Jill Mittl couldn’t sleep. The 66-year-old would wake in the middle of the night, wondering if she should jump on the computer and check for new appointments for the coronavirus shot.

She contacted provider after provider, logging on a spreadsheet her attempts at securing appointments for herself and her 70-year-old husband. At last, the couple were vaccinated in March — after contacting 25 providers, driving to another county, and having their second shots delayed and rescheduled.

Mittl is finally sleeping well again, but the experience left the Berks County woman, like other Pennsylvanians, with a dim view of state leaders.

“It’s very emotional, stressful, and maddening not knowing when you’re getting your vaccines because the Pennsylvania Department of Health … is obviously unorganized and probably uncaring,” Mittl said in an interview.

Even as Pennsylvania increases its vaccination pace, moves up in national rankings, and expands eligibility, it still battles public dissatisfaction. For months, miscommunication and mixed messages from the people charged with overseeing the distribution have prompted frustration from residents and elected officials and fueled a public perception of a tangled, messy rollout at a crucial moment in history.

Examples include:

  • In February, the state acknowledged that flawed communication with vaccine providers led scores of them to use shots earmarked as second doses for people’s first shots. The miscue caused a shortage that delayed tens of thousands of Pennsylvanians waiting for their second shot.

  • As other states set expectations over the winter about when more people could get the vaccine, Pennsylvania waited until last week — when it was pressed by Biden administration deadlines — to release plans for expanding eligibility.

  • In early March, the acting health secretary told lawmakers that the department was monitoring providers to ensure they didn’t inoculate ineligible people — and that it would increase vaccine supply to counties when the state’s calculations indicated they were being shorted. But the department later said it lacked the capability to closely monitor vaccine reports and was unable to provide a list of counties that needed help.

  • As his counterparts in some other states have made themselves the face of the vaccination efforts with detailed regular news briefings, Gov. Tom Wolf does not regularly appear alongside the acting health secretary, and appearances by him and other administration leaders have at times focused more on touting or pledging improvements than acknowledging the difficulties Pennsylvanians were facing finding shots.

Members of the Wolf administration dispute such criticisms, arguing their communication has been extremely clear. Wolf’s chief of staff said complaints about a lack of data or answers were from people who didn’t like that the administration couldn’t give them more vaccine.

» READ MORE: All adults in Pa. eligible for COVID-19 shot on April 19; Philly suburbs will give out J&J shots as state backs off mass clinic plan

In 2021, they note, the Department of Health has held 36 briefings and issued 145 news releases about the pandemic — and its top officials have attended dozens of legislative briefings, caucus meetings, and calls with officials. Since Jan. 1, the department said it has also responded to close to 3,400 media inquiries.

In an interview Wednesday, acting Health Secretary Alison Beam defended the department’s communication as “a pillar” of the vaccine rollout.

She and others conceded that communications lagged when former Health Secretary Rachel Levine joined the Biden administration. Upon taking over in late January, Beam said, she listened to feedback and instituted weekly calls with lawmakers and daily calls with vaccine providers, among other fixes.

“We came into this at the end of January, when we knew that there was a lot of the righting of the ship to be done, and we’ve been clear with folks on that,” said Beam, a lawyer who served as Wolf’s deputy chief of staff before being tapped as health secretary. “What we have delivered on is absolutely moving at a faster pace than where we were.”

The Inquirer interviewed nearly 50 state legislators, county officials, residents, and vaccine providers about their interactions with the state. Most said the state has at times been unclear, incomplete, or unresponsive in its communication. Several also acknowledged the rollout was an extremely difficult undertaking, noting Beam had an unenviable task.

On March 24, nearly two months after Beam stepped in, a veto-proof majority in the Pennsylvania House passed legislation that would force the department to share its detailed plans for responding to counties that have requested more vaccine and publicly provide more data about dose allocation and administration. The bill still needs Senate approval but was a pointed statement from 135 Republicans and Democrats about a perceived lack of transparency.

» READ MORE: Pa. House passes bill to let Philly suburbs run their own mass vaccine clinics, a bipartisan rebuke of the state’s rollout

For Pennsylvanians, the lack of clarity has sent an untold number looking for answers from local officials and physicians, scouring Facebook groups, or turning to community volunteers. On one online vaccine “matchmaker” group, people on Friday were still crowdsourcing questions and asking when they could start scheduling appointments.

Even after getting vaccinated last month, Bernice Stein-O’Neill, 76, of Skippack, concluded the state has done a “lousy job.” Tips for getting appointments spread via word-of-mouth among her friends because they didn’t find the state’s information clear. “I have not talked to one person who said they handled it well,” she said.

» READ MORE: Pa. seniors are ‘at their wit’s ends’ trying to get coronavirus vaccines

And critics in the legislature say the volume of the administration’s communication doesn’t necessarily mean the content is robust. “There’s a difference between getting a response and getting an answer,” said State Rep. Jesse Topper, a Bedford County Republican.

