The first shipment of COVID-19 vaccine arrived at the University of Washington Medical Center in Seattle this week.
Health care workers are first priority
COVID-19 vaccinations for front-line health care workers in Okanogan County could begin this week, after the vaccine begins arriving at health care institutions in the county approved to be among the first recipients of the vaccine in Washington.
“We don’t have an ETA, but are expecting them [vaccines] early this week,” John McReynolds, CEO of North Valley Hospital, said Monday (Dec. 14). “We will begin vaccinations in earnest the next day.”
North Valley Hospital in Tonasket, Family Health Centers, headquartered in Omak, and Three Rivers Hospital in Brewster have been approved by the Washington Department of Health (DOH) to receive and distribute the COVID-19 vaccine. Three Rivers was notified last Saturday (Dec. 12) that it was approved as a vaccine site. North Valley Hospital and Family Health Centers were notified the previous week.
A vaccine developed by U.S. company Pfizer and German company BioNTech got federal Food and Drug Administration (FDA) emergency use authorization last week and began shipping across the country from Pfizer’s facility in Michigan on Sunday (Dec. 13). The vaccine began arriving in Washington on Monday.
Health care workers at high risk of exposure to COVID-19, staff and residents of long-term care facilities, and high-risk first responders are prioritized as the first people to receive the vaccine, under state and federal guidelines. Washington health officials estimate that about 500,000 people will be eligible for the vaccine in this first phase.
James Wallace, chief health officer for Family Health Centers, said his organization, which operates medical and dental clinics in Twisp and five other communities in Okanogan County, is waiting to learn when its first vaccine shipment will arrive.
“It appears from a call this morning and discussions with community partners that hospitals are receiving priority for distribution from DOH at this point,” Wallace said Tuesday (Dec. 15) in an email. “North Valley Hospital is receiving vaccines this week and working on logistics for administration. Three Rivers Hospital will receive vaccine in two weeks.”
Direct shipments
The vaccine is being shipped directly from Pfizer to providers enrolled in the state vaccination program, said Danielle Koenig of DOH.
North Valley Hospital and other health care providers have been planning for vaccine distribution through a regional workgroup that includes Okanogan County Public Health, hospitals, clinics, nursing homes and emergency management services (EMS), McReynolds said in an email.
“There are three tracks of vaccine delivery we are exploring” to get the vaccine to health care workers and others included in the initial phase, which is called Phase 1a under the state vaccination plan, McReynolds said.
“The first is extending an invitation to Phase 1a workers from any employer to come to our Tonasket Family Medical Clinic for a scheduled visit to receive the immunization. This will be available the day after we receive the vaccine,” McReynolds said.
“The second is transferring the vaccine to other approved sites. Ferry County Memorial Hospital is the first partner site that we have started the paperwork to allow us to transfer doses to, and will hopefully be approved shortly,” McReynolds said.
Distributing the vaccine to other facilities is complicated by the requirement that the Pfizer-BioNTech vaccine be kept at an extremely cold temperature of minus 90 degrees Fahrenheit. North Valley Hospital purchased an ultra-cold medical freezer a few months ago when it became clear that the Pfizer-BioNTech vaccine would likely be the first to get approval. Once thawed, the vaccine must be refrigerated and used within five days.
Ferry County Memorial Hospital also has an ultra-cold freezer, but guidance from Pfizer does not allow vaccine recipients to separate a tray, which contains 975 doses, and transfer individual vials while keeping them in their frozen state, McReynolds said. So the Ferry County hospital will “only take what they can use within the five-day shelf life of the thawed vaccine,” McReynolds said.
The third track of vaccine delivery is sending North Valley Hospital employees and vaccines to other organizations to hold vaccination events. “The hurdles to transport the vaccine may prevent this from happening,” he said.
Logistical challenges
Hospitals and health care facilities enrolled in the state vaccine program expect to receive initial shipments of 975 doses, which North Valley Hospital hopes to get to health care workers and others in Phase 1a as quickly as possible, McReynolds said.
“But the challenges around transporting the vaccine, and our rural area, make the logistics challenging. As we start our process, we are planning on opening up 150 appointments per week for eligible Phase 1a patients, and hope to increase this based on demand.”
