Patchwork registration and sign-up systems, already inadequate, must deal with tens of thousands of newly eligible residents.

This story was written and produced by NJ Spotlight. It is being republished under a special NJ News Commons content-sharing agreement related to COVID-19 coverage. To read more, visit njspotlight.com.

When New Jersey officials began planning the state’s COVID-19 immunization strategy last summer, one of their biggest concerns was vaccine hesitancy.

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After all, scores of avid vaccine opponents marched upon the State House just six months earlier, derailing a public health push to expand existing immunizations in schools. State leaders worried this movement — plus other concerns about the politicization and pace of the coronavirus vaccines’ development — would leave many people hesitant to roll up their sleeves for a COVID-19 shot.

Instead, public demand for coronavirus vaccinations has grown steadily in New Jersey, rapidly outpacing the limited supplies available from federal regulators and essentially overwhelming the patchwork registration and sign-up systems that serve as gateways to the vaccinations. And this could get worse in the weeks to come, as tens of thousands of additional residents become eligible for immunization.

On Monday, Gov. Phil Murphy announced that certain educators, child care workers, transportation employees, public safety workers and individuals experiencing homelessness would be eligible for COVID-19 vaccination on March 15. Two weeks later the system will also be open to restaurant, store and food industry employees; warehouse, shipping and hospitality employees; clergy and postal workers, among others, he said.

The supply-demand imbalance

“There is a current supply-demand imbalance,” Murphy said at his media briefing Monday. “For a period of time that will continue to grow, then it will ebb,” he continued. “But we also wanted to give certainty to a whole number of communities that deserve that certainty, and that’s the spirit of the announcement today.”

The news came the day after federal authorities announced their plan to grant New Jersey-based drugmaker Johnson & Johnson an emergency authorization to distribute its version of the COVID-19 vaccine, which involves just one shot — both previously authorized serums require two doses — and can be stored without special equipment. Murphy called the new vaccine a “game changer” and said the state expects to receive at least 73,000 doses this week, which he said will be directed to high-risk individuals who are already eligible.

“We now have the opportunity to vaccinate more individuals than ever before,” state health commissioner Judy Persichilli said at the briefing Monday. “However…we are still in a place of scarce supply.”

Since the state’s immunization effort began in mid-December, more than 2 million shots have been administered and at least 690,000 people have been fully immunized thanks to vaccines produced by Pfizer and Moderna. Capacity at the state’s roughly 300 immunization sites — a mix of state-run mega-sites, county operations, local programs and clinics overseen by hospitals, doctors’ groups or other health or social service providers — has increased steadily and they can now administer more than 50,000 shots daily.

But despite the robust system New Jersey created, the limited vaccine supply and technical glitches in the online registration portal Microsoft built for the state have combined to create significant public frustration with the process. A telephone hotline developed to assist those without internet access has also struggled to meet callers’ needs.

What officials did not expect

“I don’t think we realized when we brought (the registration system online) that immediately 2.5 million people would register. We knew there was a lot of vaccine hesitancy in New Jersey,” Persichilli told NJ Spotlight on Friday in an interview on the one-year anniversary of the pandemic, which was first reported in New Jersey on March 4, 2020. Since then, the state has diagnosed nearly 800,000 COVID-19 cases, including almost 23,300 fatalities.

“We still cannot schedule appointments,” Persichilli said Friday. She described daily meetings to review capacity at the state’s network of 300 vaccine sites, noting “if we have 100 (appointments) it’s a lot.”

While people can register in advance, Murphy said appointments would not be open to the new groups announced Monday until state officials resolved additional questions that were “being machined.” Details under discussion include how and where teachers can access shots without disrupting their school day and what groups might participate in a closed, employee-only system.

Some newly eligible participants may not need to sign up through the state portal at all, Murphy noted. “Please remember, there are thousands of residents (from these groups) who have already been eligible,” he said, like those over age 65 or anyone with certain chronic health conditions and may also be teachers or frontline workers.

