The Oakley-Lindsay Center in Quincy — a five-hour drive from Chicago — became an unlikely go-to spot during the pandemic. The regional convention center along the Mississippi River has distributed 25,000 vaccine doses per month, including thousands to Chicagoans who had trouble booking shots here.

But the costs to run the mass vaccine site, even with new, reduced hours and lower demand lately, still run into the thousands each day, said Jerrod Welch, the public health administrator of the Adams County Health Department.

It’s $50,000 a month to lease the convention center. Staff are paid $20 per hour. At its peak, the total operating cost to run the mass vaccine site every month is $175,000.

Still, that’s far less than the estimated price tag for the largest mass vaccine sites across Illinois — about $400,000 a day. That’s according to a spreadsheet featuring internal calculations prepared by the Federal Emergency Management Agency and obtained by the Documenting COVID-19 project in collaboration with the Chicago Sun-Times.

As millions in federal relief money flows to local governments, the spreadsheet provides a detailed look at how much it costs to run such facilities — from a small clinic handling just 250 daily doses to “megasites” handling 6,000. So far, Illinois has received hundreds of millions in FEMA reimbursements during the pandemic, including nearly $8 million to distribute vaccines at the United Center.

A megasite — defined as a facility at least 15,000 square feet in size — could employ as many as 304 people, including security, traffic control, vaccinators, pharmacists, IT support, translators and even legal affairs officers, according to the internal state estimates. Although the vaccination site set up outside the United Center meets the guidelines for the largest sites, officials have not released its daily costs of operations or indicated whether they approach the $400,000 estimate.

The state portion of the costs for the largest mass vaccination sites is $156,240 per day, the Illinois Department of Public Health said. The Illinois National Guard, which staffs many sites including the United Center, is currently deployed under Title 32 orders, which means their pay and benefits are provided by the federal government.

“These expenses are 100% reimbursable by the federal government, resulting in zero impact to the state’s budget,” IDPH said in an email.

The bigger the site, the cheaper the per-unit cost of the vaccine dose. Megasites can average $62 per dose per day, while the smallest sites, averaging 2,500 square feet, approach nearly $200 per dose.

Then there’s the one-time costs, assuming the vaccine sites are open for three months: the freezers, the message boards in the parking lots, chairs and tables, Internet hotspots. For a megasite, the one-time costs can reach nearly $1.5 million. For the smallest sites, $140,000.

And finally the materials: needles, syringes, alcohol prep pads, Band-Aids, gloves, masks, shields, oxygen, Epi-Pens, antihistamines. The range from small to mega, each day: $3,000 to $22,000.

What the spreadsheet and the Adams County figures underscore: It can be considerably expensive, on a per-shot basis, to vaccinate those in more rural or underserved areas of the country.

Ashlee Rezin Garcia/Sun-Times

Demand for shots slows statewide

As demand slows to a crawl in some locations, some are asking if it makes sense to close the clinics — or move them to spots with higher demand. Illinois Gov. J.B. Pritzker expanded eligibility to all adult Illinois residents on April 12, and “softening” demand across the state has allowed Chicago to get doses to most anyone who wants one.

There are at least 20 statewide vaccination clinic sites throughout Illinois that have appointments available to any Illinois resident regardless of the ZIP code they live in, according to IDPH. It’s unclear how long those mass vaccine sites will stay open or if they will reduce hours and staff.

In Adams County, for example, the health department is experimenting with pop-up vaccine sites — in rural villages, in thrift stores, bus stops, churches or food kitchens, with spaced tables, moving nurses and some car vaccinations. A pop-up in a town 13 miles from Quincy, with a population of just 750, vaccinated 50 mostly elderly residents in one event. Health officials said they were surprised by the numbers who showed — and how many said they “did not want to come to Quincy, the ‘big city,’ with its big processes,’” Welch said.

Other communities are trying to make the mass vaccine sites more accessible and appealing; the Rock Island Health Department, after hearing cellist Yo-Yo Ma’s recent COVID-19 vaccine performance, is inviting a musician to perform for an hour at its mass vaccine site to reduce post-vaccination anxiety. The Quad Cities Symphonic Orchestra is working at other sites.

But public health experts say the costs of mass vaccine sites or smaller pop-up sites can still weigh on some communities and, even with federal and state reimbursement, might not last.

“We will start seeing these clinics slow down,” said Dr. William Parker, an assistant professor of pulmonary critical care medicine who is assistant director for the University of Chicago MacLean Center for Medical Ethics. “If demand for these, sometimes difficult-to-access vaccination sites start to go down, I’m sure they’ll close up shop.”

Still, as vaccine supply increases and more people get vaccinated, the use of such megasites is slowing. The week of April 12, the Adams County Health Department opened the Oakley-Lindsay Center for just 16 hours. It’s now been reduced to 12 hours.

Some appointments cancelled

Robert Davies, the emergency preparedness planner at the Champaign-Urbana Public Health District, said while the department is still calculating vaccination costs, it is seeking FEMA public assistance reimbursement for $130,000 to cover expenses from late January to mid-March. Davies said the reimbursement is intended to go to the health district’s community partners, who provided labor and a facility to run the community’s clinics.

Davies said as some of the initial vaccine demand has slowed, clinic staffing has also downsized.

“Some days, we have 250 appointments, other days, we have 200,” Davies explained. “Some weeks, we have a clinic four or five days a week. Other weeks, we have clinics just on one or two days.”

For those trying to schedule staffers and clinics, it can be a lesson in ever-fluctuating supply and demand.

On the Champaign-Urbana’s department’s busiest days, there are 16 vaccinators working on the ground, vaccinating about 1,300 people. The department has tried to plan for a larger number of vaccinations per day, but Davies said vaccine dose allocations have been unpredictable.

Sun-Times files

At one point this spring, in Springfield, upwards of 40% of those seeking the vaccine came from outside Sangamon County, said Gail O’Neill, director of public health for Sangamon County Department of Public Health.

That has slowed to just a few people from northern Illinois traveling upwards of three hours to get a vaccine dose, O’Neill said. But on a single day in mid-April, the department saw more than 300 vaccine appointment cancellations.

It was unclear how many of the canceled appointments were attributed to the pause on the Johnson & Johnson vaccine — which was found to be associated with blood clots in a very small fraction of cases — or other factors, including residents who may have gotten the vaccine elsewhere.

“At least they canceled, but in addition to no-shows, we’ve been seeing fewer numbers,” O’Neill said. “So either people have gotten it elsewhere or have decided against vaccinating that day.”

Vaccine appointments in suburban and rural sites across the state are aplenty. Hundreds of next-day, second-dose appointments are available in Kane County, in a former Sam’s Club store. At the shuttered Shabbona Middle School in Morris, there are dozens of same-day appointments available, all the way until 6 p.m.

Kyra Senese is a reporter for the Brown Institute for Media Innovation’s Documenting COVID-19 project, a collaborative open-records journalism initiative made up of researchers from Columbia and Stanford universities.