, that there are not enough qualified professionals coming forward to administer the vaccine. I came out of retirement to do so. The shots do not give themselves, and people must be monitored for 15 minutes minimum after receiving the vaccine. It takes education and planning to administer the vaccine properly. I am not sure who should take responsibility for organizing, but it seems to me it should be from the top of the State .

    1. I think that is most likely the limiting factor. Where would the funds come from to set up vaccination stations in easily accessible areas, maybe at the places they already go to vote . You could get volunteers to help with everything but the actual injection. Just a thought…… I think we need to outside the box here .

  3. We need more higher level nurses! I say that from a 40 -year career in healthcare in various venues starting in 1970. But getting more nurses has been difficult due to the sexist “master/slave” relationship under which most nurses have suffered under physicians for generations.

    Ancillary healthcare workers like respiratory therapists aren’t even treated as well as nurses. For-profit healthcare systems and chain hospitals – especially since the 1980s – have further reduced the professional ranks of registered nurses for substitution by LPNs, nursing aides, and nursing assistants to save money.

    Ancillary medical professionals (physician extenders) like Nurse Practitioners and Physician Assistants have helped fill gaps. Again, for-profit healthcare systems aren’t eager to pay for them.

  4. Dear Frank,
    Thank you for your continued service to our community. This is abysmal, but what else is new? I have made call after call to get the vaccine. I am 73, have diabetes and COPD, so I am in a high at risk profile. As you note, the state has no distribution plan, reflecting a lack of leadership.
    Mabry Rogers

    1. Mabry, I am sympathetic because I have heard versions of your story countless times. We must somehow find a sense of urgency. When the first case of smallpox was discovered in March 1947, a lone NYC physician, Dr. Israel Weinstein, sounded the alarm. Due mostly to his bully pulpit, NYC vaccinated 6.5 million people in less than one month. It can be done but we need leadership.

  5. While we wait on more vaccination stations manned by qualified people to administer vaccines, Alabamians must stay vigilant in continuing to do their part in preventing the spread! Stay home if you can. If you must go out, stay masked and socially distanced at least 6ft. Follow the guidelines Dr. Fauci and the CDC have set because they work!

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