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COVID-19 vaccine could go to seniors over 75 in just weeks, leaving states with huge logistics problems

Officials who thought the H1N1 swine flu shot in 2009 was a logistical nightmare say it now looks simple in comparison.

Boxes containing the Moderna COVID-19 vaccine are moved to the loading dock for shipping at the McKesson distribution center in Olive Branch, Miss., on Sunday.
Boxes containing the Moderna COVID-19 vaccine are moved to the loading dock for shipping at the McKesson distribution center in Olive Branch, Miss., on Sunday.Read morePaul Sancya / AP

Updated federal recommendations advise making COVID-19 doses available soon to hundreds of thousands of the region’s seniors, leaving state and local health departments little time to untangle major logistical hurdles, or risk delaying inoculations for high-risk Americans.

The Advisory Committee on Immunization Practices surprised health officials last weekend when it included people 75 and older among those who should be prioritized when the next step in vaccine distribution begins. So far, vaccinating health-care workers has gone relatively well because the vast majority of injections happen where recipients work, either in hospitals or nursing homes, whose residents also are in the first-priority group. People 75 and older, though, don’t all live in congregant settings and most don’t have jobs, said James Garrow, a spokesperson for the Philadelphia Department of Health. Reaching that demographic will be a huge test of the nation’s ability to vaccinate its diverse, dispersed population.

“There’s just so many details to it,” Garrow said Tuesday. “There are outstanding questions with allocations, how much we get, how it can be administered.”

People 75 and older, about 90% of whom, or 19 million, have not yet been eligible for vaccination, have the “highest burden of COVID-19 hospitalization and death,” according to the Advisory Committee on Immunization Practices (ACIP), experts who offer the Centers for Disease Control and Prevention guidance on vaccine use. The committee’s recommendations are not binding and states can set their own priorities, but health departments have said ACIP’s input will factor heavily into their decisions.

» READ MORE: A COVID-19 vaccine may be near, but distribution faces major hurdles

The next step in the three-phase vaccination process, phase 1b, should also include about 30 million front line workers like teachers, firefighters, police, grocery store staff, postal workers, and transit operators, ACIP said.

But with the federal government punting most vaccination decisions, each state and county is left to weigh where to send vaccines first and which of the two vaccines authorized by the Food and Drug Administration for emergency use makes the most sense for each location.

Philadephia hospitals injected the first shots of Moderna’s COVID-19 vaccine Tuesday, and over the past two weeks the city has received 50,000 doses from both Moderna and Pfizer-BioNTech.

At the city’s current rate of vaccinations, Philadelphia health officials expect the city’s 100,000 to 125,000 health care workers and nursing home residents now eligible for vaccination could all have received at least their first shots within two to three weeks, Garrow said. (The second dose, needed to provide full protection, is supposed to be administered within three weeks or so of the first dose). Then by early January, more than 93,000 people 75 and older in Philadelphia, and more than 282,000 people in the city’s surrounding New Jersey and Pennsylvania counties, may start being vaccinated.

But health officials aren’t entirely sure how that will be done.

“This is one of the most ambitious federal government initiatives ever undertaken,” New Jersey Gov. Phil Murphy said Monday. “It is not a straight line.”

Uncertainty about vaccine supplies is the first complication of planning to vaccinate so many people, and is the reason so much remains unsettled.

“The unknown here is the quantity of the vaccine,” said Kelly Cofrancisco, a spokesperson for Montgomery County. “That’s the biggest thing we’re trying to lock down.”

Hospitals in that county have received 8,775 doses so far.

The federal government had divvied up nearly 8 million doses of Pfizer and Moderna’s vaccines to distribute this week, on top of roughly 3 million Pfizer shots that were sent last week, said Army Gen. Gustave Perna, chief operating officer of the Trump administration’s Operation Warp Speed effort.

In all, the Trump administration has bought 900 million COVID vaccine doses from six companies, but most of the vaccines are still in clinical studies. Even the front-runners whose shots have received FDA emergency authorization — Pfizer-BioNTech on Dec. 11, Moderna on Dec. 18 — will require months to manufacture at that scale. The Trump administration plans to distribute 20 million vaccine doses to states by early January, Perna said Saturday.

Pennsylvania and New Jersey officials noted vaccine deliveries consistently brought fewer doses than expected. Philadelphia doesn’t believe it can count on a stable supply of 50,000 doses every two weeks, Garrow said. In New Jersey, health officials said Tuesday that they now expect to receive 20% fewer doses than anticipated in December. New Jersey officials are hopeful they can vaccinate 70% of the state’s adult population, enough to achieve herd immunity, by mid-2021.

» READ MORE: COVID-19 vaccine gives Philly health-care workers a glimpse of pandemic hope. Then it’s back to work.

Health officials had hoped older seniors’ vaccinations could largely be coordinated through their regular health care providers, Garrow said. But a scarcity of doses means health departments will almost surely not be able to guarantee access to vaccination at any doctor’s office or pharmacy.

New Jersey, Pennsylvania, and Philadelphia, which is establishing its own vaccination plan independent of the state, may not adhere to every ACIP recommendation as some may pose too great a challenge.

“Regular health care providers are probably the best place for them to get the vaccine,” Garrow said, adding that the city’s Vaccine Advisory Committee would decide soon if, “it’s the best way forward.”

In Philadelphia, where more than half the population is non-white, reaching communities that are vulnerable to serious complications from COVID-19 is an additional priority.

“There are so many issues with equity here in Philadelphia,” Garrow said. “Those issues aren’t always echoed as things of primary focus by other governments or other municipalities.”

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New Jersey has already begun plans for six “mega-site” vaccination sites in Atlantic, Bergen, Burlington, Gloucester, Middlesex and Morris counties. Montgomery County, which has run six testing sites, anticipates establishing a similar set of vaccination sites, Cofrancisco said, and similar facilities are expected across Pennsylvania.

Creating centralized vaccination centers, though, causes its own problems, Garrow said.

“That leads into individual conversations with hundreds of thousands of people about things like, ‘can you take this bus line?’” he said.

Reaching out to every eligible senior next month is daunting, officials said, and will likely require coordination with federal databases and local records, potentially including tax records.

“In terms of how people will be notified about vaccinations,” said Rachel Kostelac. a spokesperson for the Pennsylvania Department of Health, this week, “these details are still very fluid.”

This report includes information from Kaiser Health News, a nonprofit news service and editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.