State and region devise COVID-19 vaccine distribution plan

Last Thursday, healthcare leaders from across Alaska met virtually to discuss their strategy for distributing the COVID-19 vaccine, as well as their priorities for who would get the first doses. While many factors remain uncertain, hospitals across the state hope to begin administering shots in the latter part of December.
No vaccine has been officially approved in the United States yet, but some are just weeks away from approval. This Thursday, December 10, the Food and Drug Administration will meet to approve the vaccine produced by Pfizer, which has shown 90 percent efficacy and no safety concerns in clinical trials.
The other vaccine on track to be approved soon is made by Moderna, which has also been shown to be safe and effective in clinical trials. Approval for the Moderna vaccine is expected about a week after Pfizer.
The Pfizer vaccine has already been approved in the United Kingdom and will be administered there starting this week. After the FDA issues an Emergency Use Authorization for the vaccine, doses will be shipped to states, including Alaska, within a few days.
While the exact number of doses in the first shipment is still uncertain, the latest numbers show Alaska receiving 35,100 doses of the Pfizer vaccine and 17,900 doses of the Moderna vaccine in the first phase of distribution, according to Alaska Department of Health and Social Services Nurse Consultant Tessa Walker Linderman.
In a Monday press conference, Linderman said they were originally anticipating on getting fewer doses with the first phase. “We’re really excited about the numbers that we’ve received,” she said, but added that it’s still only enough to immunize a fraction of the state.
There are multiple levels of recommendations for who receives the vaccine first. The Centers for Disease Control released its recommendations on December 1, and Alaska’s Vaccine Allocation Committee met on December 3 and released similar guidelines.
According to both the CDC’s and the state’s recommendations, three groups will be given priority in the first phase of vaccinations, which is called Phase 1a: Elders living in long-term care facilities, frontline medical workers and emergency responders like EMS and firefighters.
Ultimately, though, the final decisions about who exactly gets vaccine when will be up to the local organizations administering it. In Nome and the surrounding communities, that organization will be Norton Sound Health Corporation.
Dr. Mark Peterson, Medical Director at NSHC, said he wasn’t sure exactly how much vaccine they would receive in the first shipment, and they likely won’t know for sure until right before it shipped.
“We have no idea if it’s going to be 20 vials, 250 vials, 11 vials, we don’t know,” he said. “It might be a very small amount initially, but then we’ll get more soon after that.” He added that NSHC is expected to receive enough vaccine in phase 1a to cover residents of Quyanna Care Center, medical workers including community health aides in regional villages and EMS and volunteer firefighters, over the course of late December and early January.
Vaccine will be allocated to communities across the state according to a pre-existing distribution system used for other immunizations, Dr. Peterson said, so Nome will receive its first vaccines within days of the doses arriving in Anchorage.
From there, NSHC will administer vaccine from the hospital and ship it to regional villages as needed. “We’re not waiting for anybody. When it comes, it goes to all locations right away,” Peterson said. “Every place will get their fair share.”
The mass distribution of vaccine is a logistical and technical challenge, especially for the Pfizer vaccine, which must be stored at ultra-cold temperatures colder than -90° F.
Matthew Bobo, a state epidemiologist working to coordinate the vaccine delivery network, said that Pfizer would oversee the transport of vaccines to Anchorage, and from there the state was working with a long list of governmental organizations and private contractors to distribute the vaccine across Alaska.
“It’s a heavy lift with a lot of partners,” he said. However, the distribution network isn’t being built from the ground up. It’s largely the same network used to distribute flu vaccines and other essential medical supplies.
The Pfizer vaccine will be shipped from its American manufacturing center in Kalamazoo, Mich. in specialized containers that can keep their contents ultra-cold for as long as 90 days, as long as they’re opened infrequently and kept stocked with dry ice.
The containers will be embedded with trackers and thermometers so that Pfizer can monitor them in real time, ensuring that the vaccine doses are properly handled and automatically alerting healthcare authorities if there’s any issue with their transport.
The Pfizer vaccine can also remain effective at regular refrigerator temperatures for a few days, which is probably how Nome will receive its first doses, Dr. Peterson said. Those doses must then be administered within five days of thawing.
The Moderna vaccine is stored at regular freezer temperatures and remains effective in the refrigerator for up to 30 days, “so once that starts coming, it’ll be even easier for us to distribute,” Peterson said.
Down the line, the Moderna vaccine will likely be the more prevalent one in rural areas due to ease of storage, but for the first months NSHC will receive and administer whatever doses of either vaccine are available, Dr. Peterson said.
While most residents of Nome and the surrounding region will get their vaccine from the state through NSHC, some Alaskans will get their vaccine through other means. The military will handle the vaccinations of its servicemembers stationed in Alaska, federal prisons will receive doses directly from the federal government, and some tribal organizations have opted to partner with the federal Indian Health Service instead of the state of Alaska.
Those distribution networks are separate from the state’s system that NSHC is participating in, Linderman said.
All those involved agreed that vaccine delivery was a complicated process and the exact timeline may fluctuate, but the vaccine would only become more available as time goes on. “I would think by late spring we should see lots of vaccine coming out,” Dr. Peterson said.
Dr. Anne Zink, Alaska’s Chief Medical Officer, said in a press conference that this is the most excited she’s been since the start of the pandemic. “It kind of feels like a man landing on the moon,” she said. “But the man has not landed yet.”
“It’s going to be a turbulent couple months, there are a lot of moving parts, but the end is in sight,” she said.