COVID vaccination program to expand to include more pharmacies

Addo-Ayensu

Virginia
health officials hope the COVID-19 vaccination process will speed up when the
federal retail pharmacy partnership expands.

So far, CVS
is getting 52,000 doses a week statewide, said Dr. Danny Avula, Virginia’s
vaccine coordinator, at a COVID vaccine town hall hosted by state Sen. Dave
Marsden, whose district covers the Annandale area; Del. Karrie Delaney (Loudoun
County); and Del. Dan Helmer (Prince William County).

According to
Avula, the number of doses in that program will be doubled, hopefully starting
late this week. CVS will get about half the doses, and other pharmacies, most
likely Giant, Safeway, and Walgreens, are getting the rest. Final details
haven’t been worked out yet, including how this program is being integrated
with state and local health departments.

It’s nearly
impossible to get an appointment from CVS as the website continually shows pharmacies, including the one in Annandale, are always fully booked. But Dr. Gloria
Addo-Ayensu, director of the Fairfax County Health Department, said that
program is helping reduce the county’s waitlist.

Federally Qualified Health Centers (FQHCs) – clinics and networks of clinics that serve the uninsured – will also be given doses starting at the end of next week, Avula said.

State vs.
county registry  

There were
several questions at the town hall about why Fairfax County chose not to
participate in the Virginia Department of Health’s (VDH) new system for
registering for vaccination appointments. Addo-Ayensu said Fairfax County might
eventually join the state system, but is waiting to make sure the kinks are
worked out and to see how it performs.

Related story: Fairfax County addresses confusion on vaccine registration

She
discourages Fairfax County residents from registering with the state, but if
people do, the state will refer them to the county system.

Some people
who registered with the county received an email saying they are automatically
on the state list. They don’t have to do anything, Avula said. The data is
being merged; if they registered with Fairfax County, they are still on the county waitlist.

Demand
outstrips supply

According to
Avula, about 1.57 million doses have been administered in Virginia since the vaccine became available in late December. More than 95 percent of first doses
are already in the database and in people’s arms.

Virginia’s vaccination program got off to a rocky start, ranking near the
bottom of states on the percentage of doses administered but has since improved. As of Feb. 22, the
state is in 16th place.

Avula

The big
winter storms that hit much of the country last week messed up vaccine
deliveries, however, so the 160,000 doses Virginia was expecting last week were
delayed, Avula said. The VDH hopes to catch up this week.

Avula
predicts it won’t be until the middle or end of April until everyone in group
1b who wants a vaccination can get one. That group includes people age 65 and
older, people with medical conditions that put them at risk of serious illness
if they get COVID, essential workers, and residents and staff of correctional
facilities and homeless shelters.

By the end of May through June, everyone else could get vaccinated, assuming increased production of the Pfizer and Moderna vaccines and approval of the vaccine from Johnson & Johnson.

Two of the COVID variants, the B.1.1.7 variant from the United Kingdom and B.1.351 from South Africa have been found in Virginia, Avula said. Both variants are more contagious. The Pfizer and Moderna vaccines are effective against the UK variant, and Moderna is studying the possibility of developing a booster for the South Africa variant. 

The state’s dual priority is to get the vaccine out fast and get it to the most vulnerable, Avula said, and to “do it fast and do it equitably.” 

VDH is
planning mass vaccination events, but “we don’t have enough vaccine to feed
those channels,” he said.

Avula
acknowledged the VDH hasn’t been able to get private healthcare providers
involved quickly enough but hopes to bring them in when the supply increases.
“They are a key part of his rollout,” as people have a trusted relationship
with their doctors.

Thousands
in the queue

The Fairfax
County Health Department’s waiting list for vacations has shrunk but there are
still  96,900 people in the queue, and
the department is still schedule appointments for people who registered on Jan. 18,
the first day people 65+ were allowed to sign up.

“The process
so far has not been as smooth as we’d like. We’re still working through some
kinks,” Addo-Ayensu said.

