In El Paso, Texas, Fort Bliss officials have set up a second COVID-19 vaccination site for military personnel and eligible Tricare beneficiaries, including those age 65 and older, and those 16 to 64 with underlying health conditions.
But at Naval Medical Center Portsmouth, Virginia, retirees over age 75 who received their first COVID-19 vaccine in mid-January have not been able to get their second dose within the recommended time frame due to lack of availability.
Likewise, at Eisenhower Army Medical Center in Georgia and other locations across the military health system, vaccinations have been suspended sporadically for beneficiaries 75 and older due to supply problems.
Military dependents younger than 65 -- including those at risk for severe cases of COVID or caring for an at-risk child -- currently have no priority when it comes to receiving the vaccine through the military health system. The Defense Department is largely telling them to look for vaccinations elsewhere.
The DoD adopted a policy Jan. 7 that gave the military service branches autonomy to determine their own vaccine orders and administration based on guidance from the Pentagon and the Centers for Disease Control and Prevention.
As a result, the hospital-by-hospital determination means that retirees and some dependents are getting vaccines at some locations, but no one is receiving them through the military at others.
And Tricare officials are telling beneficiaries to explore all available options for getting the vaccine.
"[Each] military treatment facility and state serves a different population base and has a different level of ability," Tricare officials wrote during a Facebook chat on COVID-19 vaccines Thursday.
"Our best recommendation is to stay in touch with your local military treatment facilities, state and local facilities and local pharmacy, and use the option that is available to you first."
According to Tricare officials, appointments are largely dependent on availability, demand and "where the location is in the population schema."
For the most part, military health facilities are in Phase 1a or 1b. Under Phase 1a, health care workers, first responders and security personnel were offered the vaccine first, followed by personnel in vital national security jobs, workers deemed essential, and those age 75 and older in Phase 1b, according to Defense Health Agency spokesman Peter Graves.
To find out what phase a local treatment facility is in, Tricare recommends beneficiaries reach out to the individual location.
But military families think there should be more updates and outreach from their health providers and Tricare.
Maureen Elias, an Army spouse whose family receives health care at the Fairfax Health Center in Chantilly, Virginia, said she saw no signs or information about vaccine availability or access when she went to an appointment in early February.
"We're hearing diddly-squat. And when I try to ask, I just get blank stares," Elias said. "We don't even know who to ask about it. If you try to look on any of the military websites, it's really hard to find something."
"The DoD vaccine distribution process appears to be creating a 'have' and 'have not' policy," wrote Diana Ottignon, a Marine spouse, on Facebook. "Some military treatment facilities are vaccinating spouses now while [others] are still only vaccinating 75+. When can we expect clear and consistent policy so I can anticipate a shot?"
The Facebook question-and-answer event was widely marketed as a resource to get answers on COVID-19 vaccines through Tricare. But officials kicked off the session by saying they would not be able to answer questions about specific locations because they "didn't know the status of vaccine availability at any particular location."
"Are you working on a better contact list of bases that will be getting the vaccine and what the best contact number [is?]. ... Current guidance is basically, 'Look up some bases and try your luck. We don't know exact details so we aren't even making a contact list,'" asked Marc Coop.
Tricare officials responded with a link containing the contact information of all military medical facilities for Coop to call directly.
More than two months into the national effort to vaccinate all Americans against COVID-19, Defense Department officials won't -- or can't -- say how many non-military Tricare beneficiaries have received the vaccine.
The Defense Health Agency referred such questions to the Centers for Disease Control and Prevention, which lists only the total number of vaccines distributed to the DoD and the number of first and second doses administered.
According to the CDC, the DoD has received 1.146 million doses of the vaccine and has administered 791,494 shots, including 200,272 second doses.
"These are the only official numbers publicly available," Graves said Feb. 12.
Air Force Brig. Gen. Paul Friedrichs said Wednesday that the DoD is collecting data on vaccine acceptance rates and demographics, but the Pentagon has not disclosed the data.
During the Facebook event, poster Craig Brown said having those numbers might give him an idea of when he can expect the shot.
"Those numbers seem to be pretty important," Brown wrote. "I'm guessing ALL Active duty will get vaccinated before ANY retiree is vaccinated … including elderly and at-risk retirees. Knowing how many Active duty/Guard have been vaccinated might give us an idea when retirees will get a shot."
But Tricare officials maintain that they are following CDC guidelines regardless of duty status. "For example, healthy adults who are active duty are not eligible for vaccines at this time, unless their job qualifies them in a group already eligible," they wrote.
Yet during the chat, Tricare officials signaled that active-duty personnel are the DoD's primary focus for vaccines.
Responding to a spouse who asked about eligibility because her husband is traveling, Tricare responded: "The DoD's focus is to provide a medically ready force. Active duty service members will go first. Essential workers will go next. This is a voluntary program based on the population schema."
"Active duty cannot perform their missions if their spouses have COVID or are in the ICU. Who is going to take care of the family then?" asked Amy Vilela.
Karen Ruedisueli, director of government relations for health affairs at the Military Officers Association of America, said many MOAA members -- primarily military retirees -- are anxious to get the vaccine and are understandably frustrated by the disparate distribution across the military health system.
She recommends they explore other options in their areas, including hospitals and county health departments.
"Most of [the retirees] understand they can try the MTF or their local pharmacies or other options in their local communities," Ruedisueli said.
With most military families belonging to age groups that have yet to become eligible for the vaccine -- even those with illnesses that put them at risk for severe cases of COVID-19 -- they, too, should be looking to their communities, said Eileen Huck, deputy director of government relations with the National Military Family Association.
"DoD has focused on essential workers, deploying service members and beneficiaries over age 75 in most locations. ... In the vast majority of cases, DoD is not close to getting to family members yet, even family members at high risk," Huck said.
The DoD has seen at least 237,000 cases of COVID-19 since the beginning of the outbreak, including 24,381 military dependents. Ten have died.
Twenty-two service members also have died, as have 184 civilian DoD employees and 65 contractors.
The CDC has said that, while the second dose of either the Pfizer or Moderna vaccine should be administered as close to the recommended interval as possible -- three weeks and four weeks -- respectively, the shots can be delayed up to 42 days.
Tricare officials said patients should get the second vaccine of the same type when it is available. "There is no need to restart the vaccination series if the second dose must be delayed," they wrote.
Many on the Facebook chat said there needs to be more communication and active outreach from military treatment facilities regarding their phases and expected delivery process.
Elias said the lack of communication to families seems reminiscent of the days of the phrase, "If the Army wanted you to have a wife, they would have issued you one."
"I want to be sick of hearing about how I can get my vaccine. Everywhere I turn, I should be getting emails, I should be bombarded with it when I go to the clinic. ... It should be public on Army websites and, quite honestly, there should be an outreach effort for this information," she said.