New York ready to go
Mass-vaccination plan has been in place since 9/11 terrorist attacks
New York and other states have for decades been planning for a mass vaccination under emergency response programs honed after the 9/11 attacks, which ignited fears of bioterrorism on American soil.
The long-established network of county-level response teams have identified “point of distribution sites” throughout their respective municipalities — from drive-thru fire departments to high schools and concert venues. But these plans have not been highlighted by Gov. Andrew M. Cuomo as he has leveled heavy criticism at the White House’s COVID-19 vaccination program, especially its ability to deliver vaccinations to communities of color.
The statewide distribution framework has received little or no acknowledgment from the governor, who on Friday again spoke of vaccine distribution only in the context of a federal plan that includes distributing vaccines to pharmacies. White House officials have countered that they will deliver the vaccines to pharmacies, as well as to any other distribution sites that a state tells them to, including hospitals and long-term care facilities.
“The private health facilities underserve the Black and brown and poor communities,” Cuomo said. “If the federal government just uses the private health facilities, it will be disproportionate and I believe illegal.”
On Oct. 30, after attending his first governors-only federal coronavirus task force briefing in nearly five months,
Cuomo declared the federal vaccination plan to be “deeply flawed.” He focused that criticism on the plan’s reliance on a “public-private” partnership in which pharmacies will play a key role in helping administer the COVID-19 vaccines.
“That is a very limited distribution mechanism,” Cuomo said. “They do not provide for a state to organize vaccination with state personnel on any scale.”
Cuomo added that “it could take one year to vaccinate the population using only a private sector network.”
But the governor has failed to note the detailed planning that is ongoing at the state and local level for a mass vaccination mobilization, and that pharmacists have for years been an integral part of that strategy. That reliance is driven, in part, by the fact that pharmacies are equipped with trained staff, refrigeration systems and software platforms that are needed to track the distribution.
Five years after the 2001 terror attacks, the New York City Department of Health and Mental Hygiene sought a uniform procedure to deal with a mass-casualty event, including a bioterror attack. All city-wide hospitals were directed to participate in a drill in which a small team of health professionals, including a pharmacist and two nurses, took part in a mass vaccination exercise.
According to a report in the Journal of the American Pharmacists Association, one five-person team was able to immunize 942 health care workers in a four-hour period. The drill indicated that in a 48-hour operation, a small team would be able to immunize 12,000 health care workers.
“By allowing pharmacists to expand their scope of practice, New York state will inevitably see a drastic improvement in its adult immunization rates for influenza and pneumococcal vaccinations through greater public awareness and expanded vaccine access,” the report noted.
The integral role pharmacists play in vaccination has been driven by a proliferation of pharmacies in the last 20 years,
including 2,869 licensed pharmacies in New York City’s five boroughs.
Still, it’s unclear how many of the state’s pharmacies will be authorized to distribute the COVID-19 vaccines. The state Department of Health on Thursday said it had received 894 “provider enrollment applications,” which are necessary to become authorized by the U.S. Department of Health and Human Services for vaccine distribution. But the state agency declined to say how many of those applications — which have been submitted by county health departments, hospitals and long-term care facilities — also included pharmacies.
Rensselaer County has submitted a plan to the state outlining a “public/ private” distribution of the vaccines similar to the one used to administer vaccines during the H1N1 outbreak in 2009. That year, the county also set up “points of distribution” sites; it has identified three locations that will be used to administer COVID-19 vaccines, with more possibly to be added.
Last week, the state Association of Counties set up an online meeting with DOH officials and county leaders to discuss New York’s vaccine distribution plans, which include mobilizing the points-of-distribution sites.
Loretta Santilli, director of DOH’S Office of Public Health, briefed county leaders on the state’s plan and noted that “it will be a state-driven, directed implementation response, but it will be all hands on deck. ... Gov. Cuomo’s charge is to put the best vaccination program in the nation out there.”
“We know that public opinion will be mixed, absolutely,” Santilli said. “The safety and efficacy
(of the vaccines), they’re concerned about that. And we also expect that misinformation will continue to be disseminated, and our public relations team will be really strong in making sure that we counteract that.”
Last month, U.S. Health and Human Services Secretary Alex M. Azar wrote a letter to Cuomo, in his role as head of the National Governors Association, warning that he was undermining public confidence in the vaccines by joining five other states that have created statelevel panels to review the Food and Drug Administration’s approval process. Cuomo’s public comments have included highlighting polls that show many Americans are wary of taking the vaccine; he has referred to the FDA’S work on the project as “reckless.”
