Why Virginia is changing vaccine distribution approach

APTOPIX Virus Outbreak Pfizer Vaccine
Posted at 5:50 PM, Jan 24, 2021

RICHMOND, Va. -- Virginia’s state vaccine coordinator said that the Virginia Department of Health will change how it allocates doses of the COVID-19 vaccine due to the on-going shortage of the vaccine and that if the supply does not increase, it could take between two to three months to finish vaccinating those eligible under Phase 1A and 1B of the rollout.

"For now, most recipients should know that they're going to, pretty reliably, get what they're getting for the next four weeks or so," said Dr. Danny Avula during a telebriefing on Friday. "We need to manage and temper expectations, because with just several hundred, or in some cases, a couple thousands doses coming to each community, there are not going to be that many slots for people to get vaccinated. And so, folks who are in 1B and are looking to get vaccinated, we need to realize that it will likely, without a significant change in the supply of the vaccine, we're looking at two to three months to work through this population."

As of Friday, the Virginia Department of Health's COVID-19 vaccine dashboard said 1,010,150 doses had been distributed in the state, with 424,857 doses administered or just above 42%. According to the Bloomberg's national vaccination tracker, the national average as of early Saturday is 49.7%. Virginia's seven-day average of daily shots administered is 19,405.

During the briefing, Avula said his role, which he started two weeks ago, to improve Virginia's vaccine rollout is organized into three phases: addressing the gap in reporting, dealing with the supply and demand issue, and building up the state's vaccination infrastructure to be prepared for an increase in supply.

Dr. Danny Avula, the Richmond-Henrico Health Director tasked with managing Virginia's statewide COVID-19 vaccination rollout.

Gap in Reporting

Avula said a lot of his work since starting the job has been accounting for where Virginia's vaccine shipments are going and being, or not, reported quickly when administered.

"Right now, if you look at the data, you see that there's just under 600,000 doses that are not accounted for," said Avula. "There's really a need to understand why that is, where those doses are, and how does the public understand the current state of vaccine supply in Virginia."

Avula reiterated what he and other state leaders have said in the past about the gap between shots distributed and administered and said they will never close that gap completely as shipments arrive each week. He said that gap will be between 170,000 to 200,000 depending on the number of first and second doses delivered each week.

"The additional second doses that we get vary. Sometimes it's 60,000. Sometimes a little more," added Avula.

Avula had said Thursday that there was approximately 90,000 doses that had been administered to Virginians, but not entered into the state database. He said a new team of ten people was deployed this week to help address that issue.

He also said that the majority of Virginia's doses reserved for the federal partnership with pharmacies Walgreens and CVS to vaccinate residents and staff of long-term care facilities have yet to be used.

"226,000 doses were earmarked and set aside for CVS and Walgreens. Now, not all of those doses have been delivered, not all of them have gone down, but they are set aside," said Avula, who added that as of Thursday they had administered around 66,000 doses. "There is a large number of cases, probably around 100,000 at this point, that have been distributed into Virginia, but, has not been administered yet."

Avula said they have been speaking with state leadership for those two pharmacies and said they are working to accelerate their vaccination pace and are aiming to get through all of the nursing homes and assisted living facilities by the end of January. He said some of the challenges they are facing include outbreaks at facilities, which pushes back when vaccinators can come in, and that the willingness of people in those facilities to get the vaccine has been low.

"We've heard anecdotally different numbers that it seems like the residents, the elderly residents of these facilities have higher uptake - 70-to-80%. But, the staff are lower. Down like 30-to-40%," said Avula. He added that some staff members are later willing to get vaccinated after seeing their colleagues do so. Avula said they are also in discussion with CVS and Walgreens to reallocate some of those federally earmarked vaccines to other pharmacies to help speed up the process. "They are looking at their projections for how much vaccine that they're going to need to get through their three phases…and that they will be willing to allow us to reallocate to other pharmacies. So, I'll know probably Monday or so what that number is and how we would go about approaching that."

