Hundreds of thousands of patients who receive treatment for high-risk conditions like cancer and diabetes at Philadelphia hospitals are unable to receive the COVID-19 vaccine from the doctors who care for them, simply because they don’t live in the city.

Philadelphia receives its vaccine allocations from the federal government, and is treated separately from the rest of Pennsylvania. The city is permitted to use its vaccines for health-care workers who live in the suburbs but work in the city. However, the same is not true for patients.

The situation — yet another symptom of the balky and frustrating vaccine rollout — is made only worse by the fact that Pennsylvania’s allocations in the suburban collar counties aren’t adequate to make up the difference. In New Jersey, where all vaccine allocations are handled by the state, and mass clinics have been operating for more than a month, some residents who seek care in Philly hospitals report they have been able to get vaccinated.

In the Southeastern Pennsylvania suburbs, vaccine doses are scarce, mass clinics are still getting off the ground, and at-risk residents who expected to receive the vaccine from their doctors in the city have been left hanging.

Officials at Penn Medicine said last week they had received no guarantees from the state that their system would receive the steady supply of vaccines needed to open more clinics in the suburbs. Temple University Health System officials said Thursday that they had reached out to the state about vaccine allocations for suburban patients, and gotten no answers for two weeks.

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Barry Ciccocioppo, a spokesperson for the state Health Department, said at a hastily called news conference Monday that “conversations are happening” with city health systems regarding vaccine supply, but offered no specifics.

Penn alone has 280,000 patients in the suburbs who are eligible for the vaccine either due to age or health conditions; the health system has managed to vaccinate just under 3,000 of them. By contrast, Penn has provided vaccines to 21,000 of its 200,000 eligible patients who live in Philadelphia.

In a contentious call with suburban lawmakers Sunday, acting state Health Secretary Allison Beam said regional disparities in vaccine distribution were “inevitable” because health care is delivered regionally in Pennsylvania — with many patients crossing county lines to get care.

Some Pennsylvania counties, such as Montour or Allegheny, may appear to have gotten larger quantities of vaccines than they should, because major health systems there distribute vaccines to several surrounding counties, Beam said.

But Philadelphia — like a number of other major cities deemed capable of handling its own program — is being treated separately from the state, making regional vaccine distribution a problem.

The state Department of Health “can and should address subjective factors like demand for the vaccine and the unavailability of the major medical centers in Philadelphia to suburban residents,” State Rep. Perry Warren (D., Bucks) said in an interview, saying residents here can’t benefit from the health systems the way residents in other regions of the state can.

He said he heard from a cancer patient who had a window of opportunity in her treatment plan to receive a vaccine. But she lives in Bucks County and her provider is in Philadelphia, meaning the doctors she trusts were unable to schedule her for a vaccine.

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”There isn’t a mechanism to help her right now,” Warren said. “And it’s unique to our counties.”

Lawmakers have also pointed out that plenty of health-care workers who live in the collar counties but work in Philadelphia were allowed to be vaccinated, and suggested the same should be true for patients.

Thomas Farley, Philadelphia’s health commissioner, said the city has asked the state to provide vaccines to the city’s health systems so that they can inoculate their suburban patients as well. Already, he said, city vaccines have gone to a large number of nonresidents. The city has inoculated a number of health-care and other essential workers who work in the city but live in the suburbs.

In Sunday’s call, Beam said the state just doesn’t have enough vaccine to give doses to Philadelphia.

”We could talk to Philadelphia about having their providers open up to more counties and more residents, but they would likely want a supply of the state’s allocation,” she said. “Right now, the one thing we don’t have a lot of extra of is vaccine.”

She added: “I’m open to that discussion, I just don’t think that’s what 66 counties need right now, is more going to Philadelphia County.”

Philadelphia’s separation from the state vaccine allocation system dates back at least three decades, said James Garrow, a spokesperson for the city health department.

The city has long partnered directly with the federal Centers for Disease Control and Prevention to distribute free vaccines for children to speed up vaccination distribution processes, rather than going through the state, he said.

Meanwhile, hospitals — already strained by the yearlong pandemic — are left unable to help their understandably frustrated patients.

“We have different [eligibility] requirements for patients who live just miles away,” said Steven Sivak, the president of Einstein Physicians Philadelphia in the Einstein Healthcare network. “There are many factors frustrating patients — there’s the general lack of access to the vaccine to begin with, and the fact that, other than in the health systems, there’s not much opportunity [to get the vaccine].”

Penn has been able to vaccinate some patients at Chester County Hospital and a clinic that opened late last month in Radnor. It sent an email to its patients last week offering sympathy and urging patience.

“We wanted to be very transparent, to empathize with them, but also want them to know that we’re working very hard with the state and local governments and departments of health to make sure that we have a vaccine supply,” said Deborah Driscoll, Penn’s senior vice president for clinical practices.

Temple doctors have been encouraging patients to try to sign up for vaccine appointments outside the health system.

At Fox Chase Cancer Center, part of the Temple Health system, doctors have “no way of vaccinating” 75% of their patients, said Tony Reed, Temple’s chief medical officer. Cancer patients are among those who need the vaccine most because of how the disease and treatments affect the immune system.

Patti Littley, 60, receives treatment for neuroendocrine cancer at Fox Chase. Littley moved from Philadelphia to Sewell, N.J., in October, and said she was “disgusted” to learn this meant she couldn’t get a vaccine from her oncologists.

She ended up getting an appointment at a mass vaccination site in Gloucester County.

“It’s a matter of encouraging patients to sign up for as many different lists to get it, and for the state’s program for notifications. It’s frustrating,” Reed said. “There’s really no other way of saying it. You feel almost helpless in the process. And we do everything we can, but it’s not enough to make a difference.”

Staff writer Ellie Silverman contributed to this article.