COVID vaccines are coming soon to Stanislaus County. Who gets them first?
Nearly 4,000 doses of Pfizer and BioNTech COVID-19 vaccine have been allocated to Stanislaus County, but don’t roll up your sleeves just yet.
First in line are health care workers in acute care hospitals with the highest risk for exposure, consistent with the prioritization set by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices. Immunizations with this group could start locally as soon as next week; rollout to the general public likely will be well into next year.
Residents of long-term care facilities also are in the top priority group, designated as 1a, but the distribution to those facilities is through a different delivery system.
The ACIP statement noted that early protection of medical personnel is critical to preserve the health care workforce so they’re available to care for all patients, not only those with COVID-19.
“The allocation is based upon the state’s population of health care workers, as (defined) per the federal government,” said Dr. Julie Vaishampayan, Stanislaus County public health officer. “Then allocation from the state to the counties is based on their number of health care workers.”
The county will receive 3,900 doses of the state’s 327,000 doses expected in the first round of distribution, once a vaccine is authorized, which could happen as early as Thursday.
But, it’s not enough for all top priority health care workers in the county, as more than 5,000 of the 11,000 workers are in high-risk settings, including ICUs, emergency rooms or directly caring for known or suspected COVID-19 patients.
With so few doses available, when will the vaccines get to the general public?
Prioritization for immunizing everyone
Anticipating limited supply of vaccines initially, the ACIP working group set priority groups looking at:
- Science —data about who’s most at risk
- Ethics — balancing risks and benefits, and mitigating health inequities
- Implementation — the logistics for delivering vaccines
After the top priority group, phase 1b lists essential workers, which includes those in education, food and agriculture, and critical infrastructure such as first responders, utilities and public safety. Lowest in the top tier 1c group are adults with medical conditions and those 65 and older.
Phase 2 captures adults of all ages with increased risk, other HCWs and individuals who are homeless or living in detention centers, and Phase 3 includes healthy young adults and children (if a vaccine is authorized for this age group) and Phase 4 includes everyone who hasn’t already been immunized.
Although race and ethnicity are not designated in the priority groups, Blacks and Latinos/Hispanics are disproportionately represented in the health care and essential workforce and because of their occupations are included in the priority groups, according to the CDC.
Ongoing studies of the Pfizer vaccine include youth, 12 to 17. No data are available yet for younger children.
No timeline has been set for progressing through the phases, as the availability of vaccines is not yet known.
Vaccines are expected soon
On Thursday, the Pfizer vaccine will be reviewed by the Vaccine and Biologic Products Advisory Panel of the U.S. Food and Drug Administration for emergency use authorization, or EUA. Under an EUA, the FDA may allow use of unapproved medical products to diagnose, treat, or prevent serious or life-threatening diseases during an emergency, such as the pandemic.
Moderna’s application for an EUA will go before the advisory committee one week later.
Vaishampayan said the state and counties have been making preparations for months for a vaccine’s arrival.
“If a vaccine gets approved, we have to be ready,” said Vaishampayan. “This is part of our preparedness, so there is no delay in getting it out and into people’s arms.”
The Moderna and Pfizer vaccines contain similar active components, which are pieces of the virus’ genetic code; specifically, the messenger RNA. The mRNA triggers protective immunity against the virus’ spike protein blocking its ability to attach to human cells.
Both vaccines require two doses, though the formulations are different. Each manufacturer has stated publicly that their vaccines are well tolerated and have efficacy greater than 94% in adults.
Importantly, the storage requirements are markedly different.
The Pfizer vaccine must be stored at an ultra-cold temperature, mandating the need for a minus 70 degree Celsius freezer and special handling during transport and administration. The Moderna vaccine requires storage at minus 20 degrees Celsius, a typical refrigerator freezer temperature.
The first doses of the Pfizer vaccine were administered in the United Kingdom on Tuesday. Globally, more than 50 vaccine candidates are in the pipeline, with six leading the pack in the U.S.