Virus Outbreak Moderna Vaccine
Boxes containing the Moderna COVID-19 vaccine are prepared to be shipped at the McKesson distribution center in Olive Branch, Miss., Sunday, Dec. 20, 2020. (AP Photo/Paul Sancya, Pool)

Demand is Greater Than Supply

Avula said that Virginia received 105,000 doses this past week, while it had requests from around the state for almost 300,000 doses and they are expecting to face a similar discrepancy for the next several weeks, so VDH will start allocating doses based solely on percentage of population.

"So, for each community we know what percentage of the population they have and then assign that percentage of this week's allotment to them," said Avula. "What we also did was we really leaned on our local health departments as the ESF [Emergency Support Functions]…leads in their community to coordinate the response."

Avula said the local health departments have been told how much vaccine their districts would receive and worked with their partners to determine how the doses would be allocated within their districts.

"So, that looks different from district to district. In some cases, health departments and hospitals are working hand-in-hand to do large scale PODs [point of dispensing]," added Avula. "In different areas, you'll have different vaccine channels. Some of that's going to happen through large scale vaccinations, some of its going to happen through partnership with pharmacies that focus on segments of the population.

"Health departments are really working hard to figure out how to prioritize that vaccine. We are continuing to prioritize 1A individuals who did not, who may not have gotten vaccinated on the first round and, so, they will be worked into clinics as available," said Avula. "And then we have this very large 1B group. And I think the challenge of this is when you're only getting a couple thousand doses a week to be distributed between hospitals, health systems, health departments, providers, and pharmacies -- how do you do that in a way that even comes close to meeting demand? And the answer is you don't. You can't. And, understandably, that has led to a great deal of confusion and frustration on the part of our public who says, 'Hey, I'm in 1B. Why can't I find a place to get vaccinated?'"

Avula said health departments and their partners should provide capacity each week for the 65+ portion of 1B and, simultaneously, provide vaccination opportunities for frontline essential workers.

Avula was asked if going forward, because of the limited vaccine supply, should health districts stop the practice of allowing people from outside their jurisdiction attend the open POD events to get the vaccine. Avula said he would watch to see how that issue emerges.

"If there are situations where that seems to be abused or is creating big inequities, because people in a neighboring district have more ability to drive themselves across the country line," said Avula. "Then we'll need to relook at that and revisit…are we more restrictive about place of residence?"

Mass vaccination event at Richmond Raceway

Preparing for Mass Vaccination Clinics

Finally, Avula said the third phase of VDH's planning is building the infrastructure for mass vaccination clinics that will be necessary to reach Governor Ralph Northam's goal of 50,000 vaccinations a day and inoculate 70%-to-80% of the population and attain herd immunity.

Avula said there is also tremendous capacity in the state's health systems and health departments, but they also have about 2,000 provider groups and 400 pharmacies who have been approved to provide vaccinations.

"I don't have any concerns about us being able to get to 50,000 doses a day," said Avula. "Except that we don't have the vaccine."

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COVID-19 Precautions

Most patients with COVID-19 have mild to moderate symptoms. However, in a small proportion of patients, COVID-19 can lead to more severe illness, including death, particularly among those who are older or those who have chronic medical conditions.

COVID-19 spreads primarily through respiratory droplets produced when an infected person coughs or sneezes.

Symptoms include fever, cough, and difficulty breathing. Symptoms appear within 14 days of being exposed to an infectious person.

Virginia health officials urged the following precautions:

  • Wash your hands often with soap and water for at least 20 seconds.
  • Use an alcohol-based hand sanitizer only if soap and water are not available.
  • Avoid touching your eyes, nose, and mouth.Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
  • Clean and disinfect frequently touched objects and surfaces.
  • Stay home when you are sick.
  • Avoid contact with sick people.
  • Avoid non-essential travel.