With release of COVID-19 vaccine imminent, distribution plan to be tested

Left to right, Don Thompson, Jeff Reeves and Kevin Brooks wipe down dry ice machines on Wednesday at the headquarters of TOMCO2 Systems, a dry ice equipment manufacturer in Loganville, Georgia. The company is gearing up for a potential increase in demand due to the distribution of the COVID-19 vaccine. (CHRISTINA MATACOTTA FOR THE ATLANTA JOURNAL-CONSTITUTION)

Credit: Christina Matacotta

Credit: Christina Matacotta

Left to right, Don Thompson, Jeff Reeves and Kevin Brooks wipe down dry ice machines on Wednesday at the headquarters of TOMCO2 Systems, a dry ice equipment manufacturer in Loganville, Georgia. The company is gearing up for a potential increase in demand due to the distribution of the COVID-19 vaccine. (CHRISTINA MATACOTTA FOR THE ATLANTA JOURNAL-CONSTITUTION)

Any day now, weary health care workers in medical facilities throughout Georgia will be lining up to receive the first doses of a COVID-19 vaccine that’s expected to put America on a path to normalcy.

At the same time, residents and workers will be rolling up their sleeves in the state’s nursing homes, which have borne the brunt of Georgia’s deaths during the coronavirus pandemic but are far from alone in the suffering.

What seemed impossible back in the spring is quickly becoming reality: COVID-19 vaccines are being developed, tested and released in record time. But the vaccine challenges are hardly over.

In Georgia, success in getting the vaccine into the arms of residents largely will rely on a patchwork of preparations. That means that, even if the vaccine is ready to go, some facilities won’t be.

Though state officials and health care systems have been planning for this moment for months, they’ve been hindered by not knowing the specifics — which vaccine would be approved; how many doses would be available; what kind of cold storage would be needed; whether federal funds will be available for them to hire people to help with the tasks.

Facilities with more money and resources to plan likely will fare better than those without, at least initially.

Marl Halbrook, operations manager at the pharmacy at Phoebe Putney Health System's main hospital campus in Albany, with one of the ultra-cold freezers purchased for the Pfizer vaccine. (Photo courtesy of Phoebe Putney Health System)

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First doses to be just a trickle

A vast network of medical workers, truckers, ice makers, pharmacy workers and state officials is about to launch the critical and complex task of getting COVID-19 vaccines to Georgians.

Thursday, a U.S. government advisory panel formally recommended widespread use of Pfizer’s COVID-19 vaccine, which has a spectacular 95% effectiveness rate.

Next to be considered is Moderna’s vaccine, also shown to be 95% effective in clinical trials. It is set to undergo a final review by the FDA vaccine advisory panel Thursday.

The speed of the vaccines’ development is unprecedented. Typically, it takes years, often more than a decade. The four-year process of creating a mumps vaccine, from viral samples to licensing, is said to be the quickest development in history.

“The fact that we’re actually talking about getting a vaccine into people’s arms in December of 2020 is remarkable,” said Dr. Phillip Coule, chief medical officer at Augusta University Health System.

Georgia will be following federal recommendations to first vaccinate health care workers and residents of long-term care facilities. Then, a federal advisory group will make recommendations on which groups to prioritize in the next phases, which will likely include essential workers, such as police officers and transit workers, and adults over 65 with medical conditions that would put them at high risk of severe COVID-19 disease, such as diabetes and obesity.

The first doses will be extremely limited.

The state’s plan says it will prioritize providers and long-term care centers with high volumes and with the capacity to vaccinate. That will favor large hospital systems, some of which created task forces that have already worked for months to plan.

Possibly left out, at least in the initial distributions, will be many small hospitals and other types of providers that lack the workers and resources needed to carry out the complex logistics of mass vaccination. That may be one reason why 2,000 health care providers expressed interest in the state vaccination program, but only 300 have completed the enrollment packet so far.

Even some large systems could strain, though, to carry out the vaccinations. Across the board, the raging pandemic has filled hospital beds to capacity and stretched staffing thin.

An added complication is that not everyone will want to be among the first vaccinated. According to a late October poll by the American Nurses Association, only one-third of the 13,000 nurses surveyed said they would voluntarily take a vaccine, another third said they wouldn’t and the rest said they were unsure.

“Modern health care is facing an operational and ethical challenge that’s really unique in its history,” said Dr. Jon Lewin, CEO of Emory Healthcare. “We’re preparing for a long battle and to require the health care workforce to do things that it hasn’t done ever.”

Jen Kates, senior vice president and director of Global Health & HIV Policy at the Kaiser Family Foundation, said she was optimistic, especially about the effectiveness rates of the Pfizer and Moderna vaccines.

