Iowa should receive 172,000 doses of the two COVID-19 vaccines currently under consideration for emergency use approval by the end of the month, Gov. Kim Reynolds said during her news conference on Thursday.
The FDA will issue a decision on whether to approve use of a vaccine by Pfizer on a emergency basis on Dec. 10, and is scheduled to make its decision regarding a vaccine by Moderna seven days later. Both vaccines are expected to be approved.
Reynolds brought Iowa Department of Human Services Director Kelly Garcia to the podium to provide some details about state’s plan for vaccine distribution, because Garcia is also interim director of the Iowa Department of Public Health.
Despite the ongoing pandemic, which has grown more severe in the state in recent months, IDPH has not had a full-time director since Gerd Clabaugh retired on July 31.
According to Garcia, Iowa will receive its first allotment of the Pfizer vaccine “the week of Dec. 13.”
“We will pre-position a portion of those doses at six healthcare sites,” Garcia said. “These are in major metropolitan areas.”
The Pfizer vaccine requires ultra-cold storage, -60 to -80 degrees centigrade, and the Moderna vaccine must be stored at -20 degrees centigrade, which many professional freezers can reach. Both can only be kept at refrigerator temperatures for limited amounts of time. Garcia said IDPH had identified 39 sites around the state capable of providing ultra-cold storage, and was working to identify more.
In order to make sure the vaccine is available in rural areas where no such storage is available, the state is participating in a distribution partnership with national pharmacy chains, such as CVS and Walgreens, that has been set up by the federal government.
“On the week of Dec. 20, Iowa will receive a second allocation of Pfizer and the first allocation of Moderna,” Garcia said. “And by week two, we anticipate actively deploying to long-term care facilities through the pharmacy program.”
The state will receive addition allocations of both vaccines the following week.
Vaccine distribution in Iowa will follow the guidance provided the CDC’s Advisory Committee on Immunization Practice (ACIP). The first groups slated to receive vaccines are frontline healthcare workers, residents of long-term care facilities and the staff that provide direct care for them.
“Going forward, while ACIP has provided clarity on these priority populations, we will convene a team of external and internal subject matter experts, known collectively as the Infectious Disease Advisory Council, or IDAC, to provide additional clinical guidance,” Garcia explained. “This council will assist the state in developing COVID-19 vaccine prioritization of population for early stages of vaccine response, when supply is limited.”
“This group will bring together ethical and clinical expertise from across the state to represent multiple perspectives, including rural and urban populations, hospital administration, infectious disease specialists, vulnerable populations in congregate settings, advocates for aging populations and individuals with intellectual and developmental disabilities and refugees.”
“The reason for this is to minimize health inequities, based on geography, poverty and other social determinates,” Garcia said.
Garcia said more information regarding IDAC would be made available soon.
“As more COVID-19 vaccine becomes available, additional populations will be added and more people will be able to receive the vaccine,” the director said. “We anticipate that by mid-2021, there should be enough vaccine available for anyone who want to receive it.”
On Wednesday, during a webinar about COVID-19 vaccines sponsored by Project Better Together, Dr. Mike Brownlee cautioned, “The logistics around this are very challenging. We’re not going to be able vaccinate a large number of people very quickly. It’s going to take time.”
Brownlee, associate director and chief pharmacy officer at the University of Iowa Hospitals and Clinics, was joined by Johnson County Public Health’s Community Health Division Manager Sam Jarvis for the section of the webinar devoted to vaccine distribution.
“From our perspective at UI Health Care as healthcare providers, we’re ready in that first wave to start the vaccination, we’re ready for that storage and we’re ready to partner with Johnson County Public Health and Iowa Department of Public Health to help support us in getting vaccine out and maximizing the uptake of vaccine,” Brownlee said. “Not just in Johnson County, but in the state of Iowa.”
Jarvis said Johnson County Public Health had begun working on plans for vaccine distribution with state agencies and local partners in mid-September.
It has been “quite the challenge keeping everyone on the same page” as information changed on an almost daily basis, Jarvis said.
The plan is to use existing vaccine distribution practices, such as the drive-through flu shot clinic the county conducts at the Johnson County Fairgrounds each fall, to vaccinate people against COVID-19, Jarvis said. The drive-through clinic utilizes a large building at the fairgrounds, so weather isn’t an issue and people don’t have to exit their vehicles to get the shot, thereby minimizing contact and limiting the potential spread of the virus.
For long-term care facility residents who cannot make the trip to a site like the fairgrounds, the pharmacy partnership will deliver the vaccines to them, Brownlee said.
Brownlee explained that both the Pfizer and the Moderna vaccines require two doses before reaching maximum effectiveness. For the Pfizer vaccine, the two shots should occur at 21-day intervals, and for the Moderna, 28-day intervals.
According to clinical trial data, the vaccines reach their highest efficacy seven to 14 days after the second injection, Brownlee explained.
Asked how much protection the first dose of the vaccines is likely to provide, Dr. Patricia Winokur, executive dean of UI’s Carver College of Medicine and the principal investigator for the Pfizer vaccine trial conducted at UIHC, said “It might be enough to truncate the severity of disease, but I don’t think it going to be enough to really limit the spread from person to person.”
Winokur, Jarvis and Brownlee all emphasized that people will need to continue to wear masks and social distance, and maintain other virus mitigation practices as the vaccination program continues. Brownlee pointed out that children will not receive these vaccines — neither has been evaluated as to whether they are safe for children — so children will remain a potentially potent source of virus spread.
And Winokur reminded viewers that even if a vaccine is 95 percent effective, that still means it won’t provide much help for some people.
“Remember, too, that the vaccine is not perfect,” she said. “So, especially in some of those vulnerable people that COVID-19 can be a very devastating illness, we’ll have to be very careful.”
“We’re going to have to really get this pandemic under control before we can move away from the masks.”