Myriad hurdles ahead for vaccine rollout

A major rollout for a novel coronavirus vaccine, once a distant glimmer, could materialize by spring. But that timeline gives the state a narrow and perhaps harrowing deadline to tackle the many challenges in dispensing it to New Mexicans.

Health officials say they must devise ways to distribute vaccines to far-flung rural areas, overcome cultural barriers and expand limited medical personnel already strained from the spiking COVID19 outbreak – all with a budget that is tighter because of decreased tax revenue during the pandemic.

Officials have expressed some confidence in surmounting the obstacles. They drafted a preliminary 60-page plan that describes the steps they are taking – and the work yet to be done – to implement an effective vaccine program.

They acknowledge in the plan that New Mexico has unique challenges when it comes statewide vaccination: 2.1 million people, almost half of them in the greater Albuquerque area. The rest are spread across 120,000 miles, mostly in rural areas with sparse health services and facilities.

“This is a historical populationwide immunization effort,” Aja Sanzone, a top infectious disease doctor leading the state’s COVID19 planning effort, told an interim legislative committee in late October. “Something like we’ve never seen before.”

Almost 20 percent of the state’s residents live in poverty, and 19 percent are 65 or older, putting them at higher risk for severe COVID-19 symptoms. The state also has 23 Native American pueblos, tribes and nations with sovereign governments and varying health care systems.

“It’s a lot to coordinate and plan logistically,” said state Rep. Debbie Armstrong (D-Albuquerque) who sits on the interim legislative Health and Human Services Committee. “It’s doable, but it’s something that must be figured out. There are still a lot of unknowns.”

Confronting challenges

The state submitted its vaccine distribution plan to the U.S. Centers for Disease Control and Prevention in October.

All states were required to craft plans by November in response to President Donald Trump’s prediction that a vaccine would become available before Election Day.

Trump’s forecast never came to pass, but it pushed states to begin planning over the summer for a vaccine rollout.

New Mexico formed a task force in August to research and help devise the plan. State officials met with hospitals, pharmacists, tribal representatives and various health care providers to identify problems and information gaps and how to fix them.

In the first phases, health care workers, first responders and residents in long-term care centers will be vaccinated. Next in line will be more vulnerable populations, such as older residents, those with underlying medical conditions and essential workers, especially in smaller communities.

Pfizer Inc. recently announced New Mexico would be one of four states taking part in a trial to deliver the company’s vaccine, which early tests indicate is 90 percent effective. The state was chosen because its vast rural areas and two dozen pueblos would make distribution more difficult. Overcoming the logistical hurdles during the trial phase will provide important information to New Mexico and other states for when they do their vaccine rollouts, Pfizer and New Mexico health officials said.

The pilot program initially was designed to be a mock-up, without an actual vaccine being delivered.

But now the state could receive a shipment of 17,500 doses from Pfizer by late December. The U.S. Food and Drug Administration would have to sign off on the company’s request for emergency use of the vaccine, which the agency has yet to approve for the market.

Those doses would be administered to health care workers, said Matt Nerzig, a spokesman for the Governor’s Office.

A prime challenge with the Pfizer vaccine is that it must be transported and stored at 94 degrees below zero or colder. That’s especially problematic in dispensing it to rural areas.

The plan calls for shipping the vaccine in dry ice containers to keep it at the correct temperature until it can be stored in ultra-cold freezers.

The state has set up the special freezers in different regions, Nerzig said.

During the Nov. 24 special session, the Legislature approved $10 million for the Department of Health to use for vaccine distribution and other coronavirus-related expenses.

Armstrong said the funding was a good start. She added temporary vaccination clinics will have to be set up, especially in rural areas where people might have to drive a long distance to the nearest town.

The state’s plan says that additional personnel must be recruited and trained to handle and dispense the vaccine. Health officials have said that medical personnel can’t do vaccination tasks on top of their regular jobs while the outbreak escalates.

“This is happening at a time when our hospitals and health care personnel are being pushed to the limit and beyond,” Nerzig said. “[It] creates additional strains on the system.”

Another difficulty in immunizing rural communities is that a vaccine requires more than one dose, so a person must make a long drive to a clinic twice, Armstrong said.

A centralizing tracking system must be set up for all people who are vaccinated, Armstrong said.

Other companies, including Moderna and AstraZeneca, also are developing vaccines. None of them, however, can be mixed and matched because they are all different, Armstrong said. If someone were to get a dose from Pfizer, they couldn’t then follow up with a dose from Moderna because both doses must come from the same manufacturer.

A logistical problem with Pfizer’s vaccine is that the company puts almost 1,000 doses in a package. That creates difficulties in delivering to a rural facility that might need only a fraction of that amount or doesn’t have the ability to vaccinate that many people in a short time.

Once opened, a package will keep the vaccine viable for five days, but the package cannot be opened more than twice a day, ProPublica reported. The vaccine also can survive five days in a refrigerator but can’t be refrozen.

A Pfizer spokesman told ProPublica the company was looking into smaller packages that would be shipped sometime in the first three months of 2021.

But as officials make these plans, they also worry about perhaps the most simple – and critical – question: Will enough people take the vaccine?

At the October meeting of the Legislature’s interim Health and Human Services Committee, officials said it would be important to convince enough people to get vaccinated. For New Mexico to reach immunity to the virus, at least 70 percent of state residents would need to take one. That might be difficult: About 58 percent of Americans said in October they’d get vaccinated as soon as possible, according to a Department of Health presentation. But that was down from 69 percent in mid-August.

Sanzone told legislators a public information campaign would be crucial to convincing enough people to take the vaccine.

Vaccinating tribal communities

The Navajo Nation and most other tribes in New Mexico will get their vaccines from the Indian Health Service instead of the state, Nerzig said.

The state Health Department will assist several pueblos that have opted to receive their vaccine from the state, and health officials will exchange information and coordinate with the Indian Health Service, he added.

On tribal lands, many people face the same hurdles to vaccination as in other rural areas, including poverty, poor internet access and long travel times to clinics, said Wendy Greyeyes, a Navajo professor of Native American studies at the University of New Mexico.

But there also can be a lack of trust, Greyeyes said.

“I believe some tribal members will be distrustful of the new vaccine,” she said. “The concerns are mainly a cautiousness of the Western medicines in these communities.”

Still, 100 Navajos volunteered recently for vaccine trials – an encouraging sign, Greyeyes said.

The biggest challenge will be getting the vaccine to the tribal communities in isolated areas, Greyeyes said. It will take cooperation between tribal and government leaders, she said.

Vaccination sites must be created because it’s not feasible to inoculate people at their homes in remote areas, Greyeyes said.

The state’s 23 tribal governments – many of which deal with communities pummeled by the virus both in the spring and fall – are key to making this work, she said.

“Their role is instrumental in planning the distribution of these vaccines to the communities,” she said.

This story first published in the Santa Fe New Mexican, a sibling publication of the Taos News.