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COURT HOUSE – The Pfizer-BioNTech vaccine was approved by the U.S. Food and Drug Administration (FDA) Dec. 11, and its disbursement began.
The Moderna vaccine appears to be next in line. New Jersey-based Johnson & Johnson is reporting its vaccine nearing final testing.
It is known that vaccines, which studies show to be highly effective, are on the way, but in what numbers, when and with what priorities among the population?
Who Makes the Rules?
Federal agencies will determine the distribution of initial doses to the states. There is no publically available database on how many doses will be sent to each state.
New Jersey officials said they expect 76,000 doses of Pfizer’s vaccine in the initial rollout, with anywhere from 300,000 to 500,000 additional doses by the end of the year.
Once an allotment has been distributed to the states, state officials control its further distribution to points of dispensing (POD).
New Jersey made health care workers most at risk for exposure and long-term care facility residents and staff priorities for initial doses. State estimates are that there are 650,000 individuals in eligible populations at health care and long-term care facilities across the state, meaning initial shipments will not cover all individuals in the priority populations.
Cape Regional Medical Center (CRMC), in Court House, Dec. 11 said that they are prepared to begin vaccinations as soon as doses arrive. The priority will go to frontline health care workers, according to a hospital spokesperson.
As of Dec. 11, CRMC reported 26 COVID-19 patients, six of whom were in intensive care.
Two doses of Pfizer’s vaccine are required weeks apart. State plans say that the Department of Health expects POD locations to administer all doses they receive within 21 days of receipt of the vaccine from the distributor. Doses will not be held in reserve for the required second shot.
In a letter to all acute care hospitals, Health Commissioner Judith Persichilli said “Booster / second doses will be sent at appropriate intervals after prime / first doses are administered.” The state will use an online system to track vaccinations.
Storage and Logistics
The technology employed in the Pfizer vaccine requires that the vaccine be maintained at ultra-cold temperatures. Pfizer’s fact sheet recommends three ways to accomplish appropriate storage.
POD locations equipped with ultra-cold freezers can store the vaccine for up to six months, although New Jersey rules would mandate quicker usage of the doses.
Sites without such freezers can use the thermal shipping containers by replenishing the dry ice they arrive in at least every five days for a maximum of 30 days.
The third, and shortest storage method, is to use refrigeration that can maintain temperatures of 2-8 degrees Celsius for five days. Once thawed, the vaccine cannot be refrozen.
CRMC reports that the hospital has ultra-cold freezer capability for storage of the vaccine.
How the distribution to long-term care facilities will work is less clear. The intent is to make use of the federal Pharmacy Partnership, with large pharmacy providers like CVS and Walgreens. Distribution to these locations would take advantage of their existing experience in running annual flu vaccination clinics at long-term care locations.
The expected protocols will involve the long-term care facility registering residents and staff through an online portal for a given date at a specific facility.
Trained pharmacy staff would transport the vaccine using dry ice to maintain needed temperatures. Details for the process in the county have not yet been released.
An unanswered question is what long-term care facilities will do with patients who refuse voluntary vaccination. Nationwide, there is a debate about whether residents who refuse vaccination will be quarantined or separated in some manner.
Within four weeks of receiving vaccines, all acute care hospital-based PODs must become “open PODs,” according to Persichilli’s letter to hospital executives.
In this open status, the hospital is responsible for “vaccinating anyone currently eligible by phase or sub-phase who registers to be vaccinated at your site.”
State Department of Health plans establishes three phases for vaccine distribution and administration. The state will announce phases and sub-phases based on the amount of vaccine available and the remaining need for priority populations.
The stated goal announced by Gov. Phil Murphy is to vaccinate 70% of the eligible population by late spring.
Education Campaign
Having a vaccine and convincing 70% of the eligible population to use it are two different challenges.
Public willingness to take the vaccine dropped to nearly 50% in September, setting a major hurdle for vaccine distribution and use. Gallup reported that public opinion rebounded to 63%, saying they would accept the vaccine if it was available now and at no cost.
This percentage is below the 70% threshold that the state prefers to reduce virus complications.
The vaccines lining up for approval were tested in terms of their efficiency in preventing the development of the disease from the SARS-CoV-2 virus that causes COVID-19. They are designed to prevent an individual from getting sick from infection with the virus.
What is unclear is the impact of the vaccine on the ability of a person to be infected with the virus and transmitting it to others.
There are two separate but related issues: reducing the severity of the disease once an individual contracted the virus and reducing the ability of an individual to either contract or transmit the virus. On that last point, scientists admit they are collecting data.
Campaigns to convince people that the vaccine is safe will be critical to the success of the effort to vaccinate a large portion of the population.
The vaccine distribution process is complex and evolving information is likely to keep the process fluid, as new vaccines are approved and shipped.
Cape May County Freeholder Director Gerald Thornton said, “There will be a great deal of public information in the coming days and weeks from the county and the state, so that our residents will be fully informed about when and how they can obtain the vaccine.”
To contact Vince Conti, email vconti@cmcherald.com.
