The rollout of COVID-19 vaccines nationwide has been slower than expected and marred by stories of logistical foul-ups and in at least one case in Wisconsin, even sabotage.
Dr. Anthony Fauci, a top infectious disease expert and head of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told National Public Radio earlier this week the holidays likely contributed to the slower-than-anticipated administration of vaccines but that communities are likely to catch up in coming weeks.
Wyoming early this week hadn’t yet used 35% of the vaccines delivered to the state, but by Friday had climbed above the national rate, having administered nearly 47% of all doses available in the state. Officials across the state say things are beginning to pick up after the holidays. Some communities have even announced dates for public vaccination clinics open to members of early priority groups.
Who’s getting it and who gets it next
Vaccinations for health care workers, long-term care residents and emergency responders in Wyoming is well underway, with many counties reportedly preparing to vaccinate the next phase of priority residents in the coming week.
The Wyoming Department of Health, in line with recommendations from the CDC, has outlined which groups of people will be prioritized while a limited supply of vaccines are available.
The phases are layered, with 17 subgroups included in Phase 1a, and 11 included in Phase 1b.
Phase 1a covers health care workers and emergency responders, as well as residents of long-term care facilities. (Sixty Wyoming long-term care facilities have opted into a federal program to vaccinate their residents, so local health departments won’t be required to include those locations.)
Phase 1b is a larger phase than 1a. It covers additional emergency response personnel, a litany of front-line workers and anyone 70 years old or older. Some counties have opted to start smaller, limiting doses to those 80 years old or older.
“These demographics are huge,” said Dr. Andy Dunn, Wyoming Medical Center Chief of Staff and one of the physicians leading the vaccination efforts county-wide.
There are almost 8,000 Natrona County residents 70 years or older, according to the Casper-Natrona County Health Department. That’s roughly 10% of the county’s population.
There are just under 3,000 county residents 80 years old or older.
Beginning next week, the University of Wyoming Family Practice, Community Health Center of Central Wyoming, the Wyoming Medical Center and the county health department will start administering vaccines to residents in that age group.
Natrona County is starting with a smaller group given the limited amount of vaccine doses it will receive in January, Executive Director of the county health department Anna Kinder recently said.
Dunn said providers will be able to easily contact all of their own patients who fall into that age group, but that there will be a coordinated effort between all four partners if appointments fall through.
Hailey Bloom, a spokesperson for the Casper-Natrona County Health Department, said a resident doesn’t have to be an existing patient of these providers to get a vaccine. Residents who fall into a priority group will be able to call to schedule an appointment.
A hotline is in the works, as is an online scheduling portal, Kinder recently told the Board of Health.
Laramie County is also preparing inoculations for the next phase.
Cheyenne Regional Medical Center Chief Medical Officer Dr. Jeffrey Chapman said the county is “very close” to completing Phase 1a of distribution.
A call to the Cheyenne-Laramie County Health Department was not returned, but a Facebook post published Friday by the department reads, “Plans for Phase 1B administration are being finalized. We will disseminate more information on where members of varying sub-groups can receive their vaccine next week.”
Vaccinations at the Cheyenne VA will begin mid January, according to a separate post. Those vaccines are through a federal program and aren’t included in the number of doses provided to the county health department, however.
Chapman said vaccinations have gone relatively smooth in Cheyenne, adding he wasn’t aware of a single wasted dose.
The hospital has vaccinated roughly 700 staff, with another 600 planned for the coming week. But he acknowledged once the county starts expanding into the larger phases, the job could get more complicated.
“It’s going to be a big process,” he said. “We’re probably talking about 35,000 people in Laramie County who are over 50.”
The Wyoming Department of Health has not yet released specifics for Phase 1c, but the CDC has recommended that group include those 65 and up, and those between 16-65 with underlying health conditions, as well as additional front-line workers. It’s unclear which conditions will qualify and which essential workers will be included in that round.
Most counties are still working through the first Phase of vaccine rollout. Phase 1b is larger and may take longer to get through as well, but some of the state’s counties are already scheduling public vaccination clinics for residents in either Phase 1a or Phase 1b.
Ivy Castleberry, Campbell County’s public information coordinator, said the holidays slowed down the community’s progress, but added “we’re really starting to see the pace pick up here.”
The county had vaccinated roughly 550 people as of Thursday, she said, but was preparing to offer public clinics at grocery stores and the senior center to vaccinate residents 70 years old or older.
Weston, Niobrara and Goshen counties are also planning vaccination clinics for that age group. Weston County is planning “mass vaccination clinics” for people in Phase 1b. There was no timeline for when those clinics would start, but according to the Wyoming Department of Health dates will be announced through local news and social media.
Niobrara County reported on Facebook it will begin hosting a drive-through clinic Jan. 12 for anyone in the community in Phase 1a or 1b.
Goshen County will start hosting drive-through clinics Jan. 12. For those 70 and older, according to an update on the Wyoming Department of Health website.
Sublette Sweetwater Counties have begun scheduling appointments for those residents, but have not announced public clinics.
