Future Delivery Plans for COVID-19 Vaccine Uncertain

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Some of the first doses of Pfizer’s COVID-19 vaccine are received and put into ultracold storage at a Riverside Health System facility in Virginia on Tuesday, Dec. 15, 2020. Riverside Health System photo.

By Carol Vaughn —

A Virginia Health Department official in a rare Saturday press briefing addressed mixed messaging coming from the federal government about COVID-19 vaccine distribution.
Earlier in the week, federal officials “gave pretty clear direction” to states to extend vaccination to people ages 65-74 and younger adults with underlying medical conditions, said Dr. Danny Avula, VDH vaccine coordinator.
“While they encouraged that movement in the states, they also intimated that there would be a large release of second-dose reserves,” he said.
Gov. Ralph Northam last Thursday announced new guidelines from the Centers for Disease Control and Prevention meant half of Virginians would now be eligible to receive the COVID-19 vaccine, after Virginia decided to add those 65-74 and people with underlying conditions to Phase 1b, based on the federal message that more vaccine doses would be coming.
“Then, over the last couple of days, we have heard very different messaging; we are not exactly sure what to do with that,” Avula said Saturday, adding officials now are getting the sense that the state’s weekly vaccine allocation may not increase after all.
“It’s certainly disconcerting and disheartening, given that we made the step forward to expand our 1b under the assumption that we’d be receiving more vaccine,” he said.
Virginia currently receives around 110,000 doses a week.
“All of that supply is being doled out as quickly as possible,” Avula said, noting last week the state had requests for more than 300,000 doses, but received only 106,000 to distribute to health care providers.
“That’s the challenge of where we are,” he said.
Gen. Gustave Perna, chief operating officer of Operation Warp Speed, the federal COVID-19 vaccine initiative, called Virginia Health Commissioner Dr. Norman Oliver Thursday to clarify that there are not “warehouses of vaccines” to distribute to states, Dr. Daniel Carey, Virginia Secretary of Health and Human Resources, said during the briefing.
Federal officials indicated that “without new vaccines, that’s what we should expect until the end of February and early March,” Carey said of Virginia’s current allocation.
The figure is for first doses, Avula said, adding, “The federal government is allocating second doses through a separate pathway. …So anybody who has received first doses is automatically getting assigned a second dose allocation above and beyond our 100,000 or so doses a week.”
Virginia in addition to receiving 106,000 first doses this week received 61,000 second doses, which went directly from the federal government to providers to administer to patients who had received a first dose 3 to 4 weeks before.
As of Saturday, Virginia providers had administered 295,202 vaccine doses, out of 943,400 the state distributed.
“We have been steadily increasing the number of doses a day,” Avula said, noting Virginia now is averaging more than 14,000 doses per day administered and had three consecutive days with more than 20,000 doses administered.
A separate program for long-term care facilities, handled through a federal agreement with CVS and Walgreens pharmacies, accounts for around 226,000 of the 943,400 doses distributed in Virginia.
Of the remaining doses, around 145,000 went to hospitals, which “did a fantastic job” vaccinating health care workers under Phase 1a, Avula said.
Acknowledging not everyone vaccinated will return for the required second dose, Avula had this message for health care providers: “What we are saying is, use the vaccine that you have. Work through all the doses; if your second doses don’t show up or don’t schedule appointments, go ahead and use that for first doses and then we’ll figure out how to ensure we can get the second doses after that; but right now, the imperative is really to to use all of the doses you have, and we’ll keep allocating accordingly as it comes in.”
The gap between doses the state has distributed and the number providers report having administered is due in part to a lag in providers entering data into the Virginia Immunization Information System, according to Avula.
He estimated between 100,000 and 200,000 “of the doses on our docket” have been given, but not accounted for.
The VDH recently hired 10 people to work with providers to make sure the data is correct, which Avula said is critical because it could determine future allocations.
As demand exceeds supply and the state has expanded those eligible for vaccination, Avula urged Virginians to let the most vulnerable be vaccinated first — “to recognize that there are people who need it more than us.”
In light of uncertainty about how much vaccine the federal government will send, Avula said, “All we can do is continue to build the infrastructure, the vehicle for vaccine delivery. To get to some degree of herd immunity in our commonwealth, we need to get to 70% to 80% of our population vaccinated. When we originally set targets…we scoped out about 50,000 doses per day; that’s what it’s going to take to get to that number; and so we are building the vehicles to get to that number,” by expanding the number of health systems, pharmacies, and providers giving vaccinations, and by having local health departments doing mass vaccinations.
There also will be a need for “a fixed-site, large-scale mass vaccination effort…a 6-, 7-day-a-week operation where we’re doing somewhere between 1,000 and 2,000 doses a day,” Avula said, adding that would be a situation where the National Guard would be deployed.
The Virginia Department of Emergency Management is planning where those sites will be and how they will be staffed, Avula said, adding, “It will be built; it will be ready…as we move toward March and April, where we expect more production” of the Pfizer and Moderna vaccines, as well as federal approval of additional vaccines being developed by other companies.