Nearly 1,000 advanced practice nurses worked as volunteers to roll out COVID vaccines for Florida seniors in January 2021. Credit: Florida Association of Nurse Anesthetists, January 2021
Update Jan. 22, 2021: British scientists and UK Prime Minister Boris Johnson announced tentative findings, reported in the Washington Post, that the coronavirus variant called B.1.1.7 or the “UK variant” could be more lethal than first thought. They insisted there is no indication at this time that existing vaccines are ineffective against the variant. Late Thursday in a White House press briefing, Dr. Anthony Fauci, chief medical adviser to President Joe Biden, said the B.1.1.7 variant is confirmed in 20 U.S. states. (That includes Florida.) He also said scientists are concerned that variant B.1.351 or the “South African variant,” not yet detected in the U.S., may have mutated to the extent that it is not neutralized by monoclonal antibodies that can heal patients sick with the original novel coronavirus, called SARS-CoV-2. The Wall Street Journal reported the South African variant may force vaccine-makers to update their vaccines or develop new ones. The “Brazilian variant” or P.1 has not been detected in the U.S. Reuters reports it too, is being studied to learn if current vaccines will work against it. The CDC is monitoring the variants.
Given Florida’s population — about 21.5 million — and the rate of progress of the nation’s vaccination program, odds aren’t good that many Floridians will get a COVID vaccination anytime soon.
In Miami-Dade County alone, with 2.7 million residents, it could take two years to vaccinate everyone age 18 and older at the rate things are going.
With supplies of COVID-19 vaccines far short of demand — to the shock and dismay of public health authorities in Florida and across the country — the nation’s best medical hope to extinguish coronavirus is to rapidly produce new lines of vaccines, says the head of the nation’s immunization managers.
Two new lines, from Johnson & Johnson and AstraZeneca, are close.
Johnson & Johnson is expected to seek federal emergency-use authorization for its experimental one-dose vaccine as soon as the end of next week, and AstraZeneca’s experimental vaccine, already in use outside the United States, could be ready for its debut here in late March, said Claire Hannan, executive director of the Association of Immunization Managers, a nonprofit, membership organization of public health agencies.
The emergency review process takes about two weeks, meaning the first of those applicant vaccine lines could be approved no sooner than mid-February. Manufacturing the vaccine after it gets emergency-use approval takes still more time.
The approved vaccines being administered now are made by Pfizer BioNTech and Moderna, with both requiring two doses administered a few weeks apart.
While states across the nation clamor for more vaccines, the U.S. Centers for Disease Control and Prevention reports states still haven’t administered the doses they have.
So far, Florida has administered about 1.2 million of the 2.5 million doses it has received, according to state and federal trackers.
Florida health authorities told lawmakers recently the rollout has been stymied by problems with supply and distribution. Florida hospital systems including Cleveland Clinic Florida and Baptist Health this week ceased making appointments for future vaccinations, citing insufficient doses.
With vaccines rolling out at a relative trickle, and Florida approaching a COVID death toll of 25,000, Hannan said Florida and all states must redouble emphasis on the basics of wearing masks, safe distancing, and cleanliness, while doing their best to administer the available vaccines under difficult circumstances.
She said the top problem from the beginning has been the lack of a good federal plan to help states across the country get vaccines out of boxes and into arms.
“The real root of the problem is that [distribution in] Operation Warp Speed is a military operation and they didn’t really know what to expect,” Hannan said. She praised the military effort for its expertise in logistics but said it was not the right choice for public health administration.
“They didn’t take everything into account. They didn’t factor in the last mile,” Hannan said.
The last mile — following research and development, manufacturing, packing and shipping, refrigeration, and distribution of vaccines to health providers nationwide — is shots in arms.
States trying to administer those shots report it’s hard to stage vaccination sites and schedule vaccinations when they don’t know how many doses they will receive more than six days in advance.
In Florida, the erratic weekly deliveries through Jan. 14 ranged from 179,400 to nearly 497,000, with the higher volume happening only once, said Jared Moscowitz, director of the Florida Division of Emergency Management.
Florida has administered about 49 percent of the 2.5 million doses received so far from the federal government, according to the CDC vaccine tracker.
In comparison, Texas has administered 56 percent of its 2.8 million doses, while California administered only 37 percent of its 4.4 million doses, the CDC tracker says.
While decrying the pace of supplies, Gov. Ron DeSantis on Tuesday expanded outlets for vaccine distribution to Floridians age 65 and older to include Publix pharmacies in 18 of the state’s 67 counties, capable of giving 100-150 shots per day. The counties include coastal northwest Florida, Lee and Collier, St. Johns, and Palm Beach.
By Thursday, all slots were booked. Likewise, Publix pharmacies administering vaccines in Georgia and South Carolina are fully booked.
How reliably the supply chain can deliver vaccines to the new and existing vaccination sites remains in question.
To bolster the ranks of certified vaccinators, Moskowitz said, the state hired 1,200 contract nurses to give shots, and another 900 advanced practice nurses recently joined the effort as volunteers after his Division of Emergency Management sent out a call for help.
“We are responding to the challenge and getting the vaccine. We’re building the infrastructure. We’ve created more throughput. We’ve made that adjustment,” Hannan said.
“But the allocations to the states … are stagnant,” she said. “I don’t know what the hang-up is. The transparency is not there.”
Also unclear is how many doses remain unused in Florida hospitals and how many allocated for residents and staff in Florida’s long-term care facilities still have not been administered. The long-term care program is run nationwide by the federal government, not by the states.
Dr. Anthony Fauci, a top U.S. expert on infectious diseases and now chief medical adviser to President Joe Biden, said Thursday during a White House press briefing that Biden is pushing to expand vaccine production, while reports of vaccines going unused need to be examined.
“That is something that we need to really take a close look at, because there is kind of an inconsistent discrepancy,” Fauci said. “One of the things we want to do is find out why that’s the case and if it is the case. Particularly, the thing that would be most disturbing, if there’s vaccine lying around and people are not using it when others would need it.”
At the Association of Immunization Managers, Hannan believes some hospitals continue to hold doses for inventory and that only a fraction of the doses intended for long-term care facilities across the country have been administered.
The CDC vaccine tracker says 2.1 million shots have been administered in long-term care facilities, but it doesn’t report how many doses were provided for that purpose. Hannan estimates, based on the national data she has monitored, that 15 million doses or more have been supplied to the states so far.
Moskowitz told lawmakers on Jan. 14 the state is committing about 40,000 of its weekly vaccine doses to the long-term care mission. The Florida Department of Health reported during a legislative hearing that in the first five weeks of the vaccination program, nearly 236,000 of Florida’s doses were distributed to long-term care facilities. The report doesn’t say how many doses actually were administered to residents and staff.
Hannan said CVS and Walgreens, under contract to give those shots, have found the long-term care mission more daunting than they signed up for.
Hannan hopes supply and distribution will ramp up and sync up better under the leadership of President Biden, who is aiming to deliver 100 million shots in 100 days. Biden invoked federal authority Thursday to compel greater supply and distribution of all materials needed to expand the nation’s vaccination effort.
Biden signed executive orders Thursday that include establishing federal vaccination centers in each state and designating for each state a federal liaison to address that state’s needs.
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