Missouri urges CDC to waive $25 limit for vaccine incentive plan

Missouri requested Friday that the Centers for Disease Control and Prevention reconsider its rejection of the state’s vaccine incentive plan.

Robert Knodell, the acting director of Missouri’s Department of Health and Senior Services, urged CDC Director Rochelle Walensky to make an exception to CDC guidance that states incentives may not exceed $25 in value per person if supplemental CDC funding is used.

“The intensity of vaccine hesitancy is significant and requires well-considered approaches tailored to each state, rather than blanket policies that preclude options that have a realistic opportunity for success,” Knodell wrote in a Friday letter.

The appeal follows Gov. Mike Parson blasting the CDC a day earlier for rejecting the state’s plan to offer incentives for vaccines as infections and hospitalizations blamed on the COVID-19 Delta variant continue to soar.

“The CDC didn’t accept our plan, which is just totally ridiculous that they would turn us down with Missouri in the situation we’re in right now,” Parson told reporters after a bill signing in Springfield, according to the Springfield News-Leader. “So, I think it’s just another obvious problem with the CDC.”

Parson, who had previously expressed doubts about the effectiveness of incentives, has turned to them in recent weeks as pressure mounts for a stronger state response to the summer surge of cases. Despite promises that an incentive program was imminent, a program has yet to launch.

“The main concern is that CDC is limiting incentive packages to $25 per person, and we do not feel this figure will be enough to significantly increase vaccine uptake in Missouri,” Lisa Cox, a spokeswoman for Missouri’s Department of Health and Senior Services, said Friday.

Cox said the funding is from the CDC and specifically allocated for incentive programs. Cox said other states have also used the CDC’s funding stream, state funds and CARES Act dollars for their incentive programs.

“We’re exploring multiple options at this time,” Cox said.

Chandra Zeikel, a CDC spokeswoman, stated Friday afternoon that the $25 per person limit applies to incentives financed with supplemental CDC funding provided to local jurisdictions. Store vouchers, generic gift cards and transportation costs, she wrote, are examples of allowable incentives. A vaccine recipient could receive multiple rewards, however the combined total cost must not exceed a $25 per person value, Zeikel said.

“Additionally, incentive funds cannot be pooled to create one, limited opportunity incentive,” Zeikel said. “Raffles, or games of chance, are not a permissible use (of the) funds.”

Unspent federal coronavirus relief funds in the hands of state and local governments can also be used to pay for incentives, she wrote, referring to recent Treasury Department guidance that allows for cash payments and lotteries, “so long as such costs are reasonably proportional to the expected public health benefit.”

The rejection comes amid a rapid rise in new cases driven by the Delta variant that has taken a firm hold throughout the state. On Friday, Missouri reported 2,337 additional cases and the seven-day average of reported cases rose to 1,805 per day — caseloads that haven’t been seen since late January.

So far in July, the state health department has reported 23,864 additional COVID-19 cases, compared to 19,184 for the full month of June. In 76 of the state’s 117 local health department jurisdictions, case totals have equalled or exceeded those recorded in June.

Hospitalizations reached 1,357 on Tuesday, the highest since Feb. 12. The state issued its fourth hotspot advisory of the week on Thursday, warning of rapidly increasing cases in Douglas, Texas and Wright counties.

Areas of the state, like the Springfield region, are nearing record case levels, with some hospitals in the area seeing record COVID hospitalizations. It’s what’s contributed to Missouri seeing the largest number of new cases per capita, only second to Arkansas, according to The New York Times’ analysis of states’ data.

Meanwhile, Missouri ranks 38th of the 50 states and District of Columbia based on the percent of residents with at least one vaccine dose, according to the CDC. Health officials have warned that vaccinations remain the best defense against severe illness caused by the more transmissible variant.

During a Thursday meeting of the Advisory Committee on Equitable COVID-19 Vaccine Distribution, Chris Eshleman of Deloitte Consulting, a firm hired to advise the state on its pandemic response, said vaccination rates were higher last week compared to June, but ultimately “held relatively constant” for the second straight week of July.