The next 18 days are crucial, as a new wave of people become eligible for shots Monday, another group follows a week later, and vaccination eligibility opens to all adults April 19. The stakes will remain high in the late spring and summer, as efforts ramp up to persuade people who are hesitant to get their shots.

“We have a system that looks broken to people. And we have messaging coming from the Department of Health saying, ‘It’s not what you think, don’t believe your eyes,’ ” Sen. Maria Collett (D., Bucks and Montgomery) said last week. “People know what they see. … And they know what it means. They know that they see their elderly neighbors struggling to get on a website at midnight when appointments might open up.”

‘Clear as mud’

Frustrations in the state’s Southeast region boiled over in March, when Philadelphia’s collar counties became concerned they were receiving a disproportionately lower share of the vaccine compared with other counties.

Beam held a March 7 Zoom call with the region’s elected officials to assure them there was not an undersupply, but attendees left frustrated. One lawmaker said their concerns had been “shut off without explanation.” A county official said Beam’s explanation “was as clear as mud”; another said a follow-up call was just “words, words, words.”

One lawmaker noted that the Department of Health sent the region’s officials infographics and talking points but never provided data to show exactly how many doses were coming into the counties from all sources. Several officials also said they never received answers to questions in letters sent in February and March.

» READ MORE: ‘What is the plan?’ Suburban Pa. officials blast Dept. of Health over region’s vaccine supply as dispute intensifies

In addition, state lawmakers in both parties said Beam’s weekly calls do not allow enough time for questions or provide new information, though some acknowledged the department’s effort to answer queries. The administration said Beam allows 45 to 50 minutes for questions.

“There’s nothing new for me to take back to my constituents afterward,” said State Rep. Wendi Thomas, a Bucks County Republican. “They give us, as best they can, answers, but oftentimes it’s not direct answers, not answers that really help us.”

In response to the claims that lawmakers and officials couldn’t get answers from the state and that their counties were shortchanged, Mike Brunelle, the governor’s chief of staff, accused them of spreading “misinformation.”

In a Thursday interview with The Inquirer, he said those officials had gotten answers from an “extremely communicative” administration, just not the answers they wanted.

(An independent analysis by The Inquirer confirmed the Southeast counties were receiving fewer doses per capita. The Department of Health said it did not dispute that analysis but said the formula the state uses to allocate doses relies on more variables than just population.)

Elected officials also pointed to instances of shifting or misleading messages about the vaccine administration rate, whether the state was monitoring whom providers vaccinated, and which counties were performing below the state’s index.

For instance, even as Beam insisted there was no systemic undersupply of vaccine doses on the March 7 call, she displayed a chart showing that Delaware and Bucks Counties were behind — but said it was only theoretical. After the call, a spokesperson told The Inquirer that concluding from the chart that Delaware County was undersupplied would be “setting aside reality.”

The spokesperson also told reporters that week that the department had not completed a data analysis to identify any shortages and could not provide the data for the month of February.

On Wednesday, however, Beam said the state had always had the analysis, citing the chart she’d displayed. She said the state in fact had aided counties. The department never provided a list of the counties or other data.

“There has absolutely been mixed communication and inconsistent communication,” said State Rep. Frank Farry (R., Bucks), who said he believed the public had lost confidence in the rollout. “If there’s questions on the transparency of what’s going on, it creates an uncertainty and a distrust.”

Feedback amid crisis

There are clear benchmarks of the state’s progress in distributing the vaccine: More than 3.6 million Pennsylvanians have gotten at least one shot, a number that had the commonwealth ranking 13th among states on Friday — a dramatic jump for a state that once ranked 49th.

The state has used 80% of the vaccine it has received, ranking 18th. It ranks 30th for the percentage of people fully vaccinated, according to a New York Times tracker of Centers for Disease Control and Prevention data. (As of Friday, New Jersey ranked higher than Pennsylvania in those categories; other neighboring states were on par.)

But some providers, advocates, and officials said they find out about state decisions that affect their operations at the same time as or shortly before the public.

Vicky Kistler, who as director of the Allentown Health Bureau serves Northampton and Lehigh Counties, pointed to the March 12 announcement setting an end-of-month deadline for making appointments for everyone in the 1A group, which includes people 65 and older and those with high-risk conditions.

Kistler was told about the state’s plan just an hour before it went public. She told the department she didn’t “see any way that that is going to be feasible,” she said, but it was too late. The deadline caused a “logistical nightmare” for her staff, which fields thousands of calls from people seeking shots, she said.

Senior-citizen advocacy groups also said they weren’t consulted on state vaccine plans until it was too late to change them.

