Allegheny County Controller
On paper, Allegheny County residents should be among the best-supported anywhere in the quest to find and receive one of the coveted COVID-19 vaccines. We have one of only six county-level health departments of the 67 counties in Pennsylvania, and are home to the $20 billion per year health care behemoth UPMC, which trumpets its “world-class care.”
But local residents spending hour after hour searching the web and working the phones in search of a vaccine have very often been left wondering where in the world the help is for them from these taxpayer-supported and -subsidized institutions.
While without a doubt the rollout of the vaccination effort by the federal and state governments has been chaotic and has left much to be desired, where is the leg up (or arm out) our residents should be getting from what should be community resources?
While the Allegheny County Health Department (ACHD) itself controls relatively few doses of vaccine (although more than any other single entity in the County other than UPMC and Allegheny Health Network), it has failed to be a clearinghouse for information on where the vaccine can be accessed. A state-provided online map shows dozens of prospective providers but provides no guidance at all on whether these sites have appointments available or are even offering shots to the public.
When ACHD fleetingly offered call-in appointment scheduling for the only site at which it is currently offering vaccines, all slots were filled within minutes, with the vast majority of callers getting a busy signal, being disconnected, or (worst of all) being diverted to scammers who had apparently hacked into the system. While several hundred were indeed helped, exponentially more were likely left even more frustrated than before.
If the goal was to help those lacking internet access gain appointments, why not identify and allocate those limited shots to the most vulnerable populations rather than sending many of them on a wild goose chase? And if those with access issues are the concern, why is the only ACHD vaccine clinic located in Monroeville to begin with?
The most robust resource as a central clearinghouse for information on vaccine appointments has turned out to be a volunteer-staffed operation begun by University of Pittsburgh students at VaccinatePA.org. While the bizarrely decentralized nature of the vaccine effort makes maintaining any such central repository of information difficult, the fact that the best effort has been made by college students of their own accord and without any public funding rather than by our Health Department should be shocking.
Similarly, private citizens have been devoting their time to finding appointments for family, friends, and even strangers. Nearly 14,000 people have joined the “Getting Pittsburgh Vaccinated – COVID-19 Appointment Tip Page” on Facebook.
A Pittsburgh native now living in the D.C. area told my office she has helped to secure about 20 appointments for family and friends.
“It could really be a full-time job,” she said. “You just have to repeatedly click until you get something.”
The former Pittsburgher, who requested not to be identified by name because she works with the federal government, described the web platforms of vaccine providers as “not accessible at all.” This has resulted in “people getting it [who] may not be the people we are most trying to reach.” She said the sites are particularly inaccessible to those with disabilities, and speculated that some providers could be in violation of federal disability laws.
She called the geographic dispersion of available shots another access issue, describing sending her father—who lives in the City of Pittsburgh—to Mars, Pa. for a vaccine appointment. “People have to be willing to go anywhere at any time,” she said, which is of course a major barrier for those lacking private transportation.
ACHD’s foremost priority should be bringing a centralized scheduling platform online for vaccination sites in the County, or at a minimum, be able to provide reliable information on which sites have vaccines and are offering shots to the public. This should be the sole focus of the Health Department’s recently hired Chief Operating Officer. (And maybe bring those college students on board, too.)
Meanwhile, UPMC has said it remains focused on delivering vaccines to health care workers even as rival Allegheny Health Network has offered limited doses to the general public. While health care workers are deservedly first in line, it just wouldn’t be the UPMC we have come to know all too well without an unhealthy measure of self-interest baked in. In violation of the spirit if not the letter of federal guidelines, UPMC vaccinated an undetermined number of its employees in areas like marketing and legal who rarely set foot in a health facility or may even be working from home. We then learned that UPMC hadn’t bothered to keep track of the racial makeup of those it has vaccinated, as the federal government has asked all providers to do. This is inexcusable in a region in which racial minorities suffer shockingly disparate health outcomes, and in response to a disease that has infected and killed minorities disproportionately.
When vaccines do become publicly available from UPMC, our region’s residents who have subsidized its growth into a global health giant should not have to search or beg for them. Shots should be readily available and accessible, regardless of whether one is a UPMC patient and what (if any) insurance they have, and should be offered in community settings to account for those who may lack transportation or are wary of hospitals. While many of us may be fortunate enough to take health care access for granted, this is not the case for so many in underserved communities. These populations simply must be reached.
The deficiencies we see from our largest regional public health agency and our dominant “charity” health care provider are, sadly, not new for either ACHD or UPMC.
My office showed that ACHD presented misleading information to downplay the threat of lead levels in drinking water exceeding those in Flint when these were detected within the Pittsburgh Water and Sewer Authority in 2017, and delayed alerting Clairton residents when a fire spiked industrial pollution in their community in 2018. UPMC has repeatedly turned its back on underserved communities locally as it opened facilities in more affluent communities and around the world, and sought to keep those with the “wrong” insurances out of its hospitals altogether, even as it gleefully maintains its tax exemptions and resists any meaningful payments to our local governments or school districts.
So many of us have committed in word and deed to come out of the COVID-19 pandemic not only to return to “normal,” but to bring greater justice to those in our community who are essential workers, who face housing and food insecurity, and who have been marginalized in various other ways that have been magnified by the pandemic. Ending the “every person for themselves” mentality in health care—which could be illustrated no better than by the scramble among the elderly and medically vulnerable and their families to secure these vaccines—must be among our foremost priorities. This must include defining what a public health agency and “charity” health provider should actually be doing for our citizens.
In the immediate term, these institutions must step up to meet the levels of service and responsibility needed now.
The County Health Department must:
- Launch an effort to provide an information clearinghouse on vaccine and appointment availability from all local providers;
- While acknowledging limits on knowledge of future vaccine allocations, provide clear communication to the extent possible on how many does are on hand in the county, when and how many more are expected, and who is expected to be eligible to receive them and when; and,
- Bolster efforts to ensure shots are made available in underserved communities, not only in the suburban communities where clinics are currently in operation or planned.
UPMC, while having a vast amount of work to do to begin to live up to its billing as a “purely public charity,” could use this opportunity to begin to rebuild trust in our communities by doing the following:
- Focus its efforts on underserved communities that have been abandoned or ignored in its quest for more profitable patients, and where much of its low-wage workforce lives;
- Once circumstances allow, provide vaccinations to all teachers and staff of the Pittsburgh Public Schools and other local districts with high poverty to allow for the return of teachers and students to classrooms;
- Begin significant payments-in-lieu-of-taxes (PILOTs) and services without charge to the City, County, and school districts to address public health concerns that have become more acute even as UPMC has grown and become more profitable.
To meet this moment, and to ensure our community comes back stronger from the pandemic, these institutions simply must do better.