Michigan's 10 most populous counties collectively received about 3,400 fewer first doses of COVID-19 vaccine last week after the state applied a formula that factors in race, poverty, housing and other social vulnerabilities instead of allocating vaccine doses by share of population, state data show.
But that only tells part of the story about how the Michigan Department of Health and Human Services' use of the federal Social Vulnerability Index or SVI in an attempt to make vaccine availability more equitable across racial groups and socioeconomic classes is shaking up the weekly allocations.
Oakland County, the state's most wealthy and second most populous county, received 7,950 fewer doses of vaccine last week than its hospitals and county health department would have if the allocations were based solely on population, a Crain's analysis shows.
Some of those vials of vaccine shifted south of Eight Mile Road.
Detroit received 4,835 additional doses of vaccine last week when the SVI was factored into the allocation formula, according to allocation data Crain's requested from MDHHS.
Dr. Joneigh Khaldun, the state's chief medical executive, said the SVI formula was designed to take into account that access to the vaccine is not universal across all communities in the state.
The SVI formula contains a weighting factor that gives more doses to communities with a higher proportion of residents with disabilities or those living in closer quarters, less stable housing as well as those with barriers to transportation and language who don't speak English.
"Those things should not impede your ability to get a vaccine, which is why we're focusing so much on equity," Khaldun told Crain's. "... The people who have the most resources and cars and abilities should not be the people who have the easiest access to a vaccine — and we are very committed to that."
Washtenaw County, which like Oakland County has a smaller portion of its population living in poverty than most counties, also saw its weekly allocation reduced by 2,465 doses using the MDHHS formula, state data show.
Ottawa, Livingston and Macomb counties saw overall reductions in vaccine allotments of 984, 726 and 687 doses, respectively, compared with what they would get by a formula tied only to population.
The data MDHHS provided Crain's only accounted for first doses of the two-shot Pfizer and Moderna vaccines shipped to providers last week before the new one-shot Johnson & Johnson vaccine became available.
Suburban Wayne County, despite having some of the state's poorest cities in Inkster, River Rouge and Ecorse, received 299 fewer doses of vaccine under the SVI formula than it would have if vaccines were allotted by population.
Overall, Wayne County's health department and suburban hospitals received a total of 18,322 doses last week for its roughly 1.1 million residents, while Oakland County received 20,854 doses for its 1.25 million residents, state data show.
"We still are not getting as much as our neighboring counties and the city of Detroit," said Dr. Mouhanad Hammami, Wayne County's chief health officer. "The social vulnerability index should be considered for more doses, and because of that, we think we should receive more."
On the allocation, Hammami said he has asked for the formula in how the doses are distributed.
"There are several factors the state bases its allocation on" for county heath departments, he said. "Population of the area, the number of essential workers, seniors 65 or older, plus the SVI. Is it one-to-one or how do they apply it? The formula seems a little questionable, but we hope as the (total) numbers of doses go up, we will all receive enough."
Khaldun defended the formula, pointing to how it helps distribute more vaccine to rural parts of the state that otherwise would get a smaller share based solely on population.
State data show a district health department encompassing Alcona, Iosco, Ogemaw and Oscoda counties — four northeast Lower Peninsula with high rates of rural poverty — received 390 additional doses of vaccine last week using the SVI formula. In southwest Michigan, Van Buren and Cass counties got a 586-dose boost in vaccine last week under the state's formula, data show.
"There are many areas across the state that have a high (social vulnerability)," Khaldun said. "I think it's a fallacy for some people to assume that we're just talking about Southeast Michigan or the city of Detroit."
While the SVI formula reduces vaccine allocations to more affluent counties in the state, their overall shipments still are increasing as more vaccine becomes available from Pfizer, Moderna and Johnson & Johnson.
Last week, Washtenaw County received a 40 percent increase in doses, 7,000, including 2,000 of the new single-dose J&J vaccine, compared with the 5,000 doses the county health department received the week of Feb. 22. Two weeks ago, the county got a shipment of 3,000 doses, giving it a 133 percent increase the past two weeks.
