Getting the COVID19 vaccine out of the freezer and into people’s arms has been slow. And, even as people battle unsympathetic websites to find slots for a shot, there still are many unanswered questions.
Will people who have been vaccinated still be asymptomatic and carriers who could infect others?
Will non-vaccinated people still need to wear PPE when interacting with them?
Will the vaccine protect against two new contagious strains of the virus?
What will the Biden administration do differently in its COVID19 response?
These questions and more, were answered by experts at an Ethnic Media Services briefing on January 13.
One of the biggest concerns to the country is the slow pace of the vaccine roll out. Though the US has 20 million doses of the Pfizer & Moderna vaccine, we face innumerable challenges at both the federal and state level, in getting the vaccine out to people. Only 5 million vaccines have been distributed as of January 11th.
According to Dr. William Shaffner, Professor of Preventive Medicine and Health Policy, and Professor of Medicine in the Division of Infectious Diseases at Vanderbilt University, a number of bottle necks choked a smooth vaccine roll out. At the national level, the uncertainty in vaccine shipments put a strain on the local level. States were not sure when vaccines would arrive, sometimes delivery was delayed, or fewer doses were received than anticipated. Occasionally shipments were sent to the wrong state in error.
The Pfizer Deep Freeze
A key challenge for local distribution outlets was storing the Pfizer vaccine which requires “a really deep freeze” to keep it stable and intact. So only large medical centers with appropriate freezer storage capacity and personnel trained to handle it, first received the vaccine. Fortunately, the Moderna vaccine does not need similar storage requirements and was distributed more easily, so vulnerable populations and frontline healthcare workers in long term care facilities, nursing homes and smaller community hospitals were able to access the vaccine.
Not Just Another Flu Campaign
“Quite frankly,” said Dr. Schaffer, many facilities assumed it would be “just another flu campaign,” but they were wrong. Insufficient preparation to administer the COVID19 vaccine rather “gummed up the works.”
California did get the science right, added Dr. Robert M. Wachter, Professor and Chair of Medicine at UCSF, “but did not get the logistics right.” Based on the way California managed its PPE and testing protocols, he was not surprised that vaccine distribution fared poorly. It’s a complicated process which ‘would have benefitted from a thoughtful national plan’ to determine for example, how to get a vaccine from a manufacturing plant in Michigan into a Fedex box that arrives in a central Californian distribution center. Glitches occurred because states, left to devise their own distribution process, “handed off responsibility to local institutions” which improvised protocols in “the last mile” of the roll out.
The lack of national guidance allowed too much “wiggle room” for error, stated Dr. Wachter.
Health Equity Gridlock
Another problem was created by rules about which cohorts got the vaccine first in a well-meaning effort to ensure health equity and that certain groups – frontline healthcare workers, the elderly and essential workers – were prioritized for the vaccine. But how does a “Walgreens decide if you are a pre-school teacher or a grocery store worker or someone with a pre-existing condition,” argued Dr. Wachter. Do you need a note from your doctor or employer? “I haven’t received a convincing answer from anybody.”
‘We’ll Figure It Out’ Won’t Work
The lesson to learn is that “we’ll figure it out is not going to work with COVID19,” declared Dr. Wachter. He called it ‘scandalous’ that only 30% of all vaccines distributed have been injected when “millions of people should have received the vaccine by now.”
Congress only passed a coronavirus relief bill in late December 2020, to provide supplies necessary for distributing and administering the COVID-19 vaccine.
What we have is a “9/11 or a Pearl Harbor worth of people dying a day” when we should be treating the distribution of the vaccine as an emergency, added Dr. Wachter.
Vaccines Going to Waste
Stories about vaccines going to waste make great news stories, but that’s not the real problem, said Dr. Shaffer. The issue is that doses are sitting in refrigerators and freezers but not making it into the final phase of delivery.
At UCSF, medical, 84% of vaccines have been distributed -15 thousand of about 18 thousand doses have been injected. The worry is how doses will make their way into rural or underserved communities.
Interestingly, Dr Shaffer reported that at Vanderbilt, a survey of healthcare providers found that they were hesitant and skeptical about the vaccine before it arrived. Vanderbilt responded with a major effort to educate its staff and address concerns to reassure reluctant people and change their minds. For example, the program had to counter fears that the vaccine is not safe for pregnant women.
Both physicians reiterated that the vaccines were safe and effective to use.
Single or Double Dose
Data from all clinical trials find that two doses are required. The first shot offers partial protection after ten days and up to 80% to 90% protected up to the minute before getting the second dose. “The second dose boosts you up to the ultimate number of 95% and creates more durable immunity,” confirmed Dr. Wachter.
While models show that giving more people a first shot of the vaccine will save more lives than withholding doses for the follow up shot, there are legitimate concerns about delaying the second dose – will immunity fall off, will it promote mutations by having more people partly vaccinated, or will people forget to come back for their second dose? A single dose only will not work in the long term, but deferring a second dose will get more people vaccinated sooner. So the Biden administration’s plan to get more first doses out is ‘a good strategy’ agreed Dr. Shaffer.
Will You Still Be Contagious?
Preliminary data from a Moderna study indicated that ‘a substantial proportion of people vaccinated would not be able to transmit the virus. However, until final data sounds the all clear, warned Dr. Shaffer, people should continue to observe precautions with masks and social distancing.
Biden Roll Out
The best first step for the new administration must be to lead its Covid19 response based on science and clearly communicate its national policy, emphasizing “public health and scientific principles,” said Dr. Shaffer. They also need to address the bottlenecks in vaccine distribution and reinforce they will work together with state and local levels to troubleshoot and resolve problems. Instituting a federal policy to ensure consistency in the COVID19 response across the country will be invaluable, he added.
There is a real risk of politically driven resistance to the vaccine especially in rural areas and persuading people that it is safe and necessary will be quite difficult, Dr. Shaffer pointed out. But as demand grows for the vaccine, websites will have to handle thousands of people going online to make appointments, and venues will have to manage large cohorts arriving for their shot. A fair system needs to be established to ensure health equity in who gets the vaccine.