“This could really change the future for all of us,” said Kates. “But I’m also worried about the massive challenge and about access to the vaccine depending on where you live.”

One of the ultra-cold freezers purchased by Phoebe Putney Health System for the Pfizer vaccine. The vaccine must be stored at extremely low temperatures, about -70° C (-94° F) to maintain its integrity. (Photo courtesy of Phoebe Putney Health System)

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Planning for a shortage

While the Trump administration has given billions of dollars to companies developing vaccines, it has authorized very little federal money toward distributing doses and vaccinating people.

Only $200 million has been sent to state, territorial and local jurisdictions for vaccine preparedness, though it is estimated that at least $6 billion is needed, according to Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention.

Georgia’s cut of the federal money distributed so far is $6.2 million, or about 58 cents per resident, according to the Kaiser Family Foundation. These funds are needed to help pay for staffing to administer the vaccine, data information system upgrades, cold supply chain management, vaccination campaigns and arranging for additional vaccination sites.

“Modern health care is facing an operational and ethical challenge that's really unique in its history. We're preparing for a long battle and to require the health care workforce to do things that it hasn't done ever."

- Dr. Jon Lewin, CEO of Emory Healthcare

While the federal government will get the vaccine to states, it’s left to them to work out the logistics of vaccination plans. Georgia pushed down many responsibilities to regional health districts, and then to hospitals, clinics, pharmacies and other health care providers.

Also left to many local providers will be prioritizing which people within their facilities are first in line for the limited vaccine supplies. Even for the groups given top priority, there won’t be enough doses for everyone. That’s even after the state makes its decisions about which facilities to supply first.

The Trump administration last summer announced that 300 million vaccine doses would be available to Americans by January; in fact, the number will be a fraction of that. On Wednesday, the federal government said it will distribute about 2.9 million doses for the first round this month, and about 2.9 million for the second round. Each state will get a pro rata share based on its adult population.

Georgia Public Health Commissioner Kathleen E. Toomey addressing reporters about the state's pandemic response at the Georgia Capitol. Toomey says that it's unclear how many doses of the Pfizer vaccine the state will get. “The whole process is changing literally daily as we’re getting more and more information from the federal government,” she says. (Photo by Steve Schaefer for the AJC)

Credit: Steve Schaefer

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Credit: Steve Schaefer

Each state has been told how many doses it can expect to receive, and almost all states have disclosed that number. Not Georgia. Department of Public Health officials were vague, saying it would be “hundreds of thousands” or maybe more. DPH Commissioner Kathleen Toomey told reporters, “the whole process is changing literally daily as we’re getting more and more information from the federal government.”

The only thing she knows, she said, is that the first batches won’t be enough to vaccinate all Georgia’s health care workers. “Nor will it be enough to cover the long-term care facilities,” she said. “We know that.”

Long-term care centers across Georgia have about 50,000 residents, and more than 58,000 people work in the facilities. The Georgia Health Care Association, which represents the senior care industry, as of Wednesday was still awaiting word on what percentage of the first wave of doses senior care homes would get.

Out of the state’s 141,000 nurses, 22,000 doctors and tens of thousands of respiratory therapists and unlicensed health care staff, state officials and hospitals will have to decide which are most vulnerable — or most essential.

Emory Healthcare, for one, is on it.

“This could really change the future for all of us. But I'm also worried about the massive challenge and about access to the vaccine depending on where you live."

- Jen Kates, senior vice president and director of Global Health & HIV Policy at the Kaiser Family Foundation

The system, awash in expertise in public health emergencies, has been preparing for months.

Emory already had ultra-cold freezers, the type required to store Pfizer’s vaccine at distribution hubs. It bought more, though. And then Emory bought smaller ones, too, that its workers can drive anywhere.

A team, including one of the nation’s top bioethicists, has worked on criteria for choosing who will get initial doses. Lewin has “a list as long as my arm” of types of workers who should get a slot in the line, including janitors who clean surfaces that patients touch and the reception staff at the ER door.

Robust planning has gone on at other big hospital systems, too, including at Piedmont Healthcare, which has purchased six ultra-cold freezers for the vaccine, and Phoebe Putney Health System, a smaller regional system in southwest Georgia that has invested in three ultra-cold freezers, each costing about $10,000.

“People are primed and ready. The providers are ready to go,” Toomey said.

Charles McFall, pictured on the right, runs Trinity EMS Transport, an ambulance company based in Monroe. His workers transport patients who may have the virus, and three of the paramedics have been infected. Two were hospitalized. (Alyssa Pointer / alyssa.pointer@ajc.com)

Credit: Alyssa Pointer

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Credit: Alyssa Pointer

Not everyone is.

