Wednesday, December 30, 2020

Getting COVID-19 vaccine into the arms of Americans is off to a slow start; why the holdup?

 

Getting COVID-19 vaccine into the arms of Americans is off to a slow start; why the holdup?

More than 12.4 million doses of coronavirus vaccines have shipped to U.S. states, but just over 2.5 million people received shots as of Wednesday, according to the Centers for Disease Control and Prevention. 

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Officials say the pace of COVID-19 vaccinations should pick up significantly in the coming weeks. For now, however, they point to a host of reasons for the lag, including vaccination systems still gearing up, federal funding that hasn't yet been disbursed to states and a requirement that states set aside vaccine for long-term-care facilities.

a person in a blue shirt: Nurse Debbie Mahoney administers a COVID-19 vaccine to nurse Alexa Zarlengo at Ascension Saint Thomas Hospital West in Nashville, Tenn., on Dec. 17.© Andrew Nelles, The Tennessean Nurse Debbie Mahoney administers a COVID-19 vaccine to nurse Alexa Zarlengo at Ascension Saint Thomas Hospital West in Nashville, Tenn., on Dec. 17.

Add to that two holidays and three major snowstorms, Operation Warp Speed's Gen. Gustave Perna said at a briefing Wednesday.

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While the vaccine rollout has been challenging, he said, problems with the system are being addressed.  

"Here's what I have confidence in: Every day, everybody gets better, and I believe that uptake will increase significantly as we go forward," Perna said. 

Operation Warp Speed, the federal vaccine program, will meet its target of delivering 20 million doses of the Pfizer and Moderna vaccines by the end of the year, said Moncef Slaoui, the program's science adviser.

"There's a learning curve in the system," he said. "As vaccines become more available in pharmacies, it will become more straightforward. I expect that things will move quickly. What we should be looking at is the rate of acceleration over the coming weeks."

Bumps in vaccine delivery expected

The first COVID-19 vaccine was authorized for use only 20 days ago, said Dr. Nancy Messonnier, medical director of the National Center for Immunization and Respiratory Diseases. 

"I would say how far we've come is an extraordinary achievement," she said. "However, we have always expected and prepared for bumps in the road." 

One of the bumps is the need to train people to prepare and administer two vaccines that require special storage and handling, especially the Pfizer vaccine, which must be stored at minus 94 degrees and reconstituted before it can be administered.

That training couldn't begin until the Food and Drug Administration issued the emergency-use authorization for the vaccine, said John Grabenstein, editor for the Immunization Action Coalition and former director of the U.S. Department of Defense military immunization program.

"As more and more people are trained and can put shots in arms, the daily achievement will rise, and so the gap should fall," he said. 

In addition, state and local health systems have been waiting for federal money to support what will be the largest mass vaccination program in the nation's history. 

"This doesn't happen overnight; it's not direct deposit," Grabenstein said. "They don't have the funding to pay for overtime or extra staff yet." 

The coronavirus relief and spending package President Donald Trump signed Sunday includes more than $8 billion for states for vaccine distribution, but the money will take time to get to states.

"We're reviewing the funds right now and the suggested activities from Congress. And we're going to move those funds out to the states where they're needed as soon as possible," said Dr. Henry Walke, the COVID-19 incident manager for the Centers for Disease Control and Prevention. 

Hospitals are under strain

Hospitals, which are vaccinating the bulk of front-line health care workers, are under tremendous strain as the winter surge of COVID-19 cases engulfs them. 

"We're launching a vaccine campaign in the midst of a pandemic surge after a year that's drained and strained health care providers and public health departments. And we're launching a vaccine campaign during the winter holidays," Messonnier said.

Hospitals also have to stagger staff vaccinations, spreading them out so not everyone in a department is vaccinated on the same day. Because a certain percentage of people getting the vaccines feel sick for a day or two afterward, they want to make sure a large number of staff are not all out sick on the same day, said Claire Hannan, executive director of the Association of Immunization Managers.

Long-term-care stockpiling

Another complexity is a requirement from the federal Pharmacy Partnership for Long-Term Care Program. It sends vaccination teams from Walgreens, CVS and Managed Health Care Associates into long-term-care facilities to vaccinate residents and staff with the aim of vaccinating large numbers of people quickly and efficiently. 

To make sure there's enough vaccine for one of those visits, the rules require states taking part to set aside enough vaccine from their federal allocation to ensure everyone in a facility can get vaccinated at once.

"They want to be sure that there was enough vaccine available so that when they entered the facility, they had enough for everybody in the facility that wanted vaccine," Messonnier said. 

States taking part in the program have to allocate at least 50% of the vaccine needed and transfer those doses to the program at least one week before a vaccination clinic is held at a given facility to make sure there will be enough on hand.

"Especially this week, that perhaps accounts for some of these discrepancies," she said.

Vaccinating in long-term-care facilities began last week in 13 states and will be in all states by the first week in January, said Claire Hannan, executive director of the Association of Immunization Managers.

It will take time for the doses allocated to this program to show up in the “administered” column, she said.

In many ways, this phase of vaccinations – to health care workers and people in long-term-care facilities – is the easy part, Hannan said.

"Where we are really going to see the lack of resources have an impact is in the next several weeks as we try to vaccinate essential workers and those over 65 and those with underlying conditions," she said. 

Especially as states open up vaccination to people 65 and older, as have Florida and Texas, supply will not meet demand for weeks, if not months. States need to have systems in place to handle scheduling and vaccinate with proper social distancing – not an easy task.

Florida is experiencing that high demand as seniors wait in line sometimes overnight and others deal with crashing appointment software, depending on how their local county has decided to organize vaccination clinics.

“The state recognizes the high demand for the vaccine and we will continue to work with county health departments and hospitals to help them prioritize vaccinations as we continue to receive additional shipments from the federal government,” Meredith Beatrice, a communications director in Gov. Ron DeSantis' office, said in an email to USA TODAY.

"States have not had sufficient time or resources to set these systems up, so there will be hiccups. But again I go back to the bottom line – every day that vaccine is going into arms is a success," Hannan said. 

Slide 1 of 7: Lou Lazzaro fron Bonita Springs waits in line in the early morning hours of Dec. 30, 2020 at Lakes Park Regional Library in Fort Myers, Fla. to receive the COVID-19 vaccine. He said the experience of waiting has been peaceful and quiet. He tried to get the vaccine a day earlier in Bonita Springs but left because of the disorganization. He feels the vaccine will alow him to have a some normalcy back. "it's been frustrating," he said. "Hopefully we are turning a corner."
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1/7 SLIDES © Andrew West, The News-Press
Lou Lazzaro fron Bonita Springs waits in line in the early morning hours of Dec. 30, 2020 at Lakes Park Regional Library in Fort Myers, Fla. to receive the COVID-19 vaccine. He said the experience of waiting has been peaceful and quiet. He tried to get the vaccine a day earlier in Bonita Springs but left because of the disorganization. He feels the vaccine will alow him to have a some normalcy back. "it's been frustrating," he said. "Hopefully we are turning a corner."

This article originally appeared on USA TODAY: Getting COVID-19 vaccine into the arms of Americans is off to a slow start; why the holdup?

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