Roy Exum
On October 16, Tennessee joined every other state in the Union as all the United States presented an “Interim COVID-19 Vaccination Plan” to our Centers for Disease Control & Prevention. The reason the word ‘Interim’ is in the plan’s title is because two months ago nobody could have predicted the first vaccines would start being shipped to most of the states this week. Right now, there are two primary vaccines with a 90+ percentage rate of early success. Tennessee is expected to get vaccines from jet-quick laboratories of pharmaceutical giants Moderna and Pfizer, with a third promising version from AstraZeneca coming very soon. Additionally, there are currently also almost 30 other COVID vaccines well into clinical trials that could greatly accelerate the distribution process in the coming months.
The horrifying bad news is that CDC chief Robert Redfield is warning that the next three months will be “the most difficult time in the public health history of this nation.” Currently 285,000 Americans have died in the last nine months from the coronavirus and that number could actually double in just the next 90 days. Do you realize every hospital in the nation is almost full! Get this – The John Hopkins Coronavirus dashboard is revealing there are an astonishing 14,784,555 active cases in the United States this very minute (6 p.m. Sunday) and that includes about 160,000 new cases in the last 24 hours.
Believe this with all your heart: COVID has never been as lethal as it is right now. Face masks, social distancing, and constant hand washing (with real soap and very warm water, please) has never been as urgent nor as immediate as it is today. Yes, we are tired of the disease, worn out by constant warnings, but health experts assure us it is almost as though the evil forces within the virus know the vaccines are being shipped and want to kill at least a half-million Americans before the vaccines finally stifle its ruin.
I agree that your freedom assures you do not have to wear a face mask, but I also deeply believe if you follow common-sense protocol it satisfies your moral obligation to your fellow man; your personal actions could protect him and his family in the very best way you possibly can. The earliest vaccines will require two doses with 21-28 days in between. And scientists believe the first dose will do little to impede the virus before the following second half of the vaccines can be given. Look at the time clock – we are still months away from the life we love. Refuse to give up an inch in this ‘fourth quarter’ against terror and in the words of Patriots’ coach Bill Belichick, “Just do your job!
There are already wild, irresponsible, and very untrue rumors flourishing as fast as COVID. One of the most absurd is that the vaccines will all have a secret additive that will identify those who have taken the medicine; these gamblers will glow green in front of some sort of magic light. That’s preposterous. Another is that only white people will get “the real vaccine” to abolish minorities or, even more unbelievably “get even with this summer’s rioters.”
And then there is this very true yet saddening excerpt from a Page One story on the Alabama newspaper group’s AL.com website on Sunday morning:
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“YOU DONE SCARED THEM TO DEATH”
[NOTE: This excerpt is from a story entitled, “Here comes the vaccine. But will Alabamians take it?” The story was written by staff writer Sarah Whites-Koditschek and appeared on the AL.com website on Sunday, Dec. 6, 2020.]
Perman Hardy said she lost more than ten family members to COVID-19 this year. The virus continues to devastate her rural, Black Belt community in sudden and unexpected ways.
“It’s been hitting my family right and left. I’ve been having death in my family going on, looks like every month, every week. It’s raining,” she said of the aunts, uncles, and cousins who’ve died in Lowndes County. [NOTE: Located at bottom of the state, Hayneville is the county seat, and of the 12,000 who live in the poverty-ridden rural county, blacks outnumber whites 4-to-1. It is 24 miles southwest from Montgomery]
Yet Hardy, who is a retired home health aide and community organizer for rural sewage and sanitation issues, sees hope ahead. Vaccines are on the way. But, to her chagrin, her sisters and friends at risk say they won’t take the shot.
“Yes, they’re scared, I’m not going to tell you they’re not scared,” she said, pointing to a lot of uncertainty and disinformation. “You got top authorities talking about this and that. A lot of people don’t have access to a lot of information as is, and you done scared them to death.”
Alabama’s top health experts and community leaders are gearing up for a distribution effort they say is unprecedented and presents huge challenges. The stakes are enormous: ending the pandemic and saving lives.
“With all the great expertise we have, nobody has ever tried to handle a (vaccine rollout) of this magnitude,” said State Health Officer Scott Harris. “There’s just so many moving parts.”
Rural states like Alabama now face unique obstacles, such as the need for expensive, specialized equipment. Pfizer’s vaccine, the first slated for FDA approval December 10, requires storage in an ultra-cold freezer. The doses will arrive in massive quantities that must be used in a matter of days, creating a unique challenge that only a handful of hospitals are equipped to meet.
Those restrictions may make it harder for people who want to get a vaccine in Hardy’s part of the Black Belt in the months ahead. Lowndes County has no hospital and around fifteen percent of the population lacks a car. “If we can’t get mobile testing, how will we get vaccine?” she asked.
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Here is a summary of the response that Tennessee filed with the CDC in October. For a more detailed explanation and accompanying information, please go to https://covid19.tn.gov/
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TENNESSEE’S INTERIM COVID-19 VACCINATION PLAN
The SARS-CoV-2 virus that causes COVID-19 has resulted in the deadliest pandemic to strike the world since the Avian Influenza pandemic of 1918. No living person on earth has memory of an infectious disease event of this magnitude. We are truly in uncharted waters.
