The Department of Veterans Affairs may be out ahead of many states and federal entities in vaccine administration, but the complexity of deciding who is eligible for the vaccine and when has still left many confused and frustrated.
So far, the VA has administered 1.26 million doses of the COVID-19 vaccine; 305,197 veterans and employees had received both doses as of Monday.
To decide who has priority for the limited vaccine supply, the VA uses an algorithm to sift through its databases and prioritize veterans. But it also considers other factors, such as local availability of vaccine doses, clinical resources and requirements at each hospital or clinic, and the number of COVID-19 infections in an area.
VA officials say the approach has allowed the department to vaccinate a large number of individuals in a relatively short period of time.
Some veterans, however, say they don't understand why they haven't been contacted, despite being what they believe is considered "high risk."
"My husband, a Vietnam vet, has not been contacted to get the vaccine. ... He is 77 with health issues," said a veteran's spouse in the Dallas-Fort Worth area who asked that her name not be used because she wanted to keep her husband's identity private.
He eventually got an appointment through the City of Dallas, not the North Texas VA Health System, she said.
"He had to wait in a car in line for four hours in Dallas to get his vaccine. It was grueling," she added.
Others cited similar problems in other parts of the country.
"I am a combat Vietnam veteran volunteer and 68 years old," said Dave Moore of Columbia, South Carolina. "I am 100 percent VA disabled with two underlying conditions. ... The Columbia VA has no clue."
The VA is using a software program called the COVID-19 Vaccine Outreach for Veterans that analyzes information from Veterans Health Administration Support Center databases to determine which patients are considered to be in high-risk groups.
The tool uses patient identifiers to weigh medical conditions, age and gender; it also indicates current treatments like chemotherapy or dialysis and other risk factors for severe COVID-19 such as smoking or obesity.
The system then provides a list of prioritized patients to local VA medical centers.
But those medical centers have their own set of conditions to consider when assessing priority, according to VA spokesman Randy Noller.
"VA issued guidance on December 30, 2020, encouraging local flexibility in order to maximize COVID-19 vaccine access and efficiency and limit potential vaccine waste, and this guidance included flexibility to overlap phases and broaden vaccination," he said.
Individual VA health systems deal with factors that include vaccine hesitancy, logistical challenges and their own lists of patients prioritized by risk factors and locale.
At the Veterans Affairs Medical Center in Anchorage, Alaska, for example, any veteran who is 60 or older is being offered the vaccine.
And in Havre, Montana -- a remote location where VA providers flew in with the vaccine for a one-day clinic Jan. 21 -- 239 veterans of varying ages were able to get inoculated.
"Montana is a very large state -- 147,000 square miles. So we have a huge area to cover. We're also a mountain state, so winter travel can be challenging between snow and small county roads. That's part of why we're so thrilled to get the vaccine out across the state," said Montana VA Health Care System Director Judy Hayman.
According to Noller, the VA largely is finishing efforts to vaccinate those categorized as 1a -- including health workers, first responders and those living in residential community settings -- and moving into Phase 1b, or veterans age 75 and older.
According to the Centers for Disease Control and Prevention, patients aged 65 to 74 are considered Phase 1c, as are those ages 16 to 64 with serious health conditions.
But again, priority also can be determined at the local level. As early as November, clinicians at some VA health facilities began drafting lists of patients at high risk for severe cases of COVID.
Vietnam veteran Wes Bickel, 73, receives his care at VA Long Beach Healthcare System in California; he got a text Saturday saying he had been identified as part of a priority group to get the vaccine.
Bickel, who has a heart condition related to Agent Orange exposure, had gotten his first dose the day before through his county, ending several weeks of frustration with the VA.
"Some of my cohorts snuck in line and already received their second shots. ... I feel fortunate that I have options and had registered with the county and not relied on just the VA," Bickel told Military.com.
VA Long Beach has had such a strong response from area residents -- including non-veterans -- wanting the vaccine that the facility's phone system went down under the strain of calls last week.
"We know the process to get vaccines has been frustrating even under the best of circumstances, and not being able to reach us only adds to that. Please bear with us as we all navigate the COVID-19 pandemic," officials wrote Friday in a notice to veterans.
The VA is "using every avenue to vaccinate as many veterans and employees as quickly as possible," according to Noller, and the process should go more smoothly once more vaccines are available.
"We've built a system ready to accommodate much larger quantities as the manufacturers move forward. I'm incredibly pleased," said Dr. Richard Stone, the VA acting under secretary for health.
Even as the VA's vaccine effort ramps up, officials are telling veterans that if they have the opportunity to register for the vaccine elsewhere, they should do so.
"We want to encourage Veterans to get the COVID vaccine as soon as it becomes available to them," said Dr. Sophia Califano, the VA's deputy chief consultant for preventive medicine, in a release. "We believe this is the best path forward and the best way to protect you and your family."
Moore, the veteran who was not contacted by the Columbia VA, said Wednesday that after contacting the office of South Carolina Gov. Henry McMaster about his situation, he was given a phone number at the VA to call to request an appointment.
When he called, he was told that it had been an oversight that he had not been contacted and he made an appointment for the next day.
David Omura, director of the Columbia VA Health Care System, told Military.com that the facility has administered more than 6,000 vaccines to staff members and veterans and "takes veterans' concerns seriously and addresses them immediately."
"In this case, we were able to quickly assist this veteran ... and have since followed-up with him to ensure that he continues to receive quality care and the services he needs," Omura said.
He added that the facility is following CDC and VA COVID-19 vaccine guidelines and has recently expanded scheduling to include additional categories.
"Additionally, we are providing regular information updates through multiple outlets on how veterans can be scheduled for vaccines, have established a dedicated hotline for those interested in being scheduled, and are hosting a mass vaccination clinic on President's Day, February 15th for enrolled veterans," Omura said.
This article was updated Wednesday to include a response from the Columbia South Carolina VA Health Care System.