Throughout the rollout of the vaccination program, New Jersey officials have stressed the importance of vaccine equity. In recent weeks, they started working more directly with faith-based and community groups to help expand access for underserved individuals; door-to-door inoculations and vaccine vans are also being considered, officials said. Some local health organizations, like the VNA Health Group, have also launched grassroots efforts to connect people with shots by partnering with senior centers, churches and other organizations.

Prioritizing those most at risk

The state has sought to prioritize vaccinations for populations that are most at risk for infection, hospitalization and death — like health care workers, elderly and sick individuals, and communities of color, which have suffered outsize impacts from the pandemic — but some aspects have proven challenging. So far, just 5.5% of the shots administered in New Jersey have gone to Hispanics and less than 4% to Blacks, while 55% have gone to white residents.

Experts believe this racial gap is caused by several factors, including a digital divide that makes it harder for minorities to access the state’s internet-based portals. But it is also shaped by a deep, historic mistrust of the medical system within Black and brown communities, based on centuries of abuse, mistreatment and racism. To address this, state and local public health leaders have hosted online information forums and recruited trusted community leaders to serve as vaccine ambassadors to certain communities.

Building trust with the community has been a priority for Dr. Shereef Elnahal, president and CEO of University Hospital in Newark, a predominantly Black and brown city. Elnahal — who served as state health commissioner before joining University Hospital last summer — said that the allies he cultivated among Newark’s community, faith-based and government leaders were “absolutely critical” in helping the hospital navigate COVID-19 and allowing it to better serve the city’s residents.

“Those relationships proved so critical,” Elnahal said.  “Whether it was simply to explain the virus to the community, or being an ambassador to the community on vaccines, or providing meals (to staff and community members) or showing up at our hospital as firefighters and police did when they showed up and honked and cheered for us,” at a time when staff was nearly overwhelmed by COVID-19 patients.

“We’ve seen incredible progress in getting people to accept the vaccines,” Elnahal said, noting that a recent survey by Newark officials showed more than 60% of residents were willing to be immunized against the virus, up from 40% a few months ago. “We are asking people to dispel these narratives that they feel about the medical establishment,” he added. “We’re asking them to suspend this belief and take this vaccine.”

Officials must now make good on the benefits they promised through immunization, Elnahal stressed, and make sure vaccines are easily accessible to these communities. But the work can’t stop there, he added. “We’re going to have to focus on the problems that have been plaguing these communities for decades,” Elnahal said, like cancers that are particularly prevalent in the Black community. “These are things people have worried about for a long time.”

How to use Johnson & Johnson vaccine 

Some public health experts have urged the state to use the Johnson & Jonson vaccine strategically to enhance vaccine equity, noting that with only one shot required, it could be particularly useful for reaching some vulnerable populations, like homeless individuals or migrant farmworkers.

Murphy said Monday that the Johnson & Johnson vaccine will be dispersed in ways that target Black and brown communities, noting he would provide counties with “explicit” information on how to target homebound individuals, residents with developmental disabilities or those who are homeless. “Equity really defines the J&J” vaccine, Murphy said.

Stephen Crystal, a lead researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research, is eager to see New Jersey make better use of its network of physicians, which he and others said can best identify who needs the vaccine most. Limited supply and complex logistics — the Pfizer and Moderna products require special storage and handling — have so far prevented the state from expanding this program, which currently involves less than 600 doctors, many involved with large practice groups that tend to cater to more affluent populations.

“If the goal is to reduce deaths going forward, you need to have a way to prioritize clinically,” Crystal said, suggesting that “trusted health care providers” are in the best position to make these decisions. “We really haven’t used our health system effectively.”

“It’s not too late” to create a more inclusive system, Crystal continued, adding, “If (the state’s) intention was to create socioeconomic and racial disparities (in vaccine distribution, it) could not have done a better job.”

To read this article in the original format, click: NJ officials, who once feared vaccine hesitancy, nowhere near meeting demand for COVID-19 immunization