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Most Alabamians may get COVID vaccine by June; nursing home patients, health workers top priorities

Alabama plans to vaccinate long-term care patients and frontline healthcare workers in the earliest phase of COVID-19 vaccinations, if the CDC approves changes this week.

But a vaccine probably won’t be available for the majority of Alabamians until June.

“There’s not enough (of the vaccine) right now, and we hope people can be patient,” said State Health Officer Dr. Scott Harris.

“There’s just so much demand at the moment.”

He said states are at the mercy of the national manufacturing process, and, given the rollout process so far, the general population may have access to a vaccine as early as this summer.

Alabama is expected to get about 40,950 initial doses of the Pfizer vaccine by mid-December, enough for about 20,000 people to be immunized with the required two doses.

Pending the vaccine’s emergency authorization by the FDA, those vaccines will be delivered to eight hospitals outfitted with ultra-cold freezers that can preserve the vaccine at -70 degrees Celsius.

The state plans to offer vaccines in three phases. The first phase includes healthcare workers treating COVID-19. It may now be expanded to include patients and staff at long-term care facilities like nursing homes.

“Healthcare workers have been disproportionately impacted by this virus because they are on the front lines taking care of all the sick people,” said Dr. David Kimberlin, a pediatric infectious disease specialist at UAB and Children’s of Alabama.

“If all your healthcare workers are sick or dead then you have nobody to take care of anybody else.”

The second phase of distribution includes essential workers and members of the general public at high risk for COVID-19 due to age or pre-existing conditions.

The third phase will aim to reach the general public.

A significant unknown is how many people will be willing to take a vaccine next year, and Alabama faces an enormous logistical challenge in distributing vaccines, especially in rural parts of the state.

For phase one, health officials had hoped to receive enough vaccines this month to immunize all of the state’s roughly 300,000 healthcare workers willing to take the shot. They lowered their expectations after federal officials said to expect closer to 100,000 vaccinations.

Last week state officials learned that the number of vaccines coming to Alabama in an initial shipment would be reduced to about 40,950.

“It’s less than 10 percent we were thinking a couple of months ago,” said Harris.

Health officials are looking beyond Pfizer in hopes that other vaccine prospects will allow for greater flexibility for distribution.

Moderna’s vaccine, which has 94 percent efficacy, can be refrigerated at higher temperatures and is in line for FDA approval this month. Other vaccines that can be stored at higher temperatures are in earlier phases of development.

In the interim, ADPH may grapple with distributing vaccinations to long-term care facilities.

On Tuesday, the CDC’s Advisory Committee on Immunization Practices recommended raising long-term care patients to a top priority level Tuesday. CDC Director Robert Redfield will decide whether to approve the change.

Dr. Kimberlin, who is a liaison to the CDC’s vaccine group for the American Academy of Pediatrics, said he thinks vaccinating long-term care residents and staff is the right choice.

“The risk is so high in that group, that it justifies the recommendation that they be among the very first Americans to receive the vaccine,” he said.

As of November 26, long-term care facility patients and staff accounted for 6 percent of cases and 40 percent of deaths nationwide from COVID-19 this year, according to the Kaiser Family Foundation.

The CDC recommendations, if adopted, could represent another last-minute logistical challenge for the early phase of vaccine rollout in Alabama.

“States are not required to accept the recommendation, but I think every one of them will,” said Harris.

Spokesperson for the Alabama Nursing Home Association John Matson said this recommendation is a positive step, but his team is waiting for more details about how or when the vaccine could be transported to nursing homes.

“Certainly we’re hopeful the vaccine is the answer we’ve been waiting on, that this is what can finally eradicate COVID-19,” he said.

“We’ve got to wait on more details, both from the state and the federal government before we can know what to expect.”

Cold storage is a limiting factor for distributing vaccines to nursing homes, especially in rural parts of the state.

Each Pfizer delivery includes nearly 1,000 vaccinations, a large quantity given the need for ultra-cold freezer storage.

In the existing plan, eight hospitals will serve as distribution hubs statewide.

“Those hospitals are going to help us by not only beginning to immunize their own staff but also immunizing other healthcare workers in their catchment areas,” said Harris.

USA Health in Mobile is awaiting its first vaccine delivery. The hospital purchased two ultra-cold freezers this fall in anticipation said System Chief Medical Officer Dr. Michael Chang.

“A vaccine rollout of this magnitude, in this compressed a time frame, with these sorts of storage requirements and so on, has never, to my knowledge, been attempted before now. These are truly unprecedented times,” he said.

He said an incomplete survey of his hospital’s staff shows about 50 percent would be willing to take a vaccine, a figure slightly lower than some estimates about the general United States population.

Dr. Scott Harris says hospitals and nursing homes in the state have no plans to mandate vaccination for workers.

Matson, with the state’s nursing home association, says it’s unclear how many of Alabama’s nursing home patients will volunteer to get vaccinated. He says there are many such questions ahead, like what to do if residents are unable to consent to a vaccine.

“That’s part of what we’ve got to work through still, is what does that look like if someone cannot make that decision, who makes that decision on their behalf?”

And then there’s the concern that the available vaccines have not been tested specifically on nursing home populations.

Dr. Kimberlin, the liaison to the CDC panel, says despite the lack of data on vaccination for long-term care populations, on balance, it’s worth the risk.

“They’re the ones that are dying,” he said. “If we have a product, a vaccine, that can mitigate that impact, then it’s ethically the right thing to do.”

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