Three million dollars for public outreach. Nearly $2.5 million for refrigerators and thermometers. And more than $71 million for mass vaccination clinics, where hundreds of thousands of Virginians could be immunized against COVID-19.
Virginia’s plan, released to the Mercury Friday, shows the size and scale of a public health campaign designed to protect millions against a historic virus. The plan was submitted to the federal Centers for Disease Control and Prevention for review this week and remains “a living document as more information is understood, more vaccines are introduced, and any other considerations develop,” wrote Joseph Hilbert, the Virginia Department of Health’s deputy commissioner for governmental and regulatory affairs, in a Friday email.
But the plan also underscores many of the factors that health workers will contend with when it comes to distributing any future vaccine. While VDH is preparing for a potential Nov. 1 release — a date requested by the Trump administration after the president suggested a vaccine could be ready as early as this month — there’s “no absolute guarantee” of when any safe and effective immunization will be approved by the U.S. Food and Drug Administration, said Christy Gray, the director of the department’s division of immunization.
Federal health officials have called a release before Election Day “very unlikely.”
What’s clear is that vaccination will be incremental and unprecedented compared to any previous disease outbreaks within the last decade. Virginia developed pandemic influenza planning more than a decade ago during the H1N1 swine flu outbreak — plans that have informed some of the state’s current coronavirus procedures.
But those mass vaccination efforts were still significantly different than what’s required for the COVID-19 pandemic — a potentially deadly virus that places certain types of people, including the elderly and infirm and those with other health conditions, most at risk. Virginia’s plans call for health experts to consider infection control measures at immunization sites, raising the possibility of drive-through clinics or events at large indoor venues that leave room for social distancing.
There are also significant outstanding questions about the vaccine itself, including how many doses will initially be available. While the federal government will determine how much of the vaccine is distributed to Virginia, according to the state’s planning document, health officials are planning a phased approach under the assumption that only limited amounts will be available when it’s first released.
The initial planning scenario tasks state officials with developing priority groups for the first distribution. Under the state’s plan, those include residents at long-term care facilities — which in Virginia account for nearly 50 percent of the state’s total COVID-19 deaths, according to VDH data — as well as health care workers and “people who play a key role in keeping essential functions of society running and cannot socially distance in the workplace.”
Those positions have yet to be determined, but could include first responders, teachers and childcare providers, according to the state’s planning document. Priority consideration will also be given to other high-risk groups, including Virginians aged 65 or older, people of color — who have also been disproportionately affected by the virus — and people living in congregate living facilities such as prisons, homeless shelters, or even college campuses.
“In the event that Virginia’s allocation during Phase 1 is insufficient to vaccinate all those included in the initial populations of focus, it is important for the Virginia Unified Command to identify and estimate the subset groups within these initial populations of focus to determine who will receive the first available doses of COVID-19 vaccine,” the plan reads.
More than 20 different divisions and agencies have a role in the 60-page document, including the Virginia Department of Education and the State Council of Higher Education for Virginia, which are expected to coordinate with local health departments on immunizing students and employees at K-12 schools and college campuses.
The plan calls for nearly $121 million in total spending for vaccination efforts, including more than $3.3 million for supplemental supplies such as Band-Aids, syringes and needles. The state anticipates paying nearly $40 million for a pharmacy benefits administrator to manage claims for un- and underinsured patients and distribute payments to pharmacies and other community providers for administering vaccines.
The vaccine itself will be supplied to the state free of charge, but the CDC says that administrative costs will likely be shouldered by state and local governments. Providers must vaccinate patients regardless of their insurance status or ability to pay.
VDH will distribute money to local health departments to assist with mass vaccination, according to the plan. But it’s still not entirely clear how the state will fund the effort. Virginia Finance Secretary Aubrey Layne recently said that roughly $700 million in remaining federal CARES Act money could go toward the state’s immunization campaign.
Gray said another complication could be the dosages for any future immunization. Many of the vaccines currently under trial will require two doses, “separated by 21 or 28 days,” according to the plan.
“Those vaccines are not interchangeable with each other, so that’s another consideration that wasn’t necessarily the case during any previous disease outbreaks,” she added. In other words, if patients receive an initial dose of a vaccine from a certain pharmaceutical company, their doctor, pharmacist or local health department will need to follow up with them to make sure they receive a second dose of the same vaccine within a certain timeframe.
It’s an effort that requires massive coordination and also the involvement of doctors across Virginia. The state’s planning document encourages patients to be immunized at their “medical home” whenever possible, and describes the early recruitment of doctors as one of the most important early factors in mass vaccination.
Earlier this month, Virginia Health Commissioner Dr. Norman Oliver sent a letter to providers asking them to register with the state if they planned on distributing a COVID-19 vaccine. Dr. Sandy Chung, a Northern Virginia-based pediatrician and president of the Virginia chapter of the American Academy of Pediatrics, said most primary care physicians already have experience in giving out vaccinations to large number of patients, but the state is likely hoping to recruit nontraditional providers such as school systems or large employers.
“I think that’s what they’re trying to assess — which health care providers are able to do this or willing to do this,” she added. “They need to know who’s ready.”