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Long way to go on vaccines, and short on supply

If you remember those car trips when someone invariably asks, “Are we there yet? Are we there yet?”, then you likely know the answer to the question about the COVID-19 vaccine: “Can I get it yet?”

And though state health officials aren’t quite giving the same answer, they aren’t exactly providing an unequivocal yes, either.

Dr. Danny Avula, new leader of the state’s vaccine rollout, said the federal government had strongly hinted that a large number of secondary vaccine reserves would be released to states, and he had been getting consistent messages from the federal government that Virginia would receive extra doses that could then be used to expand providing vaccine doses to those aged 65 and older, and those 16 to 64 with underlying conditions.

“In this week’s sample, we had over 300,000 dose requests, yet only 106,000 doses to allocate,” Avula said during a Jan. 16 briefing. “And so, already we’ve seen a tremendous demand and a tremendous ability to receive vaccine, and to get it into vulnerable populations as quickly as possible.

Avula said the state is currently getting about 100,000 to 110,000 vaccine doses per week.

“It’s going to take us a long time to get to 25,000 doses a day, or 50,000 a day,” Avula said, “and then that may not even be possible with the supply that we’re being provided. But it’s also going to take a long time to get through all of the residents of Virginia.”

He said it was the first time that vaccine demand exceeded the state’s supply, and that it could be until April when production of the two-dose Pfizer-BioNTech and Moderna vaccines increase, and other vaccines receive emergency approval from the Food and Drug Administration.

“I don’t worry about our ability to get vaccine out,” Avula said. “I worry about our ability to draw vaccine down from the federal government if it’s just not there.”

Avula said 50,000 people per day need to be vaccinated for the state to get 80% of the state’s adults to reach herd immunity.

“I think all we can do is continue to build the infrastructure vehicle for vaccine delivery,” Avula said.

In building that vehicle, as Avula put it, the state is expanding the number of medical practices that have gone through the CDC approval process. He said more pharmacies and health systems have pledged their support to do large-scale vaccinations. He said there are also plans for mass vaccination sites around the state to perform about 1,000 to 2,000 vaccinations per day at each one. It would also deploy the National Guard in this effort.

State Secretary of Health and Human Services Dr. Daniel Carey, testifying before the House of Delegates’ Health, Welfare and Institutions Committee Jan. 19, outlined the state’s priority groups for the vaccine, and showed a graphic indicating there would be 12 mass vaccination sites in different regions of the state, including two in South Hampton Roads, when there is ample vaccine supply. The slide he presented to the committee indicates that the state would need 15 people to administer vaccines and 25 as support staff at each location.

Carey outlined a goal of administering 25,000 vaccinations per day by Feb. 14 and said the state has the infrastructure in place to vaccinate 50,000 people per day by April 1. He said the state would pursue a dual-path strategy of administering vaccines through local health districts and through large vaccination sites in Phase 1B and beyond. It would also continue to have pharmacy partners, general providers and hospital systems continue to administer vaccines.

Carey said the state must reach its 50,000-vaccinations-per-day target to have everyone vaccinated by the end of the summer. He said the current rate of vaccinations just to get through Phase 1B would take through the end of 2021. President-elect Joe Biden, who will be inaugurated Wednesday, has pledged 100 million vaccinations in the first 100 days of his administration.

“The federal government has indicated that it will have it,” Carey said. “But they will not have it before March at the earliest.”

Carey said over the weekend, he received guarantees from Army Gen. Gustave Perna, chief operating officer of Operation Warp Speed, that “we will indeed have second doses guaranteed not from a stockpile, but from production, and that those will go to their proper places at the three- or four-week proper interval depending on whether it’s the Pfizer or Moderna vaccine.”

Avula said the other concern is having accurate data on vaccine distribution and administration. Currently, state health officials say there is a lag time between receiving the data, and when it becomes public. He said local health districts would focus on their most vulnerable populations.

“In the future, our data, and our ability to get more vaccine into Virginians, is really going to be dependent on having clear, accurate data,” Avula said, “and knowing exactly how much vaccine has been used.”

Avula said a new team of 10 people will begin working this week to work with providers to ensure data is entered correctly. He also said he expected most of the state’s health districts to move into Phase 1B by the end of the week.

In the United States, more than 31 million vaccines have been distributed, with nearly 12.3 million administered and about 1.6 million receiving two doses, as is needed for the Pfizer-BioNTech and Moderna vaccines.

The Centers for Disease Control and Prevention ranks Virginia 43rd out of 50 states and Washington, D.C., in the number of vaccine doses administered, with 2,861 per 100,000 people. Overall, 304,562 state residents have received at least one dose of the vaccine as of Jan. 19, with 36,826 people being fully vaccinated. In Suffolk, there have been 1,834 vaccine doses administered, with 61 people fully vaccinated. Isle of Wight County has had 842 vaccine doses administered, with 41 fully vaccinated. In Southampton County, 277 doses have been administered, with three people fully vaccinated, while in Franklin, 324 vaccine doses have been given, but just five people have been fully vaccinated.

Riverside Health System noted that “while (it is) eager to vaccinate all Riverside Primary Care patients, the supply on hand today is very limited. With that in mind, Riverside has made the decision to start the 1B vaccination process with primary care patients ages 75 and older. As additional doses become available to us, we will work to administer them as quickly as possible as allowed by the Virginia Department of Health and the federal government.”

It said Jan. 14, that it had distributed more than 9,000 vaccines to nurses, doctors and other healthcare workers in and out of its health system, and has distributed about 75% of its state-provided doses.

Gov. Ralph Northam, during his State of the Commonwealth address Jan. 13, announced that state residents aged 65 and older would move into Phase 1B of the state’s vaccination plan and would begin to be able to get the vaccine.

Riverside said it is working with other health systems and the Virginia Department of Health to develop detailed plans for an expanded rollout of the vaccine to those 65 and up, along with other essential workers “once adequate supplies of vaccines become available.”

Riverside said its goal is to vaccinate 5,000 people per week if it has enough of the vaccine.

Sentara Healthcare noted it has been getting “many calls and messages” from people wanting to know when the vaccine will be available to them. It does not cite any shortage of vaccine, but did note that its vaccine allocation “is managed by the state and distribution is under the direction of public health.” It said that with many health care workers yet to receive the vaccine, Sentara’s focus is on Phase 1A.

At a news briefing Jan. 14, Northam and state health officials said those 65 and under with underlying medical conditions would also be moved into Phase 1B of the state’s vaccination plan.

But Virginia made the decision to accelerate the vaccination program without knowing, unlike what federal officials had said previously, that there was no federal stockpile of additional vaccines available, even after Health and Human Services Secretary Alex Azar had told states that the Trump administration would begin distributing those doses to states immediately.