Vaccine Q&A: How can I get an appointment? Why are smokers prioritized?

A state adviser answers these and other questions on the COVID-19 vaccine and New Jersey’s vaccination program
Credit: (AP Photo/Ted Shaffrey)
Jan. 20, 2021: Moderna COVID-19 vaccine being administered at International High School in Paterson, the city’s walk-in site which on that day drew several hundred people, some of whom had lined up at 4:30 a.m.

Two months into New Jersey’s COVID-19 vaccination program, more than 1 million shots have been administered and some 242,000 people have received the two doses needed to provide maximum protection. The program first targeted health care workers and long-term care residents and staff, and has since grown significantly, so that demand for vaccines now far outpaces the supply provided to the state by federal officials.

The enormous public interest in the program has largely overwhelmed the state’s multi-faceted, decentralized vaccination registration system and caused growing frustration among those trying to schedule an appointment to be immunized. State officials created a telephone hotline, which has been swamped with calls since it opened several weeks ago.

New Jersey residents have lots of questions about the COVID-19 vaccine, including how they can get it. Some are also curious about the vaccines themselves, following former President Trump’s efforts to politicize their development; and they question the speed at which vaccines were tested and authorized for emergency use. Others wonder why the state made the choices it did to prioritize access for certain groups, like cigarette smokers.

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Dr. Eddy Bresnitz

NJ Spotlight News hosted a virtual roundtable in late January at which several policy experts discussed the state program and what remains to be done, particularly to ensure vulnerable communities have access to immunizations. The conversation included Dr. Eddy Bresnitz, who once served as the state epidemiologist and has returned to advise the health department during the pandemic.

To continue that conversation and help others navigate the state’s process, Bresnitz answered additional questions submitted by audience members before and during the online event. Below are his responses to a dozen of the most pressing queries raised:

Question: When it comes to the priority groups, why is a 20-year-old smoker equal to a 90-year-old nonsmoker?

Answer: I understand why this may sound like an unfair comparison, but there is a rationale for including smokers in the priority group. A Jan. 25 article in the Journal of the American Medical Association — Internal Medicine (JAMA), found that people who smoke or who have smoked in the past are more likely to be hospitalized or die from COVID-19 than people who have not or never smoked. Smoking may compromise a person’s ability to mount the appropriate immune response against infections.

Additionally, smokers are more likely to have other diseases such as hypertension, heart disease and chronic obstructive pulmonary disease or COPD, which are all linked to poor health outcomes. The JAMA article found that persons who smoked more than 30-pack years (multiply the number of packs smoked per day times the years of smoking) have 2.25 times higher odds of being hospitalized and were 1.89 times more likely to die than those who never smoked.

The Centers for Disease Control and Prevention (CDC) has included smokers on their list of high-risk medical conditions for COVID-19, without distinguishing age as a further factor.

We have heard a lot of judgment about including smokers, but we need to focus on the science and what the research shows are high-risk groups who should be prioritized to be vaccinated.

Q: Why do some counties have more vaccines than others?

A: During this time of scarce vaccine allotments, factors taken under advisement when considering vaccine distribution are the population size of the county, the disease burden of the county population, vaccine coverage of the county population, and other factors that increase vulnerability of the county population.

Q: What is the most efficient way to get an appointment? Many of us are spending one to two hours a day checking websites and making futile calls, where you get stuck on hold or cut off.

A: Currently, over 4 million people are eligible for the vaccine in New Jersey with limited doses available each week. With demand currently exceeding supply, we know that it will take more time than we want for all those who are currently eligible, and those who will become eligible, to get vaccinated.

New Jersey has many locations for eligible persons to get vaccinated. However, many of the sites have their own websites to make appointments. While this may not be ideal, it is the system in place.

Eventually the vaccine will be available to everyone who wants it in New Jersey, which is using a phased approach to ensure a fair and equitable distribution. As more and more doses become available, more appointments will become available.

As the governor recently announced, CVS and Rite Aid will be opening retail locations in the coming weeks, bringing additional vaccine into the state.

If you are eligible to receive a vaccine based on current state policy, you can make an appointment directly with one of the many designated vaccination sites across the state. The list of these sites is available on the COVID-19 information hub at covid19.nj.gov/vaccine.

You can pre-register for the vaccine on the NJ Vaccine Scheduling System. Register here. You will be notified when you are eligible to make an appointment. If you need assistance pre-registering and making an appointment, contact the vaccine call center at 855-568-0545.

Q: When can we expect a vaccine suitable for children?

A: Several companies have begun enrolling children as young as 12 in COVID-19 vaccine clinical trials. Results will hopefully be available by the summer. Some manufacturers are planning studies including children under 12 to begin over the next few months.

Q: What are the plans to vaccinate homebound people or those who do not have transportation to the mega-sites or other clinics, like homeless individuals?

A: Homebound: The homebound population is a challenge with the current vaccine supply and the complex storage and handling requirements of both vaccines. All partners are working toward a solution. We remain hopeful with information about the new vaccines that may be available on the near horizon as possible solutions.

