COVID-19 vaccinations ramp up as new shipments arrive
Norton Sound Health Corporation received a large shipment of Pfizer vaccines on Monday and expected a shipment of Moderna vaccines on Tuesday, for a total of about 1,600 doses. In response, NSHC has expanded eligibility in Nome and organized another round of vaccination teams in the villages.
In Nome, NSHC announced Tuesday that everyone aged 50 and older, along with “group two” essential workers and those with certain medical conditions, would now be eligible to sign up for first doses of vaccine online.
“Group two” essential workers include food service workers, construction workers, IT and communications workers, and more. The high-risk medical conditions include cancer, kidney disease and hearts disease, and people must have two or more of the conditions to be currently eligible.
Groups that have already been eligible, such as healthcare workers, Elders over 60 and “group one” essential workers, are still encouraged to sign up for a vaccine as soon as possible if they haven’t already. Full details on eligibility and how to sign up for a vaccine appointment can be found on the NSHC website.
NSHC Medical Director Dr. Mark Peterson also said that vaccination teams would be sent to most villages this week with new first doses of vaccine going to Savoonga, Gambell, Shishmaref, Unalakleet, White Mountain, Koyuk, Golovin, Elim and Shaktoolik. Teams were already sent to Stebbins, St. Michael and Brevig Mission earlier this week with second doses.
As of Monday, 1,791 first doses of vaccine had been administered in the region, along with 272 second doses. In Nome, NSHC was prioritizing second doses, which need to be given three weeks after the first dose for the Pfizer vaccine and four weeks after for Moderna.
Peterson said he was expecting the incoming Moderna shipment to be smaller than the Pfizer one, although they wouldn’t know the breakdown, or even exactly how many doses the shipments would
contain, until they arrived. “We don’t get necessarily what we ask for, we get what they can give,” he said. Moderna vaccine is better for remote villages because it can last in the refrigerator for up to 30 days, instead of just five days for the Pfizer vaccine, but the Pfizer vaccine has been in production longer and is currently more readily available.
Originally, the plan was to deliver the Pfizer vaccine in Nome, where it can stay frozen in Norton Sound Regional Hospital’s ultracold freezer and send the Moderna vaccine to the villages, where it could survive in clinic refrigerators for up to a month.
But the region’s first shipments were mostly Pfizer and less Moderna, “so we had to bring Pfizer to some of the villages, just to get the vaccine out there,” Dr. Peterson said. Some of the teams visiting villages this week will probably have Pfizer vaccine as well, although that depends on the size of the Moderna shipment.
The distribution of vaccine to villages is a challenge that requires daily schedule adjustments and a lot of coordination, but Dr. Peterson said it’s gone smoothly so far.
In the first round of village vaccinations, medical teams made up of physicians, pharmacists, midlevel providers and nurses flew into villages and administered vaccine out of the clinics. Teams also visited the homes of some Elders who couldn’t make it to the clinic.
They got first doses into the arms of about 10 percent of the population of each village, Dr. Peterson said. In this week’s visits they plan to deliver second doses and first doses to another 15 percent of people.
While the Food and Drug Administration recommends delivering the second dose exactly 21 or 28 days after the first one, depending on the vaccine, unique challenges like inclement weather and other logistical issues may make that impossible for some residents in outlying communities. Dr. Peterson said that they would do their best to deliver second doses as close to the two- or threeweek mark as possible, but that getting the second dose a few days late wouldn’t have a significant impact on the vaccine’s efficacy.
The first round prioritized critical infrastructure workers and Elders over the age of 65. “This time around when we go to the villages, we are expecting to open it up to everyone, if it’s Moderna, 18 and up, and if it’s Pfizer, down to age 16,” Dr. Peterson said, citing the minimum ages that the two vaccines have been approved for by the FDA. He added that the teams had “master lists” of people in the villages that needed shots, and would prioritize Elders and those with high-risk conditions, but that “depending on how many people choose to get it in each village, we’ll bring the supply and give it to whoever is willing to get it.”
Village health aides are also in the process of getting certified to give the vaccine, which will simplify the rollout process. “So in the villages that have Moderna, the health aides will take that over in a couple of weeks,” Dr. Peterson said.
The Pfizer vaccine, because of its short shelf life, will probably continue to be administered by traveling medical teams, he added, but he hoped that would become less necessary as the Moderna vaccine became more available.
The new shipment will also help spur more shots in Nome, where vaccine is still available but mostly for people who already got their first dose. “We have just a tiny supply of first dose vaccine, but we have enough second dose vaccine to vaccinate everybody that needs the second dose,” Peterson said. “When this new supply of vaccines comes, we expect to be able to open up the groups further from what we have currently,” he added.
A major advantage for Nome has been its ultracold freezer, which can store both Pfizer and Moderna vaccines at minus 94°F for months at a time. That means that the state can send Nome whole boxes of vaccine at a time, instead of sending smaller amounts for immediate delivery. “That’s been a huge advantage to the organizations that have one,” Dr. Peterson said.
As far as uptake – the proportion of eligible people who have chosen to get the vaccine – Dr. Peterson said it was too early to tell. “We’ve just rolled this out and put so much time and energy into getting the vaccine into people,” he said, “We just haven’t had time yet to sit back and look at the statistics.”
But he said those statistics would be important down the line, since a major hurdle to large-scale vaccination is convincing people who are skeptical or otherwise unwilling to take the vaccine. Both the Pfizer and Moderna vaccines have been shown to be safe and effective in clinic trials, and there are currently no credible studies demonstrating otherwise.
To speed up rollout, Presidentelect Joseph Biden has announced that when he takes office on January 20, he will release all available vaccine doses instead of holding second doses in reserve, which has been the federal government’s strategy up until now. The new tactic is already being implemented in the United Kingdom, and aims to get vaccine out sooner and save more lives. Assuming that vaccine production continues to increase, the assumption is that there’s no reason to hoard doses that could be going into people’s arms.
Critics, however, argue that the plan could backfire if a disruption in the supply chain results in a decrease in availability down the line, meaning that some people would be unable to get their second dose on time. Dr. Peterson said he didn’t think the decision would affect the region, though, because the state of Alaska has guaranteed that regional health organizations will get their second doses on time, regardless of what the federal government does.
He urged everyone in villages to contact their village clinic to find out exactly when vaccines are being given and schedule an appointment.
“We hope everybody is excited about getting this pandemic behind us,” he said. “The way to do that is to get vaccinated, and I would strongly encourage everyone to get vaccinated as soon as possible when it becomes available to you.”