The impact of this virus upon our physical and mental health, economic stability, and societal functioning cannot be overstated and, while the virus has touched every individual to some degree, Tennessee's minority and rural underserved populations have suffered disproportionately. This virus has taught us that its ability to inflict morbidity and mortality should not be underestimated and that any plans put in place to mitigate its spread must be nimble.
The Tennessee Department of Health (TDH), in coordination with State and local agencies, submitted an initial draft of the COVID-19 Vaccination Plan for Tennessee to the Centers for Disease Control and Prevention (CDC) on October 16, 2020. While this document provides an overview of the allocation, distribution, documentation, and communication of COVID-19 vaccine across Tennessee, this is an iterative process [NOTE: An ‘iterative process’ is simply a series of steps that you repeat, tweaking and improving your product with each cycle. In practical terms, think of it as practice to make your product perfect.] and the plan will be modified as more is understood about the virus and the vaccines that are in development to defeat it.
Above all, the People of Tennessee should be assured that no COVID-19 vaccine will be released in Tennessee unless the research demonstrates its safety and efficacy in preventing infection, lessening morbidity, and mitigating the spread of the virus.
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PHASED APPROACH TO COVID-19 VACCINATIONS
After careful review of the CDC’s COVID-19 Vaccination Program Interim Playbook for Jurisdictional Operations and the National Academies of Sciences, Engineering and Medicine’s (NASEM) Framework for Equitable Allocation of COVID-19 Vaccine, as well as consultation with the Unified Command Group and a stakeholder group comprised of more than 28 partner agencies and offices, the following preliminary structure has been adopted for the allocation and distribution of COVID-19 vaccines:
* -- 5% of the State’s allocation of COVID-19 vaccines will be distributed equitably among all 95 counties
* -- 10% of the State’s allocation of COVID-19 vaccines will be reserved by the State for use in targeted areas with high vulnerability to morbidity and mortality from the virus
* -- 85% percent of the State’s allocation of COVID-19 vaccines will be distributed among all 95 counties based upon their populations. Populations will be prioritized based upon risk of contracting and spreading the virus, as well as the risk of morbidity and mortality from COVID-19. Tennessee plans four allocation phases, based upon risk, and informed by the NASEM’s Framework and the Stakeholder Group:
* -- Phase 1a: Frontline healthcare workers, support staff, and first responders
* -- Phase 1b: Other healthcare workers
* -- Phase 1c: Individuals with high-risk comorbidities and older adults in congregate care
* -- Phase 2: K-12 and childcare staff, individuals with moderate-risk comorbidities, adults in congregate care, critical infrastructure employees.
* -- Phase 3: Young adults, children, industry
* -- Phase 4: All others
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CRITICAL POPULATIONS
TDH plans to utilize state and national data sources, CDC’s Tiberius application, and Geographic Information System (GIS) mapping to locate and map identified critical populations in Tennessee, including health care personnel and other essential workers, residents and staff of congregate care facilities, individuals with underlying medical conditions, or of age, disability, racial, and ethnic minority groups or other vulnerable populations, that place them at higher risk for severe COVID-19 illness and death.
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COVID-19 VACCINATION PROVIDER RECRUITMENT & ENROLLMENT
TDH is working to rapidly recruit and onboard hospitals, pharmacies, clinics, and other partners capable of storing vaccine and administering it to priority populations. These partners are required to sign the CDC’s COVID-19 Vaccine Provider Agreement and Profile, demonstrate their ability to store vaccine under the required conditions, and establish a process for reporting all administered doses of vaccine to the Tennessee Immunization Information System (TennIIS) within 24 hours of administration. Special attention is being given to ensure distribution of vaccination sites across all 95 counties, especially in rural counties and those areas with high concentrations of vulnerable populations.
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VACCINE STORAGE & HANDLING
Cold chain maintenance at provider locations will require appropriate vaccine storage and temperature monitoring equipment, trained staff, and consistent, accurate inventory management to ensure the integrity of the vaccines.
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COVID-19 VACCINATION ‘SECOND DOSE’ REMINDERS
Most vaccines currently under development are two-dose vaccines, with doses separated by 21 to 28 days. As initial research suggests little protective immunity after receipt of the first dose, it is critical that all individuals receiving the first dose of a two-dose series receive the second dose. TDH will work with vaccinating providers to ensure notices are sent to individuals who are coming due, or overdue, for their second dose. These notices will be provided through text message reminders and other communications that encourage individuals to complete the series.
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COVID-19 VACCINATION PROGRAM COMMUNICATIONS
Tennessee will leverage relationships with healthcare associations and medical providers and use existing communication platforms to ensure vaccination program communications reach appropriate audiences as quickly as possible.
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COVID-19 VACCINATION “SAFETY MONITORING”
Vaccinating providers are required to report vaccine adverse events to the federal Vaccine Adverse Event Reporting System (VAERS). Reports made to VAERS will be reviewed by TDH to ensure appropriate investigation and follow-up.
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COVID-19 VACCINATION “PROGRAM MONITORING”
TDH will ensure ongoing progress of COVID-19 Vaccination Program implementation through the tracking of provider enrollment, mapping of the locations of vaccination services with respect to the location of priority populations, monitoring of the performance of the Tennessee Immunization Information System, and tracking of vaccine ordering and distribution.
royexum@aol.com