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In the Philadelphia Department of Public Health, six full-time employees work 12-hour days to prepare for the arrival of coronavirus vaccines.
It’s a tough job, since they’re working with almost no concrete information.
“It’s harder than you think, because everything is a little bit unknown at this point,” said city immunization program manager Amber Tirmal. “You’re working with so many unknowns that you feel a little bit like you’re spinning out of control.”
Tirmal’s immunization team meets with officials from the federal Centers for Disease Control and Prevention on Mondays, getting updates and fielding planning documents. There’s also the vaccine advisory committee, a separate group that meets every other week. Health department teams also attend meetings with 63 other cities and states throughout each week.
There has been progress. Companies like Pfizer, Moderna and AstraZeneca have reported promising results from early trials, and the first two are seeking emergency use authorization from the Food and Drug Administration.
Once submitted, Tirmal said it usually takes roughly two weeks for approval. If approved, distribution would begin almost immediately, she’s been told.
“That’s assuming the decision is going to be yes,” Tirmal said. “It could be a no.”
About 30 to 40 million vaccine doses are likely to be available nationwide by the end of 2020, according to city health department estimates. Some will end up in Philly, and plans call for giving it first to the people most at-risk — health care and other essential workers, people who are immunocompromised, older Philadelphians.
When will all this begin? Tirmal estimated the treatment could arrive anytime between two to five weeks from now, but it’s still very much up in the air.
Community vaccination events and mobile pop-ups are likely
The city is currently juggling three potential “scenarios” for distribution, which range from 15 to 45 million doses being available in the region by the end of 2020. They could get here as soon as two to five weeks from now, per Tirmal.
Any place a vaccine is distributed will need to enroll in a federal registry, Tirmal said. The CDC already created an enrollment form, which Philly’s health department converted into an online survey and sent around to potential providers.
The list of likely distribution sites in Philadelphia include:
- Other health care providers
- Facilities (like congregate settings and shelters)
- Public health clinics
- Community events
In addition, the city’s plan indicates mobile distribution will be available with both walk-up and drive-through options.
Storage is a big issue. One of the current proposed vaccines must be kept at -20° Celsius — a bit colder than the average house freezer. Another needs much more extreme conditions: -70° Celsius (-94° Fahrenheit).
“Then it becomes, if they don’t have a freezer, do we have dry ice we can get out to them so they aren’t precluded from distribution?” Tirmal said. “We’re thinking through all those logistical steps.”
Patients will need two doses, which can be hard to track
Though we’re not sure which vaccine we’ll get first, it’s almost certain whichever it is will require two doses to develop immunity.
Depending on the vaccine, it might require 21 days or 28 days between each dose, creating a tracking quagmire. On the upside, Philadelphia already has PhilaVax, considered one of the country’s best vaccine registries.
Tirmal said as soon as providers give someone their first dose, they’ll be expected to make an appointment to administer the second. Then they’ll get text or email reminders from PhilaVax to make sure it happens.
Expecting a limited supply at first, “Phase 1” of the city’s distribution plan prioritizes health care workers, essential workers and high-risk patients like older Philadelphians, and peoplewho are immunocompromised.
After Philly has enough doses to immunize its priority patients, who comes next? That’s outlined very vaguely in Phase 2 and Phase 3 of the Health Department’s plans. Phase 2 is just called “broader dose availability,” and Phase 3 is known as “sufficient supply to meet demand.”
In other words, the future is still very opaque. But at least it looks likely to clear up soon.