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Alabama plans to vaccinate long-term care patients and frontline healthcare workers in the earliest phase of COVID-19 vaccination, if the CDC approves the changes this week.
But a vaccine will likely not be available to the majority of Alabamians until June.
“There isn’t enough (of vaccine) right now, and we’re hoping people can be patient,” said Dr Scott Harris, head of public health.
“There is so much demand right now.”
He said states are at the mercy of the domestic manufacturing process and, given the deployment process so far, the general population could have access to a vaccine as early as this summer.
Alabama is expected to receive about 40,950 initial doses of Pfizer vaccine by mid-December, enough to have about 20,000 people immunized with the two required doses.
Pending emergency vaccine clearance by the FDA, these vaccines will be delivered to eight hospitals equipped with ultra-cold freezers that can store the vaccine at -70 degrees Celsius.
The state plans to offer vaccines in three phases. The first phase includes health workers dealing with COVID-19. It can now be expanded to include patients and staff in long-term care facilities such as nursing homes.
“Healthcare workers have been disproportionately affected by this virus because they are on the front line caring for all sick people,” said Dr David Kimberlin, pediatric infectious disease specialist at UAB and Children’s of Alabama.
“If all of your healthcare professionals are sick or dead, you don’t have anyone to take care of anyone.”
The second phase of distribution includes essential workers and members of the general public at high risk of COVID-19 due to age or pre-existing conditions.
The third phase will aim to reach the general public.
A significant unknown is the number of people willing to be vaccinated next year, and Alabama faces a huge logistical challenge in vaccine distribution, especially in rural parts of the state.
For the first phase, health officials had hoped to receive enough vaccines this month to immunize all of the estimated 300,000 state health workers ready to be vaccinated. They lowered their expectations after federal officials said they expected more than 100,000 vaccinations.
State officials learned last week that the number of vaccines arriving in Alabama on an initial shipment would be reduced to about 40,950.
“It’s less than 10 percent than we thought a few months ago,” Harris said.
Health officials are looking beyond Pfizer in hopes that other vaccine perspectives will allow for greater distribution flexibility.
Moderna’s vaccine, which is 94% effective, can be refrigerated at higher temperatures and is on line for FDA approval this month. Other vaccines that can be stored at higher temperatures are in the early stages of development.
In the meantime, ADHD may be grappling with the distribution of vaccines to long-term care facilities.
On Tuesday, the CDC’s Advisory Committee on Immunization Practices recommended elevating long-term care patients to a high priority level. CDC director Robert Redfield will decide whether or not to approve the change.
Dr Kimberlin, who liaises with the CDC’s immunization group for the American Academy of Pediatrics, said he believes immunizing residents and long-term care staff is the right choice.
“The risk is so high in this group that it warrants the recommendation that they be among the very first Americans to receive the vaccine,” he said.
As of November 26, patients and staff in long-term care facilities accounted for 6% of cases and 40% of deaths nationwide from COVID-19 this year, according to the Kaiser Family Foundation.
The CDC’s recommendations, if adopted, could represent another last-minute logistical challenge for the early phase of vaccine deployment in Alabama.
“States are not required to accept the recommendation, but I think any of them will,” said Harris.
Alabama Nursing Home Association spokesperson John Matson said the recommendation was a positive step, but his team is awaiting more details on how and when the vaccine could be transported to nursing homes.
“We certainly hope that the vaccine is the answer we were waiting for, that this is what can finally eradicate COVID-19,” he said.
“We have to wait for more details, both from the state and the federal government, before we know what to expect.”
Cold storage is a limiting factor for the distribution of vaccines in nursing homes, especially in rural parts of the state.
Each delivery from Pfizer includes nearly 1,000 vaccines, a large quantity given the need for ultra-cold freezer storage.
In the existing plan, eight hospitals will serve as distribution centers statewide.
“These hospitals are going to help us not only by starting to immunize their own staff, but also by vaccinating other healthcare workers in their service areas,” Harris said.
USA Health in Mobile is awaiting its first vaccine delivery. The hospital purchased two ultra-cold freezers this fall, said system chief medical officer Dr Michael Chang.
“A vaccine deployment of this magnitude, in a short time frame, with these kinds of storage requirements and so on, has never, to my knowledge, been attempted before. These are truly unprecedented times, ”he said.
Matson, with the state’s nursing homes association, says it’s not clear how many patients at Alabama nursing homes will volunteer for the vaccine. He says there are a lot of questions like this to come, such as what to do if residents can’t consent to a vaccine.
“This is part of what we still have to work on, is it what it looks like if someone can’t make that decision, who makes that decision on their behalf?”
And then there is the concern that the available vaccines have not been tested specifically on nursing home populations.
Dr Kimberlin, the CDC panel liaison, says that despite the lack of immunization data for long-term care populations, overall it’s worth the risk.
“They’re the ones who die,” he said. “If we have a product, a vaccine, that can mitigate that impact, then it’s the right thing to do ethically.”
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