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Virginia tests plan to distribute COVID-19 vaccine, but taking it won't be mandatory

With the initial shipments of a new vaccine against COVID-19 potentially weeks away, Virginia is testing its plan for distributing the initially limited supply of the vaccine to the people who need it most — front-line medical workers and the employees and residents of nursing homes and other long-term care facilities.

State Epidemiologist Lilian Peake told legislators on Monday that the Virginia Department of Health was conducting an “end-to-end test” that day of its initial plan for distributing the first vaccine likely to be federally approved. It ran the test in tandem with Pfizer and BioNTech, the team that produced the vaccine, and the federal Centers for Disease Control and Prevention, or CDC, which will have the last word on priorities for its use.

“It is a practice run that tests ordering and receiving Pfizer vaccine for distribution,” Health Department spokesman Tammie Smith said. The “test does not include actual vaccine, but will require handling as if there were real vaccine.”

Smith said the CDC is leading the drill at 50 sites. Virginia is one of 10 that was scheduled to receive containers loaded with dry ice by noon on Monday to practice distribution of the Pfizer vaccine, which requires “ultra cold” temperatures for storage.

The hospital receiving the test shipment is Inova Health System in Fairfax County, according to the Virginia Hospital & Healthcare Association, which could not confirm that the shipment had been received for scheduled distribution on Tuesday.

“Recipient sites are to have basic protection in order to manipulate the dry ice shipment, including gloves and eye protection,” Smith said at the Health Department. “Pfizer will provide instruction and training on handling.”

Inova is one of 16 hospitals or health systems that Virginia has identified as capable of storing the Pfizer vaccine at “ultra cold” temperatures, ranging from -60 to -80 degrees Celsius, or -76 to -112 degrees Fahrenheit.

In a presentation to the House Committee on Health, Welfare and Institutions on Monday, Peake said the 16 hospital systems cover about 95% of the health care workers who are the top priority for vaccination against COVID-19. The first seven health systems in line for the vaccine cover about 70% of Virginia’s hospitals and their work force in all six health regions of the state.

Later phases of vaccination under the state’s plan will include people who are the most medically vulnerable and then the general population — for a total of more than 8.5 million Virginians.

But Peake said the state does not plan to require anyone to take any of the half-dozen vaccines the federal government is pushing to develop to bring the pandemic under control.

“Despite some people’s hesitancy about vaccines, the vast majority of Americans and Virginians want vaccines,” she said. “The demand for vaccines is expected to be high and initially outpace the supply.”

Alena Yarmosky, spokeswoman for Gov. Ralph Northam, said the Health Department expects to receive enough of the Pfizer vaccine to administer two doses, 21 days apart, for about 70,000 people.

Del. Mark Sickles, D-Fairfax, chairman of the House committee, said it makes sense not to make vaccination mandatory, even though COVID-19 has infected almost 238,000 Virginians and killed more than 4,000.

“You can’t do that when there isn’t enough for everyone,” Sickles said in an interview after the meeting on Monday. “How do you mandate something that’s in short supply?”

The initial supply of the vaccine will be far less than the demand for even the first phase of the state plan — covering about 641,000 front-line medical workers and long-term-care residents and staff — so the Health Department is depending on the CDC Advisory Committee on Immunization Practices to decide who gets the highest priority for immunization under the federally driven distribution strategy.

The strategy begins with approval by the U.S. Food and Drug Administration of vaccines for emergency use and then guidance from the CDC committee on who gets immunized first.

“There is more coordination at the federal level for vaccines than there was for [COVID-19] testing,” Peake said.

Julian Walker, spokesman for the hospital association, said the highest priority would be health care employees caring directly for patients confirmed with COVID-19, but a state committee of public health experts and ethicists, including one on public health equity, would decide how to prioritize the vaccine among people within priority groups if the supply isn’t enough to treat all of them.

“I think Americans are going to feel better when front-line workers in hospitals and emergency crews are vaccinated,” Sickles said.

Virginia’s Disaster Medical Advisory Committee would make those decisions based on recommendations from the Virginia COVID-19 Vaccine Advisory Committee, which includes more than 100 people from organizations with high stakes in the outcome. Using the CDC guidelines, the state would break those priority populations into sub-groups for receiving the vaccine.

“The level to which it’s broken down is going to depend on how much vaccine we have,” Peake said, “and that’s not known yet.”

The Pfizer vaccine isn’t the only one being developed on a fast track to bring the coronavirus under control, but it is the first to apply for FDA emergency approval.

Moderna, a biotechnology company based in Massachusetts, on Monday filed for emergency approval for a vaccine that is similar to Pfizer’s genetic-based approach, but would not require ultra-cold storage. The Moderna vaccine also would require two doses, administered 28 days apart.

Under Virginia’s plan, the initial doses of vaccine would be distributed through hospitals and, for long-term-care residents and employees, two national pharmacy chains, CVS and Walgreen’s, under partnership with the CDC, which would supply the vaccines directly. The state would rely on its own partnerships with pharmacies to ensure that all parts of Virginia would be covered. The pharmacies would administer the vaccine through “closed points of dispensing,” or clinics that would be held at facilities rather than the pharmacies.

The second phase, for about 3 million medically vulnerable Virginians, would be distributed through open clinics and pharmacies, and the final phase, for almost 5 million people, would be administered by pharmacies and other community partners.

“The good news is that we’re building on decades of experience in our public health emergency preparedness and public health vaccination programs,” Peake told the House committee.