The same complaint came from Southeast counties. The state “sought no feedback” before the rollout, said Bucks County Commissioner Diane Ellis-Marseglia, and last month unveiled a regional mass clinic plan that caught the collar counties off-guard. After their leaders proposed an alternative that the state rebuffed, Chester County Commissioner Josh Maxwell said there had been “communication issues.”

Days earlier, some vaccine providers had been taken off the state’s list without advance warning. The short notice forced hundreds statewide to cancel previously scheduled appointments, said Mel Brodsky, head of the Philadelphia Association of Retail Druggists.

» READ MORE: Philly hospitals care for thousands of suburban patients but can’t give them COVID-19 vaccines

Even Penn Medicine, one of the region’s health-care giants, told patients that it struggled to get answers about when Penn would get doses for its suburban patients; in early March, Temple University Health System leaders said they had gone two weeks without a response from the Department of Health.

“We are intentional about our rollout strategies, but it does happen quickly,” Beam said. “This is a crisis. The crisis doesn’t always allow for weeks of lead time before you pivot and you have to make strategic decisions.”

Some also said that if the state had done a better job telling the public what to expect — perhaps by giving earlier estimates of when certain groups would be able to get vaccinated, even if they were subject to change — residents would have had more faith in the system.

» READ MORE: New Jersey’s vaccine rollout is mostly working. In Pennsylvania, it’s more complicated.

In New Jersey, members of the governor’s administration have said it is key to give people a sense of when they’d be eligible, even if there still weren’t enough shots for everyone; Gov. Phil Murphy routinely declared who would be up next for vaccines weeks ahead of announcing the actual dates.

“People are willing to be patient if they know that they’re going to get a turn,” said State Rep. Mike Zabel (D., Delaware). “The problem had been, for weeks, nobody had even known [if] they were going to get one.”

Reaching residents

Some perception issues stem from state officials’ own remarks, or lack thereof.

While Murphy gives lengthy updates alongside his health commissioner at regularly scheduled briefings, Wolf and Beam appear together less frequently, and some critics say the messages they or their advisers broadcast are often vague or resistant to going off-message.

Asked at a Feb. 11 briefing whether the state would consider centralizing its vaccine rollout, Wolf responded: “We want to do whatever we think we can get to as quickly as possible that will give people the access they don’t have right now that they need.” He did not elaborate.

» READ MORE: Despite discontent in Harrisburg, Wolf says Pa. vaccine rollout is going well

At a March 19 briefing in Bucks County, Wolf seemed not to be familiar with sharp criticism his Health Department had levied at the Southeast counties and struck some as disconnected when he said “you’d have to scratch your head” to come up with anything the state could be doing better.

“Their messaging is pretty much: ‘Hey, we’re doing great,’” Chrysan Cronin, director of the public health department at Muhlenberg College and a professor of epidemiology, said last week. “But they don’t give a message about, ‘We have heard you, we’re listening to you, we know you’re frustrated and that the way we have gone about it is not efficient, and so this is what we’re doing about it.’”

» READ MORE: A rough vaccine rollout has even Democrats turning on Pennsylvania Gov. Tom Wolf

The governor’s chief of staff said criticisms of his appearances “aren’t based in reality” and said Wolf’s Bucks County remarks were questioning why people were focused on “political infighting” when they should be talking about the state’s vaccine administration rate.

‘A lot of growing pains’

Throughout the rollout, there have been challenges outside of the states’ control, including evolving guidance from the federal government and the extremely limited national vaccine supply. Brunelle noted that the many changes in the federal approach have contributed to public confusion.

Since the pandemic began, Wolf has dedicated two-thirds of his livestreamed briefings to the crisis, holding public appearances twice a week, including events around the state, spokespeople said.

“I quite frankly think this is one of the most extremely communicative administrations that I’ve ever been a part of,” Brunelle said. “It’s been very clear, and we have communicated. We have talked to the press, and we talk with stakeholders.”

Still, only after weeks of calls for transparency did the Department of Health make all its vaccine administration data publicly available online. Later this month, the state is launching its first ad campaign, spending nearly $9 million on TV, radio, and social media to encourage people to get vaccinated.

Zabel, the representative, said he has seen signs of improvement in the state’s communications, though “it has taken a lot of growing pains to get there.” Kristen Wenrich, director of the Bethlehem Health Bureau, said the state had become “pretty forthcoming.”

With the news that Pennsylvanians 16 and up will be eligible in two weeks, some residents remain worried, with questions about when they’ll actually get vaccinated.

Glenside resident Sean Cullen — who last month got so frustrated watching the governor’s Bucks County news conference that he called Wolf’s office to complain — said last week’s news about eligibility expanding put him more at ease.

But when it comes to Pennsylvania’s communication, “I still have a bit of a bad taste in my mouth,” said the 50-year-old, “because I feel like they effectively stalled for a month, and now they’re doing things they should have done a month ago.”

Staff writer Allison Steele contributed to this article.