Maintaining the “cold chain” requirements for the Pfizer-BionNTech vaccine will also be an issue for Family Health Centers when it receives its first shipment, Wallace said. Family Health Centers does not have an ultra-cold freezer and will need to use the vaccine within five days of opening thermal shipping containers that keep the vaccine at minus 90 degrees Fahrenheit.
“We’d like to distribute it to hospitals, EMS, schools and other partners. It will be a challenge to ensure the cold chain and adhere to administration and reporting requirements, but we want to distribute it broadly and make it as accessible as possible. EMS and other partners have been very willing to assist in this,” Wallace said.
Three Rivers Hospital ordered an ultra-cold freezer earlier this month but does not expect to receive it before the end of January, said Jennifer Best, hospital spokesman. “We haven’t heard when we’ll receive the first vaccine shipment, but it will likely arrive before our new freezer does,” she said. “We’re working on alternate safe storage methods to keep the vaccine at the appropriate storage temperature until the new freezer gets here.”
Eligible health care workers at the three approved vaccine sites in Okanogan County are being encouraged, but not required to get the vaccine. McReynolds said he expects any concerns relate to the fast development of the vaccine to dissipate.
“I believe there will be increasing acceptance and excitement for taking this step to protect our patients, our families and ourselves. We trust the science, the data, and the process,” he said.
Training required
People who will give injections of Pfizer-BioNTech vaccine must receive training to learn a precise protocol that must be followed for thawing the concentrated vaccine, diluting it with saline solution and mixing it. A vial of vaccine holds five doses, and once it is mixed, it must be used within six hours.
“Pfizer and the CDC (federal Centers for Disease Control) have made a lot of training videos and manuals available and we have been working to get the appropriate employees trained,” McReynolds said. “The cold chain requirements make this more complex than many other immunizations.”
The Pfizer-BioNTech COVID-19 vaccine requires two doses, given 21 days apart. Clinical trial data show the vaccine is 95% effective at preventing COVID-19 infection starting seven days after the second dose. People are not considered fully protected until one or two weeks after the second dose, according to information from DOH.
Washington is expected to receive 62,400 doses of vaccine this week, distributed to 17 sites across 13 counties, according to DOH. The federal government has estimated that Washington will receive another 220,000 doses of the Pfizer-BioNTech vaccine by the end of December, and regular weekly shipments should begin in January.
Second vaccine
A second vaccine candidate produced by pharmaceutical company Moderna could receive FDA authorization for emergency use by the end of this week. Moderna is also a two-dose vaccine, and requires less complicated shipping and handling because it can be stored at minus 4 degrees Fahrenheit, which is similar to many other medications.
If the Moderna vaccine gets FDA approval, Washington expects to receive about 183,000 doses by the end of December, according to DOH.
Washington’s vaccination plan, which is still being revised, includes four phases. Included in phase 1b are people with underlying conditions that put them at significantly higher risk. Phase 2 includes teachers, essential workers who are at high risk of exposure, people of all ages with underlying conditions that put them at moderately higher risk, people in homeless shelters or group homes for individuals with disabilities, people in prisons and detention centers, and all older adults not included in the first phase.
Phase 3 would include young adults, children, and workers in industries important to the functioning of society who are not included in the previous phases. In phase 4 the vaccine would be available to everybody.
“We believe that if everything goes according to plan, we’ll have most people in Washington vaccinated by mid-summer,” Michele Roberts, one of the leaders of the DOH vaccine planning group, said Monday.
“We want to make sure everyone in Washington has access to the vaccine. Almost every county in Washington has at least one health care provider enrolled in the COVID-19 vaccine program,” said Koenig of DOH.
“We are also working on a procedure for providers to share or transfer vaccine. This will help out clinics that may not have a large enough population to need a full shipment or tray,” Koenig said.
Having three designated vaccine sites in rural Okanogan County is an accomplishment, said Gretchen Aguilar, chief nursing officer at Three Rivers Hospital.
“We’re rural, but our communities shouldn’t suffer because of that. Applying for and obtaining designation to be a vaccine site took considerable effort, and we’re grateful to have the opportunity to provide this service,” Aguilar said.
Wallace said he is inspired by the way Family Health Centers has adapted during the pandemic and by the collaboration among health care partners across Okanogan County.
“In many ways, this pandemic has brought our health care systems together and we’re even better aligned in keeping county residents safe and healthy,” Wallace said.
