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First doses on the way, but only enough for 76,000. Millions more will need the vaccine for it to be effective

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By Lilo H. Stainton

With New Jersey slated to receive its first 76,000 doses of a COVID-19 vaccine any day now, public health officials are finalizing their plans for immunizing priority groups, and hospitals are preparing to store and administer the serum.

This first shipment is expected to be followed by another 76,000 doses, since each person needs two doses of the vaccine, state health officials said Monday morning. That first shipment is slated to arrive in advance of the U.S. Food and Drug Administration’s final decision on the Pfizer product, scheduled for Thursday, which could allow coronavirus immunizations to begin nationwide. The FDA intends to review a vaccine by Moderna the following week.

“We are ready for this moment,” Gov. Phil Murphy said Friday, noting the state is expecting rolling shipments and could have 300,000 to 500,000 doses on hand by the end of 2020. “The light on the other side of this pandemic is now becoming visible. This is a game-changer.”

Late Friday, the state Department of Health confirmed that those first in line for the vaccine will not only include the 650,000 first responders and health care workers most at risk, but also another 75,000 nursing home residents. While the state’s draft vaccine plan initially focused on health care and emergency professionals — both paid and unpaid, in all settings — that has evolved.

Prioritizing long-term care facilities

Early last week, the federal Centers for Disease Control and Prevention urged states to also consider prioritizing residents in nursing homes and other long-term care facilities as part of this first phase to be vaccinated. Long-term care providers, including the Health Care Association of New Jersey (HCANJ), also highlighted this recommendation.

“This announcement is great news to long term care providers and the residents they serve, and we are grateful for the hard work that the (CDC advisory committee) put into establishing a system by which those who are in the greatest danger of infection get earliest access to a vaccine,” said Dr. Stuart H. Shapiro, interim president and CEO of the HCANJ, a trade group that represents hundreds of the state’s long-term care facilities, in a statement distributed before the state made its decision public.

Long-term care residents are particularly vulnerable to COVID-19 because of their congregate living setting and the likely presence of other clinical risk factors, like advanced age and underlying conditions. Roughly 43% of the coronavirus-related deaths in New Jersey since March are connected to long-term care, according to state figures.

DOH submitted its draft vaccine plan to the CDC in October and was scheduled to provide them an updated version by the end of last week. Murphy said at his press briefing Friday that the state has “refined” the draft plan but did not provide details.

When will vaccines be administered?

Also unclear is how quickly any vaccines will be administered once FDA emergency approval is granted, even to those in the priority group. Murphy suggested Friday that additional batches of the Pfizer product could be shipped to New Jersey within 24 hours of this decision but the health department is also set to conduct its own review of the data submitted by the federal vaccine committee. It is not clear how long that will take.

DOH communications director Donna Leusner said Friday evening that the goal was to begin immunizations “as soon as possible.”

The vaccine program appears to be evolving on the federal level as well, based on Murphy’s reports of his weekly meetings with the Trump administration. In late November, Murphy said New Jersey anticipated an initial shipment of 130,000 doses — or enough to protect 65,000 residents — with at least 1 million doses to arrive by year’s end.

DOH Commissioner Judy Persichilli has set what she calls an ambitious goal of immunizing 70% of the state’s eligible population — about 4.7 million people — within six months of the COVID-19 vaccine being widely available, likely in late April or May. (It has not been tested in children, pregnant individuals or those with compromised immune systems.) Until then, Persichilli underscored the need to continue wearing masks, maintaining distance and taking other infection-control precautions.

“To be clear, the mere presence of a vaccine in our state does not mean that we can flip a light switch and remove all restrictions or lift every advisory. COVID isn’t going to simply vanish just because there are vaccine doses in a freezer waiting for distribution,” Murphy said Friday. “This is going to be more like a dimmer, and the light will get brighter and brighter over time. To get to full brightness will take months and it will take millions of New Jerseyans getting vaccinated,” he said.

Even with ample supply, challenges will remain

Even when the state has sufficient vaccine supply, the challenges are significant: At least one of the vaccines must be stored in extreme deep freezers that are not readily available, and distribution must be coordinated among thousands of public and private vaccination sites under the draft DOH plan. Plus, skepticism about the vaccine is widespread, even among health care providers.

To improve the distribution and tracking process, Murphy said Friday he would sign an order so that anyone who gets a COVID-19 vaccine would automatically have their results and other data included in an existing state immunization database, unless they choose to opt out of the system. In the past, most people getting immunized against the flu or other diseases had to opt in to be included.

“Let me be perfectly clear that this order does not force anyone to receive the vaccine,” Murphy said Friday, although he said the state would likely “strongly recommend it” based on the DOH final review. “We’re doing this for a simple reason — to ensure that those who choose to receive a vaccine get the most effective course in the most streamlined manner possible, on the proper timetable and without logistical or bureaucratic hurdles in the way.”

Header:  Photo by Daniel Schludi on Unsplash

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