BOISE — It has been just over three weeks since the COVID-19 vaccine rollout began in Idaho, with a Rexburg hospital physician receiving the first dose of a federally authorized vaccine created by Pfizer/BioNTech.
More than 20,000 people in Idaho have since received shots in the first stage of a schedule that puts certain high-risk groups at the front of the line for immunizations.
Questions remain. Why haven’t more people been vaccinated? Is the rollout going too slowly? Why do some groups seem to be left out of the plan? How many people are declining the shot, and what happens to their dose? Have any vials of the vaccine gone bad or been thrown away? How will Idahoans find out when it’s their turn, and where will they go for their shot?
The Idaho Department of Health and Welfare updated its list of frequently asked questions about the vaccine last week and is holding weekly media briefings about the rollout.
Many of the same questions are popping up in other states. The distribution and administration of COVID-19 vaccines has followed a trajectory similar to coronavirus testing, personal protective equipment and other pandemic needs — a decentralized rollout of a centrally controlled resource, with federal entities offering some guidance but leaving it mostly up to state and local agencies to figure out the details and logistics.
“The fiasco in the rollout of the testing, the fiasco in the rollout of the supply chain (of PPE) and then, here we go again,” said David Pate, former CEO of St. Luke’s Health System and a member of Gov. Brad Little’s coronavirus working group.
The federal government “screwed it up in the first two weeks,” to a point where Idaho received about one-third fewer doses than it was initially told to expect, he said.
HOW DID IDAHO DECIDE WHO GETS THE VACCINE FIRST?
The governor directed the Idaho Department of Health and Welfare to put together a Coronavirus Vaccine Advisory Committee, charged with figuring out the details of Idaho’s vaccination plan for COVID-19.
These are the group’s stated goals and guiding principles, as it plans how to prioritize and distribute a scarce resource in a way that is fair:
- Reduce transmission, severe illness and death
- Preserve functioning of the health care system
- Recover functioning of society and the economy
- Protect persons at risk who have access and functional needs
- Ensure equitable distribution within groups prioritized for vaccination phases and equity in the opportunity for health and well-being
- Ensure transparency regarding vaccine decision-making
The committee includes dozens of people who represent stakeholder groups such as hospitals, medical providers, older and vulnerable populations, pharmacies and social services.
The Department of Health and Welfare on Dec. 30 issued an estimated timeline for various groups to start getting immunized. That timeline is based on the committee’s decisions and guidance from the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices and largely follows the broad priority groups laid out by ACIP.
The timeline shows the last group — the general public — starting to receive vaccinations in May. That is consistent with what national vaccine development experts projected last summer.
Health care workers and long-term care facility residents have already begun receiving their first doses, with some receiving their final dose as early as this week.
Between now and late spring, the vaccine will go to a mix of front-line and essential workers, such as grocery store employees; and people at higher risk of complications or death from COVID-19, such as older adults.
WHAT ABOUT IDAHOANS WHO DON’T FIT INTO A PRIORITY GROUP?
The timeline doesn’t include some people who are high risk and may also have essential jobs — a county jail inmate, a 70-year-old judge or a university janitor with health conditions, for example.
The vaccine committee is working through subgroups for each stage. (For example, it created seven different subgroups for the first category of vaccine recipients, health care personnel.) So it may soon answer questions about when those Idahoans will have their turn.
So far, it has largely been up to local public health departments like Central District Health to troubleshoot logistics — how to get vaccines to health care providers who aren’t part of a larger health care system, for example.
That has been a problem elsewhere in the country, too, as the initial roll-out of vaccines relied heavily on health care employers administering the shots to their staff.
IS IDAHO TRULY BEHIND SCHEDULE FOR COVID-19 VACCINES?
Yes. That is because of limited supply.
The state has received a total of 83,475 doses from manufacturers Pfizer and Moderna as of this week, according to Elke Shaw-Tulloch, Idaho’s public health administrator. Of those, 67,875 were earmarked to be used in first doses; the rest were set aside to complete the two-dose series for the first people vaccinated last month. And another 15,600 were shipped to Idaho for use in a program to vaccinate people in long-term care facilities.
So far, more than 20,000 Idahoans have received their first dose.
