Who gets it and when? 3rd and final COVID-19 vaccine panel discusses distribution
STEAMBOAT SPRINGS — As the first Routt County residents received their first dose of the Pfizer COVID-19 vaccine this week, Friday’s third and final vaccine town hall covered what will happen in coming months related to the provision of vaccines to more people.
Dr. Ronald Krall, adjunct professor of neurology at the University of Rochester and former chief medical officer for GlaxoSmithKline, began the panel discussion with an update on the soon-to-be approved Moderna vaccine.
Krall said the Pfizer-BioNTech and Moderna messenger RNA vaccines have “remarkable similarities” in terms of how they were tested, and the resulting data.
He detailed the data released from the Moderna trial, which involved about 30,000 people, half of whom were given the vaccine and half given a placebo.
Of those, 22% of participants had high-risk conditions and 25% were over the age of 55.
The Moderna vaccine is showing a 94.5% efficacy rate, compared to 95% for the Pfizer vaccine.
Krall pointed to early research suggesting encouraging signs the vaccine may be safe for pregnant women.
There were 23 women who became pregnant during the Pfizer trials, and 13 during the Moderna trials.
The numbers are small, and there has not been a very long duration of time, but he said, “There is no signal yet for pregnant women not to be vaccinated.”
He also pointed to “encouraging” research suggesting the Moderna vaccine trials show some protection against asymptomatic infections, even after the first dose.
“The message is, while we don’t know some things that we would like to know about the vaccines, each week we see more data emerging that will enhance our understanding about how these vaccines behave,” he said.
Dr. Jessica Cataldi, a pediatrician at Children’s Hospital Colorado who specializes in pediatric infectious diseases, joined the panel to discuss where children fit into the testing and vaccination process.
The immune systems of children are different, she said, and change and mature as they age. The Pfizer vaccine is authorized down to the age of 16 while the Moderna vaccine is authorized to age 18.
Both companies have started trials on kids ages 12 to 17.
Cataldi said she sees it as a positive that one vaccine is authorized to 16, in that “there’s not much difference biologically different between a 16 year old and an 18 year old.”
In addition, there are some 16- and 17-year-olds who work in high-risk jobs and some who are incarcerated.
In terms of what is known at this time about the safety of the vaccine for breastfeeding mothers, “the benefit likely outweighs the risk,” she said.
Cataldi said experts and doctors are recommending at this time that breastfeeding women should be eligible to get the vaccine.
With the studies now extending to age 12, Cataldi said that information is very useful, in that while kids appear to be at lower risk than adults, teens seem to have more significant disease, especially those with obesity, asthma and sleep apnea. In addition, teens seem to be at more risk than younger children, she said, and “children seem to spread the virus less than adults, but teens do seem to spread it in a way similar to adults.”
Cataldi said she anticipates studies on 5- to 12-year-olds to be the next phase, before moving to kids under the age of 5.
There may be data on teens in the spring, she said, and potentially a younger group by the summer.
Cataldi also discussed how ethics, addressing health care inequities, and justice work into the guidelines for vaccine allocation.
“For people who work in settings where they are put at increased risk because of their work — being able to give them a vaccine is a component of justice.”
Routt County Public Health Director Roberta Smith addressed how the Colorado Department of Public Health and Environment’s guidelines will be used to allocate and administer the vaccines in Routt County.
The framework starts with 1A, those who have the most direct contact with COVID-19 patients, she said, and the places most impacted, which includes residents and staff at Casey’s Pond and The Haven.
Phase 1B includes moderate-risk health care workers and responders. UCHealth Yampa Valley Medical Center, the public health department and other medical facilities will all assist in providing vaccines during the first phase.
Phase 2 is large, and Smith said they expect more specificity from the state as that phase approaches.
It includes “higher-risk individuals and essential workers,” which will involve people older than 65 and with high-risk conditions, teachers and people who work in grocery stores, among others.
By that time, there will be more detailed information available about how to sign up, where to go and what needs to be done in advance, Smith said.
“The timeline is subject to change based on the supply chain,” she noted.
On whether a 90-year-old will be prioritized over a 65-year-old, Krall said the “interchange of science, ethics and implementation is at the heart of this question.”
With more guidance expected from the state and local officials, “I think a lot will depend on how much is available,” Krall said. “If there is a fair amount, we may be able to do whole over 65 group in one block of time — but if supply of vaccines is more limited, then we will need to have gradation.”
There will likely be subprioritizations within the other Phase 2 groups, Smith said.
Phase 3 is everyone else.
“Hopefully by summer,” Smith said, “we do have the vaccine available to the whole community.”
Routt County Chief Medical Officer Dr. Brian Harrington noted that clinics are not keeping waiting lists at this time, so while he is happy to see interest, people don’t need to call to put themselves on a waiting list. And more communication will be forthcoming about the process.
Asked why Casey’s Pond and The Haven have not received vaccines despite being in 1A, Smith pointed to the partnership created by the federal government with Walgreens and CVS pharmacies.
“(The Steamboat Walgreens) will receive the doses and help to administer them,” Smith said. “We expect to see that happen starting next week.”
Harrington said there will be neither a reward nor a penalty for people who choose to get — or not get — the vaccine in Routt County. It will be completely voluntary, he said.
In time, Harrington noted there could be decisions made by individual “regimes” — Hawaii for a hypothetical — that could ask for an immunization card before permitting entry.
For people who have contracted the virus already, and have antibodies, Smith said it isn’t really necessary to have that test and proof. And that in general, the vaccine is thought to bring an additional benefit to those who have had COVID-19, especially more than 90 days out from recovery, she said.
Cataldi said all vaccines will be free, and patients will occur no cost. The federal government is covering the vaccines and supplies required for administration. Providers can charge insurance companies and Medicaid a fee for the actual administration, but uninsured patients cannot be charged that fee, she said.
CDHPE is launching a data dashboard to track vaccination data. It will be available at 4 p.m. Friday at covid19.colorado.gov/vaccine.
To reach Kari Dequine Harden, call 970-871-4205, email kharden@SteamboatPilot.com or follow her on Twitter @kariharden.
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