Gov. Ralph Northam is hoping that all Virginians might be vaccinated against COVID-19 by mid-summer. But as state leaders prepare for a largely unprecedented rollout, it’s clear that scarcity will inform at least the first few weeks of vaccine distribution.
Health officials outlined the state’s coalescing approach in two meetings Tuesday, a little over a month after the Virginia Department of Health submitted its initial vaccination plan to the federal Centers for Disease Control and Prevention. Since then, two vaccines — developed by Pfizer and Moderna — have emerged as frontrunners in the race toward immunization, with initial doses expected as early as mid-December. (A third potential vaccine by AstraZeneca could be easier to store and distribute, though the company admitted to a mistake in its trials and reporting that raises questions about effectiveness).
“We have a number of weapons in our arsenal to fight COVID-19, and we’re now on the verge of adding another one,” State Epidemiologist Dr. Lilian Peake said in a virtual presentation before a House committee. Right now, it’s also clear that health care workers and residents in long-term care facilities — some of the groups most impacted by the virus — will be first in line for the vaccine.
But it’s possible that even high-priority groups could be subcategorized depending on how many doses Virginia initially receives. In a weekend interview with NPR, Northam suggested the first allotment was likely to be around 70,000 doses. When the state’s Vaccine Advisory Workgroup met on Tuesday, Christy Gray, the director of VDH’s division of immunization, said the first phase could involve at least some dosages distributed directly to the pharmacy chains CVS and Walgreens, which would then assist in vaccinating residents and employees at nursing homes across Virginia.
“This would be to decrease the burden on the long-term care facilities that’s involved with receiving, storing, handling, administering and reporting COVID-19 vaccine doses,” she added. “It is an intense process that most facilities are not equipped to do.”
Virginia, like other states, is anticipating potential complications when it comes to storage and distribution. Pfizer, which submitted an emergency use authorization request for its vaccine on Nov. 20, requires it to be shipped and stored long-term at extremely cold temperatures — about -94 degrees Fahrenheit, according to VDH. Ultra-cold storage facilities aren’t uncommon at many hospitals, but the requirements make it difficult to ship to or hold the vaccines at sites like nursing homes or community health centers.
If the CDC distributes doses directly to the states, Virginia is also developing a strategy to accommodate storage requirements and distribute the vaccine to high-priority groups. Peake said the state will adopt recommendations developed by the federal agency’s Advisory Committee on Immunization Practices, which is still in the process of finalizing its prioritization plan. In an ideal scenario, the initial allocation would cover everyone in those first-phase priority groups. In that situation, the dosages would be shipped to designated vaccinators across the state.
What’s more likely in the first few weeks — or even months, according to Gray — is that the initial doses of vaccine won’t cover everyone included in the early priority groups. In that case, the ultra-cold vaccine would be distributed to health systems, who would then administer it to employees with the highest risk of being exposed to COVID-19.
“At this point, we’ve put together an internal prioritization policy statement that sort of looks at health care personnel in terms of risk of exposure or direct contact with patients who have COVID-19,” said Julian Walker, the vice president of communications for the Virginia Hospital and Healthcare Association.
The state has already compiled a list of 16 different hospitals where early doses of the Pfizer vaccine could be “pre-positioned” in the initial phase of distribution. Walker declined to identify the individual facilities, but Gray said all 16 sites would be positioned to distribute vaccines to at least 95 percent of hospital health workers.
For vaccines without the same cold storage requirements, the state will prioritize other health care providers, medically vulnerable Virginians, and “critical infrastructure,” according to Gray’s presentation. Northam has also called it “important” to prioritize the minority communities hit hardest by COVID-19 — including Black and Latino Virginians — which are still identified as critical populations in the state’s most recently updated vaccination plan.
Other vaccine-related policy decisions are still up for discussion. Peake said there are currently no plans to mandate a vaccine in Virginia, but it’s not clear whether a COVID-19 vaccine would be added to the state’s list of required immunizations for school children — a question posed by many legislators after her presentation.
“The vaccines that are coming out now — and this is typical — are going to be approved for adults,” Peake said. “The vaccines have not yet been studied in children, or pregnant women, those types of groups. Those studies would still have to be done before the vaccine is recommended for children, and that’s one reason why we haven’t started that planning yet.”