Priority for long-term care facilities
Long-term care facility residents are high priority because they have several risk factors for COVID-19 complications and death, including advanced age, high rates of underlying medical conditions and living in congregate settings.
By mid-November, residents and staff in these facilities accounted for more than 100,000 deaths due to COVID-19 nationwide, according to the Kaiser Family Foundation. Local nursing homes have also been hard hit.
Nursing homes and similar care facilities could enroll in a government-sponsored pathway, the Pharmacy Partnership for Long-term Care Program, to receive vaccines.
CVS, Walgreens and a few managed-care pharmacies partnered with the CDC in the program to assume full responsibility for administering, monitoring and documenting COVID-19 vaccinations to residents in those institutions, free-of-charge to the facilities.
Facility staff can also be vaccinated as part of the program.
Distribution to local hospitals
The vaccines will be allocated to the five acute care hospitals in proportion to their number of HCWs. Doctors Medical Center and Memorial Medical Center are the two largest hospitals in the county, followed by Kaiser Modesto, Emanuel Medical Center and Oak Valley Hospital.
Vaishampayan said, “Public health tells them (local hospitals) the number of doses that can be requested and the hospitals then place their orders.” The orders are then sent to California Department of Public Health for approval.
Individual hospitals set the sub-prioritization for their own facility, with the highest risk workers going first.
Non-clinical health care workers, such as cleaning and laboratory staff, who are at high risk of exposure to infectious material may also be prioritized.
Both paid and unpaid workers are eligible for vaccinations.
A Kaiser Permanente Modesto spokesperson said in an email to The Bee, “Once a vaccine is available, we will offer it to those who meet the criteria in each phase of the prioritization process. We will be working closely with our employees who meet criteria.”
Krista Dean, spokesperson for Doctors Medical Center and Emanuel Medical Center, said in an email that they are anticipating initiation of immunizing their workforce in mid-December, also following the ACIP prioritization.
A Memorial Medical Center, part of Sutter Health, spokesperson said in an email they will offer vaccines to their health care workers using a staged approach, also prioritizing front line workers who care for COVID-19 patients and high-risk groups.
State distribution blueprint
California is expecting at least 2 million vaccine doses during subsequent distributions through December and into early next year, according to Dr. Mark Ghaly, Secretary of Health and Human Services, in Monday’s press conference.
The anticipated continued distribution of vaccines should help secure supplies for the needed second doses for top priority groups, and subsequent delivery to the general public.
Seven hospitals with ultra-cold freezers located throughout the state have been “pre-positioned” to store and promptly distribute COVID-19 vaccines, once they have an EUA. Valley Children’s in Madera is the only designated location in the Central Valley.
Gov. Gavin Newsom said in Monday’s press conference California’s goal is “safe and equitable vaccine distribution.”
CDPH has a Community Vaccine Advisory Committee to assist with the governor’s goal by advising about the plans for delivering vaccines equitably, including identifying and removing barriers for underserved communities.
What’s next?
The FDA advisory panel is expected to recommend approval of the EUA for Pfizer’s vaccine on Thursday. Pfizer vaccines are already positioned for shipping to distribution centers and if all proceeds are anticipated, immunization of HCWs in Stanislaus County could begin as early as next week.
Until vaccination is widespread, public health officials and representatives from Kaiser Permanente and DMC hospitals strongly recommended that everyone continue COVID-19 mitigation efforts, including wearing face coverings, social distancing, hand hygiene and staying home as much as possible.
Availability of the vaccines may be the beginning of the path to end of the pandemic, but the timeline is likely months long.
“Though this is the first round, we’ll continue allocating doses as we get vaccines,” said Vaishampayan.
This story was produced with financial support from The Stanislaus County Office of Education and the Stanislaus Community Foundation, along with the GroundTruth Project’s Report for America initiative. The Modesto Bee maintains full editorial control of this work.
To help fund The Bee’s children’s health and economic development reporters with Report for America, go to bitly.com/ModbeeRFA
This story was originally published December 9, 2020 at 11:07 AM.
