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Vaccine shortages force shift in distribution strategy

With just 105,000 doses per week of the COVID-19 vaccine available in Virginia for at least the next four weeks, the state health department will begin using an allocation formula based on a locality’s population and its ability to administer it.

Dr. Danny Avula, the state’s new vaccine coordinator, said as of this week and going forward, local health districts will begin receiving their allotted vaccine supply based on their population, due to shortages in supply from the federal government of the Pfizer-BioNTech and the Moderna vaccines.

Based on July 2019 population estimates from the U.S. Census Bureau, the Western Tidewater Health District, with about 147,815 people from its four localities — Suffolk, Franklin, Isle of Wight County and Southampton County — it would receive about 1,785 doses per week.

However, vaccine supplies, according to Dr. Danny Avula, the new vaccine coordinator, are not expected to increase before March.

“I think the challenge of this is, when you’re only getting a couple thousand new doses a week to be distributed between hospitals, health systems, health departments, providers and pharmacies,” Avula said, “how do you do that in a way that even comes close to meeting demand? And the answer is you don’t. You can’t.

“And understandably, that has led to a great deal of confusion and frustration on the part of our public, who says, hey, I’m in (Phase) 1B. Why can’t I find a place to get vaccinated? So really the approach that health departments and partners are taking on the ground, is to provide some capacity each week for the 65 and up and underlying condition population.”

The state had been able to provide enough vaccines to meet the demand until last week, which necessitated the change in allocation. At that point, the state received 300,000 dose requests for just 105,000 total doses available.

Avula said the change to a population-based allocation gives local health districts some stability in scheduling vaccines for their residents.

Still, expect it to take months before those in Phase 1B who want to get a vaccination will receive one.

“Without a significant change in the supply of vaccine, we’re looking at two to three months to work through this population who wants to be vaccinated,” Avula said of people in Phase 1B (http://bit.ly/Phase1Bvaccine).

Avula said the infrastructure in place will allow the state to ramp up to 50,000 vaccinations per day when the supply meets the demand, noting about 2,000 different provider groups who have been approved as vaccinators and the roughly 400 pharmacies across the state approved to provide vaccinations. Avula has said the state needs to vaccinate that amount to achieve herd immunity by vaccinating 70% to 80% of adults by the end of the year.

“I don’t have any concerns about us being able to get to 50,000 doses a day, except that we

don’t have the vaccine,” Avula said.

Currently, the state is averaging 21,823 doses of COVID-19 vaccines administered each day, with 522,853 doses administered out of just over 1.1 million doses distributed.

In Western Tidewater, 5,501 doses have been administered, with 647 people fully vaccinated. That includes 3,251 doses administered in Suffolk (459 fully vaccinated), 1,464 in Isle of Wight County (153 fully vaccinated), 411 in Franklin (19 fully vaccinated) and 375 in Southampton County (16 fully vaccinated).

Avula said that once a health district receives its allocation, it works with local partners, health systems and other pharmacies to determine where the vaccine should go and how it should be prioritized.

Avula said allocating based on population would not likely be the permanent way the state distributes the vaccine, based on information it is receiving from the federal government.

“There’s so many people who fall into high-risk categories that we will likely continue to use the geographic driver to distribute for the next few weeks,” Avula said.

Citing the Biden Administration’s pledge of 100 million vaccinations in 100 days, “we just need to see that happen,” Avula said.

Some of it will happen with new COVID-19 vaccines, such as one-dose vaccines from Johnson & Johnson and AstraZeneca that have not yet received emergency use authorization from the Food and Drug Administration, and more could come online with increased production from Pfizer and Moderna, though there is no indication of that currently.

Avula also addressed the lag in vaccine data reporting, with 582,847 unaccounted-for doses, saying he is still trying to find where the vaccine is and how many doses are getting into arms. Through a federal partnership with CVS and Walgreens, Virginia, like every state except West Virginia, agreed to provide doses directly to them. About 226,000 have been set aside for them, but all haven’t been delivered.

The two pharmacy chains were supposed to administer vaccines to staff and residents at long-term care facilities, with about 47,000 that have been administered as of Jan. 22, according to state data. However, data from the two pharmacies indicate they have administered about 56,000 doses.

At long-term care facilities, vaccination delays are not due to supplies, Avula said. Anecdotally, he said about 70% to 80% of residents are receiving the vaccine, versus 30% to 40% of their staff. Avula said their goal is to have their allotted vaccine doses given by the end of the month.

“We’re going to start looking to other pharmacies to see if we can employ them to augment the efforts and reallocate some of that vaccine,” Avula said. “Alternatively, we’re considering other strategies to make sure that that vaccine that we have been allotted in Virginia under the federal pharmacy partnership, can get out to other individuals quickly so that we’re not just holding on to that vaccine.”

Avula did say that the state is being allocated “above and beyond” the 105,000 doses for those who have already received a first dose of one of the vaccines.

“I think it’s really important for everybody to understand that there is not a lot of new vaccine coming into the state,” Avula said. “And when you start to drill down to the county level or the health district level, that is a very limited amount of vaccine each week.”

That has forced health departments to figure out how to prioritize the vaccine. Avula said the state continues to prioritize Phase 1A people who have not yet received a first dose, with those people to be worked into clinics where there is availability.

This week, Avula outlined a goal of having local health departments, on their local websites, list upcoming vaccine opportunities, while managing expectations.

“With just several hundred, or in some cases, a couple of thousand doses coming to each community,” Avula said, “there are not going to be that many slots for people to get vaccinated.”