City plans for COVID-19 vaccine distribution

City plans for COVID-19 vaccine distribution
One of the Alexandria Health Department's COVID-19 testing sites. (Photo/Denise Dunbar)

By Cody Mello-Klein |

With the possibility of a COVID-19 vaccine being made publicly available in the coming months, the Alexandria Health Department is working on plans for distribution in the city.

Two viable COVID-19 vaccines are on a fast track through Food and Drug Administration testing and approval processes and could be distributed to states as soon as this month.

In November, the companies behind the two vaccines, Moderna and Pfizer, announced that each vaccine was about 95% effective against the coronavirus. Distribution of the vaccines, both of which require two doses spaced three to four weeks apart, is dependent on final testing and approval of emergency use by the FDA.

Dr. Stephen Haering, director of AHD, told City Council at a legislative meeting on Nov. 24 that the effectiveness of both vaccines is promising, given the flu vaccine administered every year is often only 30% to 40% effective.

“We know the influenza vaccine saves tens of thousands of lives a year and prevents hundreds of thousands of hospitalizations,” Haering said. “This is very promising that we’re having vaccines that, at least from the trials, look to be 95% effective.”

Although Haering said news of the vaccine could be the light at the end of the tunnel for many people, he acknowledged that “we really don’t know how long the tunnel is.” As a result, AHD has plans not only for vaccine distribution in the coming months but continued testing and contact tracing.

The Virginia Department of Health announced that the state is expecting an initial shipment of 480,000 doses by the end of December, assuming the FDA approves emergency use, according to Dr. Anne Gaddy, deputy director of AHD. The initial shipment will include only the first dose of the vaccine. It is unclear how many of the 480,000 doses will go to Alexandria.

The first phase of vaccine distribution in the city will likely focus on first responders, healthcare workers and residents and staff in long-term care facilities, according to the Centers for Disease Control and Prevention. This first phase will be a joint effort between AHD, hospitals, healthcare systems and pharmacy partners, according to Gaddy.

Pharmacies that have partnered through a federal program will help in vaccinating staff and residents at long-term care facilities, which have been especially hard hit by the pandemic.

The CDC has yet to determine who will be vaccinated in the next phase. However, Gaddy said it will likely include critical infrastructure workers – those in law enforcement, education, transportation and agriculture – and people who are at high risk of infection, such as those 65 and older.

During the second phase of distribution, AHD plans to assume a more significant role in vaccinating residents through public points of distribution, or PODs.

“We will be setting up distribution points in community sites that are accessible to those groups of people and be basically having clinics that are much like the flu clinics that we’ve run in the past,” Gaddy said.

Once the vaccine is available to the general public, the health department will continue its distribution process with an emphasis on uninsured and underinsured residents, according to Gaddy.

Dr. Basim Khan, executive director at community health care provider Neighborhood Health, has expressed interest in aiding with this effort, similarly to how Neighborhood Health collaborated with the city on community testing efforts throughout the pandemic.

“Our hope and our concern is that our patient population, which has been disproportionally impacted by the pandemic, gets access to a vaccine quickly,” Khan said.

AHD is currently conducting site analysis for PODs but plans on spacing sites throughout the city so that they are easily accessible as vaccine supply increases.

“All our staff will be working in PODs in one way or another,” Haering said. “In terms of having people on site with flow control and traffic control, registration, reviewing the forms, vaccinating and supporting the vaccinators, we’re looking at 90 people per POD, three or four PODs a week at a lot of different locations through the city.”

However, before AHD even receives the vaccine, health officials will need to overcome what Haering called “vaccine hesitancy.”

Certain community members are hesitant about the vaccine, its effectiveness and potential side effects. In some cases, this hesitancy is for good reason, Gaddy said.

“We realize that certain parts of the community, in particular people of color, have very valid historical reasons for distrusting the medical system and a vaccine coming out,” Gaddy said.

The Tuskegee experiments, which took place from 1932 to 1972, still loom large among communities of color. During these experiments, doctors recruited 600 Black men with syphilis for a study. The doctors gave the sick men placebos and did not treat them, then tracked their deteriorating health and, in some cases, deaths. Enslaved people were also regularly used to test new medicine or surgical techniques that resulted in death or permanent health issues.

That history has left a fog of distrust. A recent national study released by the COVID Collaborative, NAACP and UnidosUS found that only 14% of Black Americans trust that a vaccine will be safe, while only 18% trust it will be effective. Meanwhile, the same study found that 34% of Latinos polled trust it will be safe and 40% trust that it will be effective.

In anticipation of the vaccine, AHD staff are establishing open, transparent communication with communities of color and other people who are skeptical of the vaccine, Natalie Talis, population health manager at AHD, said. That involves acknowledging this disturbing history while also sharing concrete data about the pandemic.

“Part of that information sharing is also being really transparent and open about the data and the fact that COVID has disproportionally impacted communities of color, the same communities that might be more hesitant about the vaccine,” Talis said.

In response to concerns about potential side effects from the vaccine, Gaddy said any side effects, which may include body aches or fever, would be far less severe than the symptoms of the virus itself. Side effects occur with any vaccine and indi- cate that the body’s defense mechanisms are working.

“In general, those are expected to be more mild symptoms that should resolve in a day or two, as compared to COVID itself, which can cause extreme fatigue, prolonged fever, severe respiratory symptoms and put people in the hospital or even lead to death,” Gaddy said.

Another challenge for AHD’s vaccine distribution plans is staffing.

Staffing has been an ongoing challenge for AHD throughout the pandemic. AHD currently has about 140 full-time staff, according to Haering. However, city staff and members of the medical reserve corps will also be assisting with vaccine distribution.

Some staff will pivot from testing to the vaccine PODs, but Haering said he anticipates that increased demand – and steady supply – for testing will continue through the winter. AHD has been sending funding from the state health department to Neighborhood Health to allow the community health organization to increase its community testing operations as well.

The development and distribution of effective vaccines are significant steps toward a return to normalcy, but AHD staff urged residents to remain cautious, even after they’ve been vaccinated. Social distancing, handwashing and mask wearing will remain necessary as health professionals assess how long the vaccine’s protection lasts and how it works on a large scale.

“Everybody is very hopeful and excited because of the vaccines,” Gaddy said. “At the same time, we want to emphasize that the vaccine being available doesn’t mean that everybody’s going to be able to throw away their masks just yet and that the vaccine is really one component of people protecting themselves and their loved ones.”