Everyone is working on “logistics.”
There are a few complicating factors for both the Pfizer-BioNTech and Moderna COVID-19 vaccines approved for emergency use in the U.S.
They both require two doses to reach their full efficacy. Pfizer claims it’s vaccine is 95% effective after a second dose, with Moderna’s reaching 94.5% efficacy, according to vaccine trials conducted by those companies.
The second Pfizer dose can’t be distributed earlier than three weeks after the first dose, and the Moderna vaccine requires a second dose after four weeks.
When a person gets vaccinated in Wyoming, they are documented in the Wyoming Immunization Registry — a tool many say will be crucial in tracking when and if a person gets their second dose.
Most health officials who spoke with the Star-Tribune aren’t concerned Wyoming won’t receive those second doses — the vaccines are paired and when Wyoming gets sent 975 vaccines, 975 are earmarked for the state for later.
But there is some concern that doses could be delayed, whether by manufacturer delays or weather — a genuine concern in Wyoming where storms can close miles of highway.
“It’s hard to plan for that kind of supply-chain breakdown,” Dunn said, but added doing things in phases will hopefully minimize the impact of those delays if they were to happen.
The CDC doesn’t specify how long a person can wait between a first and second dose, but suggests delaying the second dose won’t make it less effective.
“There is no maximum interval between the first and second doses for either vaccine,” the agency says.
A larger concern is that doses will go to waste if they aren’t administered within a limited timeframe.
Both the Pfizer and Moderna vaccines are frozen, and must be used within six hours after being reconstituted. The Pfizer vaccine must be stored in ultra-cold temperatures — requiring a powerful and expensive freezer many Wyoming counties don’t have.
Communities unable to store the Pfizer vaccine have been allotted doses of Moderna, instead. They’re both within .5% efficacy of each other.
Dunn and Chapman both said this is why planning and coordination between the health departments and other entities will be crucial.
“You want to make sure you have back-up lists so you don’t waste those doses,” Dunn said, adding “We haven’t wasted one dose.”
While vaccines have been moving in Wyoming, not everyone has wanted to get one. Kinder reported Wednesday to the County Board of Health that 50% of residents who had been offered an inoculation had declined it.
The information is gathered through surveys the health department has sent employers whose staff fall into the first priority categories, Bloom explained. Employers are asked to survey their staff to see who would be interested in getting the vaccine, and the department derives the acceptance rate from there.
Because of that, they aren’t hearing specifically what reservations people are expressing.
While the first priority groups are predominantly medical personnel, not everyone in those categories has a clinical background. Bloom said among groups with predominantly medical backgrounds, acceptance is closer to 80%.
Chapman said he’s seeing a similar trend in Cheyenne.
“We’re seeing about a 60% acceptance rate,” he said.
The staff members who are declining the vaccine are largely not clinical staff, he added, but said there are still some medical personnel with hesitations.
Some of the reservations he’s heard deal with the lack of long-term studies about the vaccine, as it’s only been available for two months.
“If we don’t simplify it so people can understand, they rightfully don’t know what to make of it,” he said, adding the hospital is working on educational campaigns among staff.
Dunn said he hasn’t seen the same skepticism among Wyoming Medical Center staff, but attributed that to proactive educational efforts led by the hospital.
Conspiracy theories about the vaccines have suggested it’s a conduit for microchips and government surveillance, while others have said mRNA vaccines, which is what Pfizer and Moderna vaccines are, can alter a person’s DNA.
The conspiracies aren’t niche, either. A Wyoming Health Department doctor resigned this winter after publicly suggesting the vaccines were a Russian biological weapon intended to spread communism across the globe.
These theories have been heavily debunked, and Dunn said for what it’s worth, he hasn’t heard those reservations from people he’s spoken with.
The county health department, too, is working to market the vaccine through AdBay, and hopes to clarify misconceptions through a public information campaign.
Health officials have said it’s important skepticism about the vaccine is dealt with in order to reach 70-80% herd immunity and stop COVID-19’s ability to spread unchecked.
Looking to the future
Wyoming has received just under 26,000 vaccine doses as of Friday. State estimates suggest another 20,000 will arrive in the state this month. Almost 7,000 second doses have arrived in the state with 1,127 administered as of Friday.
As the nation struggles to hit a stride in vaccinations, national experts have debated whether the protocol for administering two doses is too rigid. Some have said it is more important to get as many first doses of the vaccine in people as possible, and that the second dose is less of a priority.
There’s disagreement in the global medical community, the New York Times reports. Some say doses should be halved to reach more people, but others worry that will affect the vaccine’s efficacy. Clinical trials show the Pfizer vaccine reached upwards of 80% efficacy in some patients 12 days after the first dose—before a second dose was ever given. But many, including Natrona County officials, say both doses are needed for the vaccines to be truly effective.
Dunn said the Wyoming Medical Center and other officials are keeping an eye on those conversations, but added he firmly believes two full doses should be administered, rather than rushing through half doses or delaying second doses.
Follow health and education reporter Morgan Hughes on Twitter @m0rgan_hughes