Homeless: New Jersey agencies are working with shelter operators to plan vaccination of residents of shelters. This includes education, pre-registration in the New Jersey Vaccine Scheduling System, and vaccination via pop-up and mobile clinics.

As announced at the governor’s recent briefing, New Jersey is also working with commercial pharmacies such as Rite Aid and CVS to begin to provide vaccination to eligible people. These pharmacies are in many neighborhoods, and in many cases within walking distance of vulnerable populations.

Additionally, New Jersey is working with faith communities to host vaccine clinics in churches and community centers. As vaccine supply increases, more vaccination options will become available.

Q: Will doctors be permitted to vaccinate patients in their office, particularly special needs patients — like autistic children — who have developed a particular rapport with their provider?

A: Currently, one COVID-19 vaccine is authorized for persons 16 years old and older and another for adults 18 and over. The two vaccines currently available have storage and handling requirements that most private providers are unable to accommodate, such as ultra-cold storage and administering multiple doses within a shortened time frame. The goal is to vaccinate as many people as efficiently as possible, which is why COVID-19 vaccines are not yet available in sites such as primary care physician offices.

As additional vaccines become available with more manageable storage and handling requirements and expanded indications, private practice physicians will be able to become COVID-19 vaccine providers and administer vaccine in their offices to adult and pediatric populations.

Q: What is the state doing to make sure the vaccine is equitably distributed, so those most adversely affected by COVID-19 have real access to immunizations?

A: The first strategic aim of New Jersey’s vaccination plan is to provide equitable access to all who live, work, and/or are educated in New Jersey. The state is committed to equitable vaccine access for previously underserved communities who have been disproportionately impacted by COVID-19. The Department of Health has an evolving Vulnerable Populations Plan that involves partnership with places of worship, senior centers, community centers and local health agencies. We are also training community health workers to provide education and access to vaccination through pop-up, mobile, and possibly door-to door vaccination in cities hard-hit by COIVD-19. The plan uses the same strategy we used to ramp up COVID-19 testing in our urban centers.

New Jersey is purchasing mobile vans that will be dispatched to neighborhoods for testing and in the future, possibly vaccination. As you know, the two vaccines that currently are approved and being administered have certain storage requirements that present challenges outside of a very controlled setting. We are hopeful for additional COVID-19 vaccines that may be easier to administer in a mobile or pop-up clinic setting.

Q: How is the state addressing vaccine hesitancy, particularly among communities predominated by people of color.

A: New Jersey is using a phased approach to vaccination to ensure that limited vaccines are distributed in a fair and equitable manner. The department has conducted numerous listening sessions/focus groups with diverse communities to learn how to best address immunization barriers and vaccination concerns, such as vaccine hesitancy. Direct outreach to these communities has been underway over the last few months to work with community leaders about how to best offer vaccination.

To reduce access barriers, New Jersey is working with community leaders to set up mobile units and local pharmacies to ensure vaccinations are available in underserved communities.

As part of our statewide public awareness program, the DOH along with our vendor, Princeton Partners, has produced a series of videos and digital ads featuring physicians and nurses of color on social media and YouTube. There are also three virtual town halls scheduled this month. On February 11th, we will be hosting a town hall geared toward African American and Caribbean communities; on the 15th we will address the Latinx community, and a Spanish-only virtual town hall is also planned.

Q: What are the long-term effects of the vaccine? Will we need to get it every year, or every other year?

A: Both this virus and the vaccine are new. We don’t know how long protection lasts for those who get infected or those who are vaccinated. What we do know is that COVID-19 has caused very serious illness and death for a lot of people. If you get COVID-19, you also risk giving it to loved ones who may get very sick. Getting a COVID-19 vaccine is one of the tools that we have to prevent illness. The vaccines currently authorized for use have gone through rigorous studies to ensure they are efficacious with a favorable safety profile.

Q: If you’ve had COVID-19, do you still need to be vaccinated? How long after you test positive should you wait to get a shot?

A: Great question. The answer is yes, we are recommending that anyone 16 and older and is eligible consider getting vaccinated if they have previously had COVID-19. Current evidence suggests getting the virus again (reinfection) is uncommon in the 90 days after the first infection. A person may delay getting vaccinated for 90 days after being diagnosed with COVID-19 to get the vaccine.

Q: What percentage of the public must be vaccinated before it is safe to reopen businesses? What percentage is needed for full community protection?

A: Experts do not yet know what percentage of people would need to get vaccinated to achieve community protection (also referred to as herd immunity) to COVID-19. The Centers for Disease Control and Prevention and other experts are studying this and will provide more information as it is available.

Some experts have estimated that at least 70% or more of the population needs to be vaccinated to achieve community protection.

Q: When will the general population be eligible for a shot and when do you expect they can actually get vaccinated?

A: At this time, we are awaiting more doses of the vaccines to be manufactured and distributed and additional vaccines to receive FDA Emergency Use Authorization from the Food and Drug Administration.

New Jersey has vaccination infrastructure in place across the state (mega-sites, hospitals, community health centers, local health departments, commercial pharmacies and more) and is working with the federal pharmacy program to vaccinate residents and staff in long term care facilities. As soon as more vaccine becomes available, the state will open additional vaccination sites.

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