“When governors express doubt about the integrity of the FDA ... they are feeding public fear and suspicion at a time when just the opposite is needed,” Azar wrote in the Oct. 30 letter.
Santilli told county leaders that “promoting that vaccine confidence will be really, really important. ... Something like positive news is very influential to the public.”
But Cuomo last week reaffirmed his position on the FDA’S approval process, saying: “People should have doubts about the approval process.”
“Black and brown communities do not have the national drug chains,” Cuomo claimed. He said President Donald J.
Trump “did this before, where he said national drug chains were going to (do) the COVID testing. Of the hundreds of the national drug chains, only a couple dozen were in Black and brown communities.”
Azar countered last week that pharmacies will make vaccination “as easy as getting a flu shot.”
“The vast majority of Americans live within five miles of a pharmacy, so vaccination in pharmacies is a huge piece of ensuring easy access to vaccines once they are authorized or approved and recommended for the general public,” he said.
But Cuomo’s health department leaders, and multiple county officials contacted for this story, have confirmed that their vaccine distribution plans are being readied for deployment under the program that relies on health care workers, emergency responders and a network of volunteer health and emergency services workers. Those teams are also mobilized in the New York City metropolitan area, where their training and ability to conduct mass vaccinations is considered the “gold standard,” according to a health official familiar with the training.
In Albany County, health and emergency services officials have for years been running drills and planning for a mass vaccination. Nearly every community in the county has a point of distribution site, including at least five in the city of Albany.
One of those sites is the Times Union Center, where the plan indicates that more than 38,000 people could be vaccinated in a 10-day period. That site would be equipped with 46 vaccinators who would administer the vaccine to roughly six people per hour.
The vaccination centers — which in many counties are set up at local health departments, schools, firehouses, churches and college campuses — also have detailed plans for staffing, including the number of volunteers who would be involved with processing, screening, medical treatment and security.
Cmdr. Brian Wood, head of the Albany County sheriff’s emergency operations unit, said for years they have been planning for a mass vaccination. In one training exercise, he said, a Central Avenue firehouse in Colonie was used to administer regular flu vaccines to the public.
Those receiving the vaccine “were able to drive in a back door and drive out the front door,” Wood said. “They never got out of their car. In that one they used the flu vaccine just to simulate a smallpox response. You gave your name, you showed your driver’s license, and you ... pulled up your sleeve and they gave you the flu vaccine, and you went about your business.”
Santilli, who was joined on the county leaders’ conference with state Health Commissioner Howard Zucker, said the point-of-distribution sites will be critical to the vaccination plan.
Those PODS, as they are called, will be especially important in reaching inner-city communities where residents may not have the medical infrastructure or might be reluctant to leave their communities to obtain a vaccination.
“How do we push those PODS into those neighborhoods that maybe do not have the access or maybe have a bit more hesitation?” she said.
The coronavirus vaccines come with unique challenges, including the fact that people will need to receive two dosages — roughly 21 to 28 days apart, depending on the type of vaccine. The volunteers and health care workers also will need to wear personal protective equipment, and the federal government is delivering those supplies as well as needles and kits used to administer the vaccines.
Santilli said the state already has a COVID-19 call center in operation and the software is in place to track intricate details of the vaccinations, including who has received it and the ability to notify individuals they must receive their second dosage.
The data system will ensure that people who receive one of at least two types of vaccines slated for distribution — one by Moderna and another by Pfizer — receive the same strain on their second vaccination.
The vaccine in development by Moderna, which according to initial findings is 95 percent effective, requires freezer and refrigeration storage, which are already required at pharmacies that administer children’s vaccines. The Pfizer vaccine, however, requires a “deep freeze” storage that will make it more challenging to distribute, especially in rural areas.
Officials noted the pandemic’s solution could be aided by an artifact of its devastation: The high rate of fatalities in New York in the early months of the viral onslaught prompted many sheriff’s departments and coroners to purchase freezer trucks for storing bodies as funeral homes became overwhelmed.
Those freezers, however, may now be used for cold storage of vaccines.
“We know that public opinion will be mixed, absolutely. The safety and efficacy (of the vaccines), they’re concerned about that. And we also expect that misinformation will continue to be disseminated, and our public relations team will be really strong in making sure that we counteract that.” — Loretta Santilli, director of DOH’S Office of Public Health