The vaccine rollout, at least to date in Lincoln County, has been a bit like wheeling a square-wheeled cart over a muddy, rut-filled road. “Smooth” is not a term that would be used. This is pretty much the case across much of the United States. The process is simply not rolling out as it should, or at least how people would like to see it done. This is due, in part, to the federal government continually changing priorities and to there not being sufficient vaccine or staffing available to vaccinate the massive number of people who want to be vaccinated.

This should not be a huge surprise given the United States has never vaccinated as large a population for any disease like they are now. It’s understandable that people are both anxious and frustrated given the country has been dealing with COVID-19 for almost a year now. Even in Lincoln County, lots of people are testing positive, getting sick and some are dying. That’s frightening for many. The misinformation that is spreading across social media and beyond adds even more confusion, anger and fear to the equation.

During a budget workshop on Friday, the Lincoln County Board of Commissioners requested that Lincoln County Health Director Davin Madden update them on the health department’s response to vaccination.

“Kelly asked me to give an update, and I think the time warrants an update because of the circumstances of the vaccine rollout,” he said. “I don’t want to go much into the challenges because I could go into a lengthy discussion on that. I wanted to give you a quick overview of how we got to where we are and how we’re getting out.”

He explained that the health department received a 30-day notice saying they were getting vaccines. The team he put together was expected to administer about 500 vaccines over a course of about two weeks. They were initially told that the vaccine supply would be limited.

“We placed ourselves in a position to administer about 60 in a day through the appointment system,” he said. “This is not like a flu vaccine which is a one and done, this is a two-dose vaccine, and the state is requiring everyone to be put in a very aggravating database.”

The day before Christmas eve, the health department received a notice saying they were getting 1,200 doses, not 500, according to Madden.

“It was too short a period of time for us to activate the staff,” he said. “We started giving vaccines on December 29. Even with the 1,200 allocation, our ability to administer approximately 500 doses in two weeks was doable assuming we were just doing Phase 1a.”

Things went south, Madden explained, on Dec. 30, 2020 when Secretary of the North Carolina Department of Health and Human Services Dr. Mandy Cohen indicated that vaccination would now be opened up to those aged 75 and older with no restrictions.

“That was not forecast to us and it created an avalanche of problems because one, our phone system is not designed to handle 2,000 calls a day when I have five people answering phones and they’re also the ones who also do appointments and scheduling,” he said. “We ran into a hardware volume problem which started to landslide. It started slowing down our ability to get vaccine moving because staff were getting caught up in trying to navigate people.”

The health department moved into no longer returning voicemail which resulted in the commissioners receiving irate telephone calls and emails from citizens.

“The issue with that was manpower – trying to use it with the most bang for our buck,” Madden said. “When we looked at returning voicemails, we were having callers in that 75+ range leaving five to eight voicemails, sometimes each, and they were calling continuously throughout the day. After going through nine pages of voicemail, staff would often find out that the person they were trying to call back already had an appointment or were on their way in to do walk in appointments. It became a waste of manpower and I made the executive decision to stop that. It was not feasible at that time in trying to get vaccine appointments made which was what the critical issue was.”

After a week of dealing with a system that wasn’t able to handle the volume they were receiving, Madden, who described himself as a servant to the public, said he knew that people want to talk to people, they don’t want to leave voicemails.

“What I did, knowing the likelihood of forecasting what the secretary was going to do would be impossible, I came to Kelly (Atkins) and told him that we needed to pivot hard because the plan that was in place was not equipped to handle the surge volume of people,” he said. “I have seven total nurses at the health department. We knew that we could do up to 100 shots a day, 60 was our baseline, but that’s still not going to cover it when they’re trying to manage the influx of people coming in. I told Kelly this was slipping through my fingers and I was about to lose it.”

On Wednesday, Madden asked Atkins to shift resources to the health department to deal with the surge. Since then, a full operation incident command system and a call center, staffed by volunteers, is being set up at the Lincoln County Senior Center. There will be four people in charge of dealing with the state database which is currently causing the choke point.

“We’re going to have human beings on the phone to answer every resident’s call,” he said. “They’re not going to make appointments but will help them understand the resources available. With the call center set up I think it’ll give people some answers. They’ll be able to forward people over to those who are setting people up in the database.”

The amount of time it’s currently taking when an unregistered person walks in for a vaccine is about 12 minutes, eight of those spent getting the individual registered in the database. To preregister people will eventually open more appointments because it’ll cut down on the amount of time dramatically.

Madden is also setting up a volunteer coordinator to mobilize volunteers to answer calls, push paper and those qualified to do so, give vaccinations. Madden is also in the process of setting up the first mass-vaccination pod in the county. It’ll be by appointment only with the plan to vaccinate 250 people per day.

“This should allow us to handle the surge and be able to open up to the next phases with a whole lot more control,” he said. “My goals are, one to serve the people of the county and two, staff retention. My staff have been embattled and entrenched for a year and this is unacceptable to me how this has rolled out. It has not really prepared us for what was going to happen so quickly.”

Initially, Madden said, they were told that the phases would last two to three weeks to allow them time to get through the people and pace themselves which is necessary given this is a two-dose vaccine.

“I think we’re in a better place and are getting the resources in place where they need to be so we can satisfy the public to the extent that we can and at the same time be reasonable on the staff,” he said. “I think we’re going to get on top of this. We’re not going to be able to please everybody. The problem is that there’s so many people right now who want it and they’re anxious and afraid and now they’re angry. Social media doesn’t help because everybody’s saying they got a shot here or there. We’re overhauling the website so that it’ll be clearer.”

Times-News will continue to follow the vaccine rollout in Lincoln County and what procedures will be put in place. Follow the Lincoln County Health Department web site ( and Facebook page for up-to-date information.

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