While Minnesota's large health care systems are wrapping up COVID-19 vaccinations for their employees, some independent providers say they are still waiting for the shots despite being in the state's high priority group.

Six weeks after the first COVID-19 vaccine was administered in Minnesota, clinics that are not part of the large health systems are getting their first notification about where they stand in line, although some have not been contacted.

"We've had 10 months knowing the vaccine was coming. To think that there was no plan for distribution for that last mile to get the vaccine into arms is a bit frustrating," said Carmelo Cinqueonce, executive director of the Minnesota Dental Association.

Things have improved recently, he said, with about 75% of dental practices responding to a survey saying that they have now been contacted, up from 25% two weeks ago. "It absolutely feels as though the independent practitioners who were critical health care providers were overlooked," Cinqueonce said.

The Minnesota Department of Health said local public health agencies "made a big push" to contact unvaccinated providers this week and that the state will allocate vaccine for that purpose. The state is also sending e-mails to licensing boards and other stakeholder groups saying their turn is coming.

"We appreciate that the health systems are helping us get vaccines out to unaffiliated providers across the state, and we regret any confusion that may have existed about guidance we provided in December," the agency said in a written statement.

Statewide, 345,636 doses have been given to health care workers and long-term care residents as of Wednesday. The state estimates that 6.3% of the population has gotten at least the first dose, a number that has been increasing over the past week, aided by state community testing sites that are vaccinating nearly 10,000 elderly and 15,000 education or child-care workers this week.

Minnesota Health Commissioner Jan Malcolm said Thursday that no decisions have been made on whether the pilot vaccination events will continue next week, although she added that they will be available for second doses, which typically come three to four weeks later.

The delays for independent clinics, which also include chiropractors, physical therapists, primary care and specialty physicians, were one consequence of the state's hub-and-spoke model for vaccine distribution, which was rooted in the large health systems — especially hospitals that had the deep-freeze equipment needed to safely store one of the two vaccines in use.

The Mayo Clinic, which serves as one of the hubs in southeast Minnesota, said that state health officials did not provide direction about sending vaccines to clinics outside the Mayo orbit.

"The question and the guidance on who was responsible for the unaffiliated health care providers in the community was never clarified until essentially the last week," said Dr. Abinash Virk, who is coleading Mayo's vaccine distribution response. "We made a decision last week that we will allocate some of our doses."

Like other providers, Lake­view Clinic in Carver County has been working the telephones and sending e-mails trying to get clarity on how it can get vaccines.

"We were hearing nothing. We weren't getting our e-mails answered" that were sent to local officials, said Dr. Mark LaRose, clinic president. "In their defense, there wasn't a lot of guidance from the state."

At one point, an independent pharmacist in their building offered to get some doses.

"Are you flipping kidding us? We are making all these phone calls," LaRose said. "It has been a difficult system to navigate."

Eventually, a local hospital provided doses to clinic staff and the county health department has made a limited number of doses available for patients.

"The vaccine we've gotten so far [for patients] is all from the county," LaRose said. "We haven't had any plan presented to us from the state level."

Other independent clinics wonder when they will get vaccines for their high-risk patients, especially since several systems, including Mayo, HealthPartners, Allina, M Health Fairview and Essentia are giving shots to their elderly patients.

Red Wing-based C.A.R.E. Clinic was notified that it will be getting some doses for its patients.

"I am excited about that possibility," Clinic President Julie Malyon said. "We will see when and if it actually translates into getting vaccine."

Still, some clinic staff, including dental providers, have yet to be inoculated, as well as some of the 200 volunteers who provide essential services such as interpretation.

"We've been functioning without them, which is really hard," she said, noting that about half of the clinic's patients are first- or second-generation immigrants.

Troy Simonson, chief executive of Infinite Health Collaborative, told a Minnesota Senate health committee last week that clinics in his group, which employ 180 physicians and 2,500 workers, have had limited success in getting vaccine doses.

"There are other health care workers in the state beyond those employed by the major health systems," he said. "Many of the health care workers that are part of those independent physician practices have patient-facing roles."

Although some systems have made some doses available, Infinite Health has assigned the task of finding doses to some workers.

The situation has not changed since last week.

"We have not received any of the vaccine yet and have not been notified if we are going to be receiving any," a spokesman for the collaborative said.

Although case counts, hospitalizations and deaths have fallen dramatically since the fall, health officials say that the introduction of more infectious coronavirus strains into the United States underscores the need for mass vaccinations.

Minnesota health officials announced 28 deaths and 1,145 new infections Friday, bringing the state's pandemic total to 6,168 fatalities and 459,747 confirmed cases.

Twenty-two of the newly reported deaths involved people 65 and older, including 11 long-term care residents.

The state's hospitals are caring for 450 COVID-19 patients, including 95 in intensive care. Most who require hospital-level care have underlying health conditions that make them susceptible to COVID-19 complications, including heart, lung and kidney disease.

Glenn Howatt • 612-673-7192