“I’ve heard nothing,” said Charles McFall, director of operations for Trinity EMS Transport, a small ambulance company that’s based in Monroe and operates between Atlanta and Athens. The company carries non-emergency patients, like hospital transfers or patients going to dialysis.

He doesn’t know whether his workers will be eligible for the early vaccinations, much less where they would go for the shots.

Three of his paramedics have caught the virus; all recovered, though two had to be hospitalized. “Nurses get all the love, and we are the redheaded stepchildren,” McFall joked.

“That’s a tough thing for the state, right? You want to put it where it’s most effective. Statistically, we roll the dice on whether or not we’re going to be exposed.”

Larry Richardson runs AmeriPro EMS and has about 200 employees in Georgia. His employees operate in metro Atlanta and come in contact with COVID-19 all the time, he said, and a number have contracted the disease. He’s heard nothing solid about how soon his workers might be vaccinated, though on Thursday the state emailed his company about becoming a provider.

Cynthia Torrez pre-screens a patient for COVID-19 symptoms and gives her hand sanitizer before allowing her into Good Samaritan Health Center in Northwest Atlanta.  (Ben Gray for the AJC)

Credit: Ben Gray

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Credit: Ben Gray

Breanna Lathrop, chief operating officer of Good Samaritan Health Center in Atlanta, is also waiting for information about the vaccines.

Good Samaritan has been pushed to the limit this year trying to provide routine care for needy patients and care for those infected with COVID-19, she said. The clinic will need considerable help with coordination and staffing to carry out vaccinations, she said.

“We are ready and willing to participate,” Lathrop said. “But, as a nonprofit clinic that is still responding very much to COVID-19 testing and patient care, we’re still waiting on what support is coming to enable us to add vaccinations, on top of all that.”

Reaching the vulnerable

The state also has a massive communication challenge before it.

When it comes to the first phase of vaccination, hospitals will vaccinate their own workers, and pharmacy teams will bring doses to most long-term care facilities.

When there’s enough for the broader population, though, most Georgians will have to come to the vaccine rather than having it come to them.

DPH says it plans to lean heavily on Georgia’s county health offices. They have a lot of work to do to educate the public and to get them to make the vaccine a priority.

Some simply may be out of reach, without transportation, or not part of an organization that gets the information.

Dr. Pinar Keskinocak, director of Georgia Tech’s Center for Health and Humanitarian Systems, said the state will have a challenge making sure vulnerable populations have full access to the vaccine.

Many health experts and state leaders are worried that not enough dosages will go to Black and Hispanic communities in Georgia since they’ve been disproportionately impacted by the virus.

Georgia’s initial vaccination plan does propose involving community-based organizations in the distribution process, which experts say is important. Many opinion polls show African Americans and Hispanics are less likely to get vaccinated because of historical distrust of government vaccinations

“The information aspect, the financial aspect, the physical and geographic location, and so on — all of these multiple dimensions of access are going to be very, very important,” Keskinocak said.

“Simply counting the numbers — in terms of how many people we vaccinated in an area, or how many doses we shipped to a certain area — on paper it might look equitable. But, in practice, it might not be.”

The vaccine itself is to be free of charge, but providers are allowed to charge up to $21.93 to administer each dose. They must waive the fee if the patient “cannot afford” it.

The bright side

Two of the most crucial pieces of communication will involve ensuring that people get the second dose of their vaccine brand at the correct time and in tracking the health of people after their shots.

Looking for side effects is complicated because not every health problem that arises is a side effect of the vaccination.

This could also be a particular challenge for nursing homes. It will be up to the caregivers to monitor residents after they are vaccinated. Caregivers also will need to enter information about any adverse effects into the reporting system, yet another responsibility for facilities already short-staffed.

Coule, with Augusta University Health System, is among those optimistic that the state will get it right, despite the crash course.

“This is moving at an unprecedented speed and so that can create complications in terms of getting too far ahead of the planning publicly, given the other pieces that have to fall into place,” Coule said.

Georgia, though, for years has depended on robust vaccination efforts to reach tens of millions of Georgians, he said.

Dr. William Sewell III, chief medical information officer at Phoebe Putney Memorial Hospital in Albany, is hopeful, as well.

“We really don’t have an option but to pull this off,” said Sewell. “I think everyone understands some counties will not be as prepared as others, and you have to make moral and ethical decisions and there will be some fallout. And we will deal with it as it comes. We are all human beings, and we will make mistakes. But we will try to make as few as possible and learn from this.”

Staff writers Kelly Yamanouchi, Carrie Teegardin and Yamil Berard contributed to this article.