As Virginia takes the first steps in an unprecedented vaccination campaign, there are still questions health officials can’t answer — from when the vaccine will become widely available to how many doses the state will receive over the next few months.
Another detail they’re trying to confirm is who will be administering the COVID-19 vaccines. Health Commissioner Dr. Norman Oliver put out an “urgent” call for volunteers earlier this month, urging health care providers to sign up for the state’s Medical Reserve Corps. Even in normal times — and with diseases far less deadly than COVID-19 — coordinating a statewide vaccination campaign is a logistical challenge. But as local health departments struggle to contain a third surge of cases, all while planning for a frontline role in vaccine administration, Virginia health leaders are working to expand the state’s medical workforce.
“As we expand vaccines to more and more people, we’re going to need strike forces,” said Dr. Wendy Klein, a member of Virginia’s Vaccine Advisory Workgroup. “Like this year with flu vaccines — I got my flu vaccine in the parking lot of a Bon Secours facility where they had 11 drive-through bays. That’s a good vision when it comes to COVID-19.”
Klein emphasized that it wouldn’t happen right away. After initially anticipating nearly half a million doses of vaccine by the end of the year, the Virginia Department of Health rolled back that estimate on Friday, saying new projections from the federal government placed the figure closer to 370,650. Currently those vaccines are being shipped directly to hospitals, though state health officials won’t identify exactly which ones.
Given the initial scarcity, health care workers “who directly engage in the care of” COVID-19 patients are prioritized for the state’s early doses. That’s given hospitals wide latitude to distribute and administer the vaccines, with many health care workers still uncertain when they’ll be immunized against the virus.
Klein said the centrality of hospitals in distribution is also based on the intensive storage requirements of the Pfizer vaccine — currently the only one that’s received emergency approval from the U.S. Food and Drug Administration.
Pfizer’s doses must be stored at ultra-cold temperatures of roughly -94 degrees Fahrenheit until they’re ready to be administered. Once thawed, the vaccine can only be stored for five days in the refrigerator — and the vials can’t be re-frozen.
That presents logistical challenges when it comes to distributing the vaccine to community health clinics and even primary care offices, which generally don’t have the same ultra-cold storage capacity as hospitals. NPR also reports that Pfizer’s vaccine can only be ordered in doses of 975 or more — a quantity that’s just too large for most community providers.
But the supply chain is expected to change quickly. Virginia has already placed an order for roughly 146,000 doses of a second vaccine from the pharmaceutical company Moderna, which could receive FDA approval as early as Friday. With storage at normal freezer temperatures — around -4 degrees Fahrenheit — and a refrigerated shield life of 30 days, Moderna’s vaccine is expected to be more accessible and shippable to community providers.
Local health departments are gearing up for a central role in vaccine distribution. Even before the state moves into the second and third stages of its campaign, the agencies expect to assist in vaccinating health care providers outside hospital systems. Staff will also be tasked with vaccinating some of Virginia’s most vulnerable residents, including homebound patients who can’t physically travel to get a vaccine.
“A lot of our staff are going to be going out and doing our mass vaccination pods,” Dr. Karen Shelton, director of the Mount Rogers Health District, which covers Bland, Carroll, Grayson, Smyth, Washington, and Wythe counties, and the cities of Bristol and Galax, said in an interview last week. But staffing is expected to remain a challenge as local departments fight the pandemic on multiple fronts, from community testing events to case investigation for dozens — and sometimes — hundreds of new cases every day day.
“That takes away resources both for case investigation and for testing,” Shelton continued. “So, with strapped resources — we’re working to increase our workforce, but it just gets to the point where you just need so many more people right away for the tasks at hand.”
The Medical Reserve Corps is dedicated to public health emergencies and has become an important component of the state’s COVID-19 response, supplementing health department staffing at community testing events and even temporarily filling in for employees at long-term care facilities who tested positive for the virus.
State leaders hope that credentialed volunteers will play a key role in immunizing health workers and eventually the general public when vaccines become widely available. Klein compared the vaccine rollout to the growing availability of COVID-19 testing throughout the pandemic. While testing resources were initially available only through hospital systems and the state’s public health laboratory in Richmond, ease and accessibility grew with the supply chain — to the point where most Virginians can now be tested at community events or their local doctor’s office.
“One of our workgroup’s suggestions was let’s bring in more volunteers,” Klein said. “There are many people who want to help.”
At the same time, the state is recruiting primary care doctors and other frontline providers to register as vaccinators. As of last week, 318 medical workers were fully enrolled to administer vaccines — a bureaucratic process that involved signing up through the state and the U.S. Centers for Disease Control and Prevention. Klein said several hundred more have applied but haven’t had their applications fully approved.
“The data collection for these vaccines is very important.” she said. “So, the enrollment process is quite complex.”