Wondering About Nebraska's COVID-19 Policies or Lack Thereof?
Here’s an overview of how the decisions are made in Nebraska:
Photo Credit: Laura James
By Emily Chen-Newton
As the nationwide vaccine rollout picks up, it can be disheartening to hear that some doses are going to waste, yet we know it's happening around the country. In one of Governor Rickett’s recent COVID-19 news conferences, the state’s Chief Data Strategist said that she could not offer an estimate of how many vaccine doses have gone to waste in Nebraska.
Ashley Newmyer, the chief data strategist for the state Department of Health and Human Services (DHHS) explained there is currently a way for healthcare providers to document when a vaccine dose has to be thrown out, but she said, “It’s more like a clinical chart note. So, it’s difficult to pull that information from our system at this time.” Andrew Ozaki, of the KETV news team (Lincoln Bureau Chief), asked the question during the press conference about wasted vaccines and Ashley Newmyer gave assurance that smoothly aggregating data of wasted doses is “one of the pieces we are working to enhance...one of our continuous quality improvements that we have on that registry system.”
Image Credit: https://unsplash.com/@schluditsch
Nebraska is not alone in this lack of tracking lost doses. One way this can happen is when a vial of vaccine has more doses than was anticipated. This is a perfectly normal occurrence as vial are often overfilled to ensure the vial don't come up short. But when this happens clinic workers must scramble to find arms to stick before the vaccines expire.
There are many reasons a vaccine site staff might find themselves with more doses than they prepared for, but looking around the nation, the waste seems due in part to a combination of state directed vaccine distribution guidelines, distributors’ misunderstanding of those guidelines, and communication about those guidelines regarding specific situations. In Nebraska, there is currently no statewide waitlist, nor has DHHS coordinated with clinics/distribution sites to provide those waitlists to the public on one unified web page in case there are extra doses.
When asked in last Friday’s press briefing about the waitlist, Ricketts responded, “There really isn’t a waiting list, because again, there’s no guarantee what you will have leftover at the end of a clinic. And it really is up to the local health directors to manage that. And again, it’s the kind of thing that you won’t really know ‘til the end of the day.”
To get a better understanding of how these guidelines, procedures, or lack of procedures, have been developed in Nebraska, NOISE spoke to former Nebraska State Senator Sara Howard and former State Epidemiologist, Dr. Tom Safranek. Dr. Safranek retired from DHHS in late January moving to an Omaha company focusing on vaccine distribution, where he feels his expertise can be most effective at this time.
Sara Howard said when we think about how the state’s Directed Health Measures (DHMs) were first developed for this pandemic, “The challenge was really in our statutory framework going into the pandemic, that said a Public Health Department can issue a Directed Health Measure for everything but an infectious disease”. For a DHM related to an infectious disease to be put in place, the State’s Chief Medical Officer must sign off on it.
Guidelines for developing DHMs are laid out in the “Nebraska Pandemic Bench Book”. The handbook states, “If the Director determines a DHM is needed and issues a type of DHM, the Director will consult with the Chief Medical Officer (CMO).” But because our current director of public health holds a medical degree, he serves as both the Director and CMO. So the approval of a DHM rests in the hands of the chief medical officer, who is appointed by the governor and “shall serve at the pleasure of the Governor”, according to Laws 2007, LB296, § 4. Our current Chief Medical Officer Gary J. Anthone, M.D. is certified by the American Board of Surgery, and has a background in private practice surgery, but not in Public Health. In The Nebraska Hospital Association’s Fall 2020 publication when asked what most surprised him about his role with DHHS, Dr. Anthone said, “I realized how much I needed to learn when it comes to the public health system and how it operates.” Anthone serves under the CEO of the Nebraska DHHS, who is also appointed by the governor.
Notably, Nebraska Law and the state’s pandemic guidebook, does allow for the Chief Medical Officer to “make use of the expertise and observations of any health care provider who has treated a person for whom a DHM is being considered.” And until late January an important member of the DHHS team was Dr. Tom Safranek. As an infectious disease expert with substantial research under his belt, he acted as the State Epidemiologist for 30 years before being removed officially from the role and made the ‘special assistant’ to CEO Smith in September of 2020.
When speaking to NOISE Safranek noted that even after the role change, his job remained much the same. He explained, his job at DHHS was not to make or even suggest policies. Rather, his job was to “paint the picture” for those making the policies. With his understanding of how infectious diseases spread within a population, he would describe what the state of the pandemic looked like in Nebraska and what it could look like in the future to those enacting policies, like the Chief Medical Officer.
Sara Howard explained, “So when you think about, ‘Was it just one person’s decision to decide how we handle our Directed Health Measures?’, ultimately, the statutory framework we had in place really did make it one person’s decision. And it ultimately became the governor’s decision because the chief medical officer was willing to go along with the direction the governor recommended.”
Nebraska has not had a state epidemiologist since early September, but DHHS Public Information Officer Julie Naughton noted DHHS now has “an entire epidemiology team, many have worked for the state for a number of years, so we are well positioned to continue the necessary work at present.” However, she added, “Also, we are advertising for a state epidemiologist.”