Half of the doses
received by the Fairfax County Health District are allocated to the 65+
population; the rest goes to frontline essential workers and people with health
conditions.

One person
who submitted a question at the town hall said he and his wife registered at
the same time and wanted to know why she was notified about an appointment and
he wasn’t.

That could
happen for a variety of reasons, Addo-Ayensu said. When Health Department staff
worked on cleaning up the data, they found a lot of errors, such as people who
put in the wrong email or accidentally typed an extra space.

Related story: Fairfax County issues new vaccine dashboard

Also, the
registration for the 65+ population opened at 9 a.m. on Jan. 18, but a lot of
people signed up between midnight and 9 a.m. At that point, there wasn’t an
option for 65+ plus, so people chose 75+ and put in their correct date of
birth. The system had a hard time reconciling that, she said.

Also, volume
was so high on Jan. 18, that the system crashed and some data wasn’t fully
captured. “As the data gets scrubbed, they are being placed back in the queue,”
Addo-Ayensu said. But as a result, it’s possible that someone who registered
later than you is getting notified earlier. [Also, it’s a good idea to check your spam folder.]

The Health
Department’s new vaccine dashboard provides a general sense
of where people are in the queue. But it doesn’t tell you when people who
registered on a certain date and time might expect to get an appointment.
People can confirm whether they registered here and sign up for an appointment here. 

When the
vaccination program expands, the pharmacies that already provide flu
vaccinations will be brought into the program, Addo-Ayensu said. The
county is also working with clinics and healthcare providers to build capacity
for when the supply increases and is planning vaccination clinics targeted
to the Hispanic population.

Health conditions

One of the
biggest challenges – and one reason for why demand far exceeds the supply – is
because so many people are in the queue who are age 16-64 and have health conditions that put them at greater risk if they get COVID, Avula said.

According to
the CDC, some of those conditions include heart disease, chronic kidney
disease, obesity, chronic obstructive pulmonary disease, and others. The CDC
also lists diseases that might put someone at risk if they get COVID, such as
asthma, cystic fibrosis, and type 1 diabetes.

Virginia
lumps all those conditions together in 1b, even though a person with leukemia
is at a higher risk than someone with asthma, Avula noted. “We don’t want
vaccinators on the ground requiring proof of a condition or a doctor’s note.”
Doing that would slow down the process of getting as many people vaccinated as
fast as possible.

Nevertheless,
Avula said, a team of professionals is considering whether there is a way to
prioritize those risks.

The Fairfax
County Health Department isn’t prioritizing certain health conditions either,
Addo-Ayensu said, but “maybe sometime down the line there could be a way to
look at priorities.”

There are
priorities listed online for different categories of essential workers. So far, K-12 school staff are on top of that list in Fairfax County.

Avoiding
waste

When asked why
many vaccine doses are wasted, Avula said the Pfizer vials were previously
rated for five doses, but some vaccinators are able to get six doses per vial
if they have the right type of syringe. 

The federal
government began shipping the right syringes, but some of those shipments were
delayed due to bad weather. In some cases, vaccinators were still getting five
doses per vial and listing the sixth as waste. In other cases, they are
vaccinating volunteers at the end of the day, so the doses aren’t wasted.

Fairfax County
reduces waste by cutting off new vials at a certain time. As the closing time
nears at vaccination clinics, vaccinators aren’t allowed to open a new vial.
They share what’s left in the vials already opened.

At the town
hall, there were complaints about why Virginia wasn’t better prepared for vaccines.
When the pandemic started over a year ago, public health officials were working
16 hours a day, trying to get enough masks, ventilators, and hospital beds, Marsden
said. Mistakes were made, but they were focused on saving lives, rather than
planning for vaccines, which at the time seemed much further down the road.

The rates of
diagnoses, hospitalizations, and deaths are declining. But COVID is still here.
“Don’t get careless,” Marsden said. “Keep your guard up.”