"We're tremendously relieved to have more vaccine available, and we continue giving vaccinations as quickly as possible," said Susan Ringler-Cerniglia, Washtenaw's communications and health promotion administrator.
"Its an incredible relief to start moving though our lists faster and to be able to offer vaccination in more locations, including more accessible community sites," Ringler-Cerniglia said in an email to Crain's. "We'll continue to prioritize those older adults who have been waiting for appointments as we start adding newly eligible individuals to the list next week."
Washtenaw County plans to expand hours at its mass vaccination clinic at Eastern Michigan University in Ypsilanti, from 5,000 to 9,950, where it has partnered with St. Joseph Mercy Health System, a division of Trinity Health Michigan.
It also has been collaborating with Michigan Medicine and the medical group IHA to vaccinate about 1,200 educators and school employees. This week, the county will add another unspecified mass vaccination site, she said.
"We are adding multiple pop-up vaccination sites throughout the week (with more than 1,000 doses," she said.
Meanwhile, eight-hospital Trinity Health Michigan, which has been working with local health departments and physicians to expand vaccination opportunities, received more doses of vaccines last week than in previous weeks, but not a large amount, an official said.
"When we do (receive more doses) it will allow us to ramp up appointments to all eligible groups," said Dr. Rosalie Tocco-Bradley, chief clinical officer with Trinity Health Michigan.
Tocco-Bradley said Trinity Health has been transferring a number of vaccine doses to local health departments in its market and also physician groups, where "eligible community residents and patients can more readily access it."
Over the past several weeks, Tocco-Bradley said Trinity also has worked with local school districts to make appointments to vaccinate their staff.
"We are also now reserving doses each week for eligible patients who reside in vulnerable ZIP codes in our communities," Tocco-Bradley said. "Hospital team members are conducting phone outreach to schedule appointments for these community members, many of whom who may not have access to the Internet and live in ZIP codes disproportionately affected by COVID-19."
At Henry Ford Health System in Detroit, the state shipped a total of 17,900 doses of the COVID-19 vaccine. The number included 700 of the J&J vaccine, 10,760 first doses of Pfizer and 6,440 second doses of Pfizer and Moderna.
Under state directions, Henry Ford plans to use the 700 doses of J&J single-dose vaccine on patients 65 and older who are being discharged from the hospital or the emergency department.
"Once we know the quantity of vaccine we expect to receive next week, we will begin contacting those who would meet the state's expanded eligibility criteria that are set to begin March 8," said a statement Thursday by Henry Ford.
Beaumont Health spokesman Mark Geary said the eight-hospital health system received more doses than usual the past week. First and second doses from Pfizer and Moderna last week totaled 17,190, up 106 percent from 8,320 doses last week, including 3,510 donated by Oakland County.
"We are thrilled more vaccine will be flowing into Michigan," Geary said. "We have the capacity to provide 50,000 doses each week. We have said from the beginning that our goal is to vaccinate as many Michiganders as possible. Our ability to achieve that goal is dependent upon the amount of vaccine we receive. We will continue to work closely with the state and local health departments to vaccinate as many people as we can."
MDHHS notified the county it should expect a shipment of 7,000 J&J doses Friday, Hammami said.
This week, he said Wayne County will start using the J&J vaccine on people over age 65 or those in areas with low vaccination rates.
"It has been encouraging the past two weeks that we received a considerable increase. Is it enough? I don't think anything will be enough until we hit our demand" levels, Hammami said.
Detroit Mayor Mike Duggan has shunned the J&J vaccine, saying he considers Pfizer and Moderna's vaccines "the best" because they were found to be 95 percent effective in preventing severe illness. Experts have warned against comparing the clinical trials and outcomes of the three vaccines since they were tested at different times during the pandemic involving different variants of the virus.
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