COVID-19 vaccination plan relies on public and private health providers

First look at state proposal raises questions, such as how providers will maintain its unflagging pace over six months to protect 70% of residents
Credit: (AP Photo/Hans Pennink, File)
Nurse gives volunteer an injection as part of a study of a possible COVID-19 vaccine in New York state.

New Jersey will rely on a network of public and private health care providers to immunize millions of residents over the next year or so, according to a draft COVID-19 vaccine plan state officials released early this week.

Gov. Phil Murphy said Monday work on the proposal began in earnest in July and continues today as members of the state’s Vaccine Task Force seek to refine the plan, which was submitted for federal approval in mid-October. Whenever a vaccine is approved for emergency use — possibly by the end of 2020 — and distributed to the states, Murphy promised, “We will be ready.”

The state’s goal is to vaccinate 70% of the eligible population — all adults who are not pregnant — within six months of the vaccine being widely available, something that might not happen until late March 2021. The plan does not say how large this group could be, but according to calculations made by NJ Spotlight News based on population figures and birth data, it would be roughly 4.76 million people. The state Department of Health has $6 million in new funding to establish an office to oversee the task. Since March, nearly 233,000 New Jerseyans have tested positive for the disease, including at least 16,300 likely killed by the coronavirus.

Murphy’s strategic goals

“Our strategic aims are threefold,” Murphy said at his media briefing Monday. “One, to provide equitable access to a vaccine. Two, to achieve maximum community protection. And three, building public trust in not just a COVID-19 vaccine, but the vaccines that can protect residents from other potentially debilitating and deadly illnesses.”

Building trust is likely to be a challenge, in part due to widespread concerns about political interference in the approval process for a COVID-19 vaccine. New Jersey has also witnessed intense opposition from a vocal minority of vaccine skeptics, who flooded the State House late last year to beat back a proposal to expand compliance with school-based vaccine requirements.

The 181-page preliminary plan outlines the administration’s intentions, details the history of its pandemic response and maps the multiple provider resources that will be involved in distributing and administering the vaccine. But questions remain about the timeline and targets, and additional funding will be needed to carry out the mission, officials said. Evolving federal guidance could also alter the preliminary strategy, the document notes.

Here are highlights of what we know — or don’t know — about the plan.

Who will go first?

Among the key goals of the task force was to identify who will be considered a priority for the new vaccine, since immunization kits will be shipped by a federal distributor in batches and are likely to be limited at first. Using an approach outlined by the federal Centers for Disease Control and Prevention, which provided a template for all states to develop their plans, New Jersey expects to phase in its immunization program to ensure those most in need get vaccinated first.

Phase 1 — which has two subgroups — addresses individuals who are vulnerable as a result of their work, health or housing status.

Phase 1A includes roughly 500,000 health care workers with the highest risk of coronavirus exposure, whether they work at hospitals, nursing homes, doctors’ offices, ambulance squads or for local public health agencies.

Phase 1B includes other essential workers — estimated to top 776,000 people — like law enforcement, government officials, farmworkers and those with jobs in food production, transportation and the energy sector. It also extends to nursing home residents or seniors living at home, another 1.5 million citizens. An estimated 2.6 million residents with chronic conditions that make them particularly at risk for COVID-19, like lung problems or obesity, would also be eligible for vaccines in this phase.

Some of these categories overlap — an essential worker may have chronic conditions, for example, or be over 65 — and the state’s plan estimates more than 1 million people are likely double-counted in Phase 1B. When they are subtracted, state officials estimate nearly 4.27 million people will need to be vaccinated in Phase 1 alone.

Remaining state residents are eligible under Phase 2, which will begin once the program’s first phase is complete, according to the plan, and only when vaccines are no longer in short supply. Flowcharts show another 4.6 million-plus citizens will be inoculated under Phase 2. Between the two phases, nearly 8.9 million New Jerseyans would be protected, based on the plan.

It is not clear why the plan appears to account for all residents, not just non-pregnant adults, or at what point the state will have met its goal of immunizing 70% of eligible adults.

Phase 3 also raises questions. It is described in the document as a time of “likely sufficient supply (with) slowing demand” and is designed for anyone who still wants a vaccine but has not been immunized. However, flowcharts in the document do not include a third phase, and no target population numbers are provided for it.

“New Jersey recognizes that there may be a mismatch between vaccine supplies and public demand, so these factors may inform when New Jersey progresses between Phases: federal guidance, vaccine availability, time, public uptake, coordination across jurisdictions,” the plan notes.

Where will people get vaccinated?

The plan features dozens of maps with potential places to get the vaccine, including hospitals, federally funded health centers, urgent-care facilities, county and regional public health agencies, doctors’ offices and pharmacies, among others. In all, state officials appear to have identified more than 2,600 possible immunization sites. The graphics underscore that while citizens in Bergen and Hudson counties can find a location for the vaccine close to home, residents of Sussex or Salem counties may need to cross the county to get vaccinated.

Not all vaccine distribution points will be operating at the same time, the plan notes, but facilities will be opened as needed to support the phased-in approach and public demand. For example, hospitals may first be used just to vaccinate health care workers, with private pharmacies or government-run sites coming online for other groups later. Identifying proper storage is also a complication, as the vaccine may need to be kept cold, or near-frozen, before it is administered.

Planning assumptions in the document suggest that the state’s 18 smaller hospitals, with fewer than 200 beds, will be tasked with the highest volume of vaccinations, administering as many as 400 doses per day, per site, six days a week for six months. Larger acute-care facilities are slated to provide between 50 and 200 doses over that period, depending on their size and other factors, and chain pharmacies are estimated to administer up to 100 daily doses. County health programs, previous COVID-19 testing sites and community clinics are slated for between 30 and 50 vaccines daily, also six days a week for six months.

How quickly will this happen?

The timeline is hard to pin down, due in large part to the uncertainties of the federal vaccine-review process; several pharmaceutical companies have had to halt the trials to review adverse impacts, adding to the unpredictability. State Department of Health commissioner Judy Persichilli has called her goal of getting 70% of the eligible population vaccinated within six months “inspirational,” noting that roughly half of New Jerseyans get annual flu shots.

The DOH said the clock won’t start ticking on widespread distribution until there is sufficient vaccine in stock, something that could take several months after emergency approval. When that time comes, Persichilli has said clinicians will need to vaccinate about 81,000 people a day, five days a week, for six months, or about 3,200 a day in each county, five days a week, for six months. DOH said it is working on the assumption that each individual will need two doses for full protection, a factor that will require additional public outreach and careful record-keeping.

However, it is not clear how state officials came up with those two scenarios, which produce significantly different results, neither of which appear to square with the figures listed in the plan’s flowcharts. A DOH spokesperson declined to elaborate on Persichilli’s comments or explain the calculations she outlined.

The draft plan does identify who will likely do this work, and the pace they need to keep to meet the state’s goals. Clinicians at vaccine distribution sites slated for high-volume vaccination — which depends on the facility, phase and target population — are expected to inoculate 12 people per hour, six days a week for that six-month period; clinicians at “low-throughput” operations will need to conduct six vaccinations per hour, five days a week.

Officials estimate that more than 150,000 health care professionals currently hold licenses that would enable them to vaccinate people under this program and predict more than half of the work will fall on the state’s 80,000 registered nurses.

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