Areas of the state experiencing the worst outbreaks, like Springfield, Joplin and Branson, had significantly higher rates of new vaccinations compared to the rest of the state, with up to 2.5 percent of the adult population in some census tracts getting inoculated, Eshleman said.

“​​So hopefully the anticipation of the incentives… don’t ironically cause people to slow down and wait to see what eligibility is around the corner or what prizes might be in the works,” Eshleman said, “because these high rates you would hope to see them stick around for a few weeks longer.”

Areas of the state with some of the lowest vaccination rates are seeing a rise in cases, and state health officials have predicted at least “a few more weeks” of increases. Missouri is the place Francis Collins, the director of the National Institutes of Health, told McClatchy he is “most worried about.” 

On Wednesday, Springfield healthcare providers requested the state provide funding to set up temporary hospital beds in order to free up existing space to treat the most severely ill.

Asked about the alternative care site Thursday, Parson said the state will “for the most part probably” fulfill the request and suggested local funds, like those received through the federal CARES Act passed in March, may help cover the costs, according to the Springfield News-Leader.

Aaron Schekorra, a spokesman for the Springfield-Greene County Health Department, said Friday that the department remains hopeful the request will be approved.

“If the full request is not granted we will explore alternatives with the Office of Emergency Management and our hospital partners at that time,” Schekorra said.

Parson has previously expressed doubt over offering incentives to take a shot, and said last month he was hesitant to do so.

“Now, when you start giving away incentives to do that, I think you’ve really got to think through that, because what’s it going to be next year if it’s something else?” Parson previously said. “Are we going to start rewarding people to take a vaccine? And is that really what we should be doing?”

Last week, Parson told reporters the state was nearing an announcement on an incentive program, but expressed his support for a smaller-scale lottery prize, “like $5,000 or $10,000,” according to St. Louis Public Radio.

Few specific details have yet to be released. However, notes of a June 25 Missouri Center for Public Health Excellence meeting obtained through a public records request by the Documenting COVID-19 project at the Brown Institute for Media Innovation, indicated the direction state officials were leaning at the time.

The notes indicated there was a “big focus” on incentives, with a program likely to start in July.

Potential partners included the Missouri Lottery, and according to the notes, would entail three separate drawing structures: one for those vaccinated by a certain date, a second group for a second time frame and a “third incentive for adolescents, possibly education scholarships.”

The notes suggested an opt-in system was being considered and could be structured around Congressional districts.

“Anticipate a substantial grand prize,” the meeting notes read.

Other states have launched lotteries, with prizes ranging from everything from guns to college scholarships, to incentivize taking a shot. Many local healthcare providers have partnered with businesses to offer incentives of their own, like a free pint of Mother’s Brewing beer when getting a shot.

On Wednesday, the Missouri Chamber of Commerce and Industry announced a new “COVID Stops Here” campaign to recognize and encourage businesses who reach a goal of at least 70 percent of their staff being vaccinated.

Meanwhile, the Missouri Hospital Association warned in its weekly COVID update Tuesday that the current situation in Southwest Missouri “is dire.”

“If the rest of the state follows current trajectories — with Delta systematically picking off localized pockets of unvaccinated Missourians — our entire health care system will be very near the brink it flirted with during the winter of 2020-2021,” the MHA newsletter read. “This is avoidable”

Clay Dunagan, BJC HealthCare’s chief clinical officer, said during a St. Louis Metropolitan Pandemic Task Force briefing Thursday the St. Louis region’s trajectory of new COVID cases is likely headed in the same steep upward curve as the southwest part of the state “unless we take some aggressive actions.”

As people move indoors with the onset of winter the seasonal characteristics of the virus will likely “pile on top” of the current situation, and it “can only be worse” if vaccination rates and masking don’t increase, Dunagan said.

“The bottom line is, to this date we have taken care of a lot of patients in this region with COVID. We’ve discharged — alive — over 23,000 patients. But we’ve also seen 2,200 patients expire while under our care,” Dunagan said, later adding: “So if we’re going to avoid more deaths and more hospitalizations, we really need to take action.”

This story has been updated since it was first published. D.C. Bureau reporter Laura Olson contributed to this report.