The state publishes the number of vaccines administered on its coronavirus.idaho.gov website each day, but the number is actually higher than that. Health care providers have up to three days to enter vaccination records into the state’s database. (The records are stored, as are all other vaccination records, in the state’s Immunization Reminder Information System — IRIS — which can only be accessed by specific people, such as health care providers and licensed child care providers.)
The state will soon start to publish the number of people vaccinated, instead of just doses administered, to make the data more transparent as some Idaho health care workers get their second dose this week.
WHEN WILL IDAHO REACH HERD IMMUNITY?
Nobody knows the precise vaccine tipping point for herd immunity from COVID-19. That’s because research is still ongoing to determine how long people who recover from COVID-19 are protected from reinfection. It could be weeks or months, depending on the person and their immune response to the coronavirus.
Based on what is known and some educated guesses, it’s possible that Idaho could reach herd immunity later this year.
State health officials said Tuesday that they anticipate being able to vaccinate 20,000 Idahoans a week. At that rate, it would take about a year to vaccinate 80% of the 1.3 million people currently able to be vaccinated. (There is no vaccine yet authorized for use in children.)
Even an 80% vaccination rate would be far higher than Idaho’s usual rate of vaccination for other contagious diseases. Less than half of Idaho got the flu shot during the last flu season.
One statistical estimate projects the U.S. reaching herd immunity when about one-third of the population has been vaccinated — assuming that another one-third of the U.S. population has immunity from prior infection, and assuming that herd immunity is possible when a combined 65% of people have some kind of protection. The data scientist who created the projection, Youyang Gu, estimates that more than 27% of Idaho has already been infected with COVID-19.
WILL THE STATE REQUIRE COVID-19 VACCINES?
Don’t count on it.
Little’s communications director said he “will not mandate the COVID-19 vaccine for Idahoans of any age group.”
It’s possible that the vaccine could be included in the required immunizations for public schools in Idaho. But there is no COVID-19 authorized or approved for use in children younger than 16 yet. And Idaho law allows parents and guardians to opt out of the vaccine requirement for any reason.
Idaho is one of the most lax states for vaccination mandates. That was highlighted last year, when groups of people testified against vaccine rules, including some new Idahoans who said they relocated from states like California so they wouldn’t have to vaccinate their children.
WHAT HAPPENS TO EXTRA DOSES? CAN I TAKE SOMEONE ELSE’S TURN?
Some health care providers noticed as the Pfizer vaccine was rolling out that, after administering the official number of shots per vial, they had enough left over to make a full extra dose. Other health care organizations have had staff decline the vaccine or not show up for an appointment.
So what happens to that coveted shot?
One local health system employee posted on social media about her excitement at getting a surprise offer for a dose that would otherwise have gone to waste. St. Luke’s spokesperson Anita Kissee explained that while she’s not a medical worker, she does go into the hospital and into COVID-19 units to do her job, so she was eligible for the vaccine but planned to wait longer for her turn. She dropped everything and hustled to the vaccination site as soon as she got an offer to take a dose.
Other health care organizations have assembled waiting lists to notify people when they have an opening, too, while still adhering to the rollout timeline.
“One of the things we really want to prevent from happening is any sort of wastage of vaccine,” Shaw-Tulloch said Tuesday. “As providers are working their way through that (first group of vaccine-eligible people), of course we want them to stay as close to that path as they can ... but certainly if they find themselves in a situation where they have doses that may be expiring, we don’t want to waste anything.”
Pate said he wishes there was a streamlined way to ensure that, for example, people most at risk could be first in line on those waiting lists.
That presents some of the same challenges as determining where people belong on the timeline, when they don’t fit neatly into one of the priority categories.
He said that every vaccine administered to others puts him more at ease — and that a lot of people wanting the shot is a better problem to have than a lot of people turning it away.
“The state has done, I think, a reasonable job, and they have done the best they can on short notice,” he said. “There’s just so many permutations. ... Let’s just get large numbers of people vaccinated.”
HAVE ANY VACCINES EXPIRED OR BEEN THROWN AWAY?
Yes. State officials wouldn’t say how many when asked about it Tuesday, but they said it wasn’t much.
“We have had very, very few reports of any wastage,” said Sarah Leeds, Idaho Immunization Program manager. “And I don’t have a number. But it has been very minimal, and we consider this a huge success. This vaccine has so many complexities with storage and handling, and our providers have done a fantastic job of not wasting it.”