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Healthcare workers and nursing home residents to get first shots at COVID vaccine

Getting a COVID-19 vaccine is not like getting a flu shot: It won’t be first-come, first-served, it will likely come in two doses and it could take months to get.

Federal officials are pushing those most likely to come into contact with COVID and those most likely to die or suffer from it to the front of the line for the vaccines, one of which is expected to be made available this month.

On Tuesday, the U.S. Centers for Disease Control’s advisory committee on immunization practices voted 13-1 to provide the first vaccines for healthcare workers and those in long-term care facilities.

The committee cited COVID’s impact on healthcare workers and those living in long-term care facilities in setting the priorities. They will set other priorities in the population as more vaccines become available.

The CDC expects 40 million doses of the vaccine in the next few weeks, enough to inoculate about 20 million health workers with a two-part dose. Officials then expect the doses to start trickling in by the millions every week to health departments and hospitals across the country.

Locally, the distribution will fall primarily to the Thomas Jefferson Health District, which distributes most influenza and other vaccinations.

“We have plans already in place because we are responsible for providing points of dispensing for vaccines and distribution of antibiotics and other drugs in case of emergencies,” said Jessica Coughlin, emergency manager for the health district. She also manages the districts COVID-19 testing programs as well as the mass vaccination program.

“We don’t know exactly what the priority groups are going to be or when the vaccines are going to be available to the general public,” Coughlin said. “Like everything that’s happened with the pandemic, we’re ready with our plans but we’re also ready in case our plans have to be changed.”

University of Virginia Health officials are in a similar plan now, revise later mode.

“There has been a lot of discussion at the federal level about how to distribute it to the population and we know there will be a point where supplies are simply outstripped by the demand, especially early in the distribution process,” said Dr. Costi Sifri, director of hospital epidemiology at the University of Virginia Medical Center.

“It’s a logistical challenge and we’ve had many of those with the pandemic,” he said. “It’s a significant challenge, but it’s a hopeful challenge compared to so many of the others.”

Sifri said current information indicates a vaccine could be available this month. Other vaccines, he said, are likely to follow.

“We’ve heard there will be some ready to distribute in a few weeks,” he said. “We’re hopeful that we’ll see multiple, different vaccines become available so that the availability improves as the year goes on. That would allow you to choose which vaccine is best for which individual.”

“Allocation of COVID-19 vaccine should maximize the benefits of vaccination to both individual recipients and the population overall,” CDC officials said in their planning documents for vaccine delivery. “Identification of groups whose receipt of the vaccine would lead to the greatest benefit should be based on scientific evidence, accounting for those at highest risk for infection or severe COVID-19–related disease or death, and the essential role of certain workers.”

The CDC has recommended that the second round of vaccines be given to essential workers, including those in meat packing plants, truck drivers and grocery store workers, and those with health risks followed by adults over 65. Those recommendations have not been formalized.

CDC officials said the vaccines will be distributed to the states through channels similar to current influenza and other vaccines. The states will deliver them to hospitals, health departments, doctors and other providers as they come in.

“The vaccine supply is projected to increase quickly over the proceeding months, allowing vaccination efforts to be expanded to additional critical populations and the general public,” the CDC planning document states.

Sifri said UVa Health will first distribute its supply of vaccine to those nurses, doctors and staff who work on the COVID wards first, followed by other health care workers and those at highest risk if they contract COVID-19.

The Thomas Jefferson Health District, which serves the region, will be responsible for administering the vaccine to the general population. Coughlin said vaccination events will likely resemble the health district’s drive-up testing programs. The drive-in program provides easy social distancing by keeping people not living in the same household a car-length apart.

“The biggest change we’ve seen has been the way we do testing by using a drive-through program rather than the traditional method of providing vaccinations in school buildings or public buildings,” she said. “We’ve now got a good feel for how it would work.”

Currently there is one COVID-19 vaccine approved for emergency use by the U.S. Food and Drug Administration. Another vaccine was submitted on Nov. 30 for FDA review for emergency approval.

Medical officials say they are concerned that many residents will doubt the safety of the vaccines, either because of how quickly they were developed or because they mistrust the medical community itself.

“There are people at high risk for complications of COVID and there are concerns that there may be some vaccine reluctance,” Sifri said. “We need the right communications so that people trust the vaccines.”

The vaccines must go through three trial phases before the FDA will consider them for distribution. The first phase determines if the drug is safe. The second shows whether it works. The third assesses how effective it is.

Normally, the process can take years, but with the pandemic firmly in place, the FDA approved and the federal government funded efforts by drug companies and researchers to step up development of vaccines under emergency use authorizations.

That specifically allows vaccines and treatments during public health emergencies when there are no adequate, approved, and available alternatives.

Although the vaccines are moved through the process at a much faster rate than normal, they must still go through and pass all three phases of study and FDA review. The CDC estimates 60 vaccines are being tested on humans and another 90 are in tests on animals. One has been granted emergency use authorization and another is being considered for emergency use.

Sifri said UVa Health officials are preparing for the arrival of vaccines, knowing that each one approved will likely have different storage needs and protocols. That in itself is an issue as the emergency approval has been given to a vaccine created by drug company Pfizer that requires storage at -94 degrees Fahrenheit.

A vaccine under review by the FDA created by drug company Moderna requires its product to be stored at -4 degrees Fahrenheit.

“We’re challenged by the fact that we don’t know which vaccine or what type we will get or what vaccines will become available later on or how those will need to be handled and administered. It’s like skating after a moving puck,” he said.

Coughlin said that health officials will do their best to track those who receive the vaccine but that it’s important for those who receive the shot to be sure they receive the second dose.

“Once the program is running and we have vaccines coming in, it will be important for people to keep their paperwork, know when they need to come in for the second dose and follow-up themselves,” she said.

“We’re planning on being ready with plans from A to Z because we know we’ll need more than just plan A and plan B,” she said. “Once the vaccines are here, we know things are going to change and we will react with whatever changes we need to make.”


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