Cities and towns have been hosting seasonal flu vaccination clinics for decades. But in 2020, as the coronavirus pandemic continues to rage, some health departments are viewing those annual clinics as dry runs for the eventual distribution of a COVID-19 vaccine.
“I am sure that some medical providers, pharmacies, doctor’s offices, they will all be doing it eventually,” Framingham Health Director Sam Wong said of coronavirus vaccine distribution. “But for a good part of the population, I think it’s still going to fall to the local health departments.”
Wong’s guess is based on precedent.
“Looking back on H1N1, it was the local health department that organized and conducted the vaccination for H1N1,” he said. “Even back then, we used our regular seasonal flu clinic operation as a model for the H1N1 clinic. There’s a similarity here.”
Framingham’s seasonal flu clinic is typically hosted at an elementary school, but this summer health department staff determined vaccinating hundreds of people for the flu in an enclosed, indoor space would be “counter-productive,” Wong said.
Wong and his team decided a drive-through flu clinic would be safest.
On Sept. 26, roughly 65 health department staff and Medical Reserve Corps volunteers vaccinated about 1,100 residents for the seasonal flu at Keefe Regional Technical School on Winter Street, the same location that was flooded with vehicles full of people waiting for a drive-through coronavirus test this August.
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Wong expects coronavirus vaccine distribution will also largely follow a drive-through model. This week, the health department plans to review lessons learned from the drive-through flu clinic with COVID-19 vaccination in mind.
Neighboring Marlborough will host two types of flu clinics this fall: one walk-in clinic and one drive-through. For both options, the city is requiring pre-registration to avoid crowding.
“These events are similar to how we anticipate our COVID-19 vaccinations to be conducted,” Marlborough Health Director John Garside told the Daily News by email last week.
Tory Mazzola, a spokesperson for the state’s COVID-19 Command Center, told the Daily News by email Monday that any eventual coronavirus vaccine will flow from federal distributor McKesson to hospitals, other healthcare providers and states. Massachusetts is using its Infectious Disease Emergency Response plan, which includes plans for distributing vaccines during a pandemic, to develop its coronavirus vaccine plan. Vaccine allocation and order processing will be tracked using the Massachusetts Immunization Information System.
“In anticipation of the approval of a safe and effective COVID-19 vaccine, the COVID-19 Command Center has an active inter-agency working group evaluating the deployment of a vaccine,” Mazzola said. “The working group is developing plans to ensure an equitable and speedy distribution to Massachusetts communities based on guidance provided by the CDC.”
Framingham’s health department has not yet received guidance from the state or federal government on the role local health departments will play in coronavirus vaccine distribution, though Wong said the department did get a memo from the state asking about the city’s capacity to store vaccines in medical-grade freezers.
“We do have one medical grade freezer, and we are in the process of looking for ways to purchase one or two more,” Wong said. The required refrigeration units cost $2,000 to $3,000.
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Other cities, including Worcester, are also preparing to purchase the equipment necessary for vaccine storage, and planning which city buildings could house the vaccines.
While much about the eventual COVID-19 vaccine remains unknown, Wong is starting to consider how the city might distribute a two-dose vaccine that requires people to return to a vaccine distribution site to get a second shot of the drug, potentially weeks after administration of the first.
In addition to setting up the logistics and infrastructure required for distributing a coronavirus vaccine, health departments will also likely have to convince at least some residents to take it.
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A September poll by Kaiser Family Foundation found that 62% of Americans worried political pressure from the Trump administration will lead the Food and Drug Administration to rush and approve a coronavirus vaccine without making sure that it is safe and effective. The poll was conducted before the president contracted the virus.
Participating in the trial
Worcester Health & Human Services Commissioner Dr. Mattie Castiel is concerned about vaccine skepticism in the diverse city of roughly 185,000. So when Castiel had the opportunity to participate in the third phase of Pfizer’s coronavirus vaccine trial at UMass Memorial Medical Center, she raised her hand.
“I wanted to tell the community that I went through the phase three trials to get the vaccine,” she said. “I’m doing it. And it wasn’t just me. A group of us Latinas on the COVID Equity Task Force went together to say, ‘We’re going to do this. This is what we want all of you to do.’”
Though vaccine skepticism is widespread among all Americans, Castiel said it is particularly important to show Hispanic and Latino residents, who have contracted the virus at higher rates nationwide, that the vaccine is safe by demonstrating that other members of those communities are willing to take it.
“Once you have somebody from the community talking to people about vaccination for COVID, I think people are willing to listen to you,” Castiel said. “They don’t feel part of the system, and when the system comes to them as one of them, people will listen to you more.”
The trial that Castiel participated in requires two doses, the first of which she took on Sept. 4. She took the second dose three weeks later. Although there is a possibility that Castiel received a dose of saline because the trial is double-blind, she thinks she got the real thing.
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“I can only say that when I got the first shot, I got a fever, I had generalized body aches. I felt sick that day. I went to bed and I woke up and I felt better,” Castiel said. “The second shot, exact same thing. I don’t think saline would do that.”
The effects Castiel described are similar to commonly reported side effects from a standard seasonal flu vaccine.
Estimates about when a coronavirus vaccine might reach Americans vary widely, but Wong said he is currently expecting a spring to summer time frame. The first sign that health departments should kick into high gear on distribution planning will be FDA approval of one or two vaccines now in the final phase of clinical trials, he said.
“From what I understand, almost all manufacturers are lining up their manufacturing capacity right now so on a moment’s notice they could start manufacturing millions and millions of doses,” he said.
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Wong is ready to advocate that Framingham gets its share of vaccine doses when that happens.
Both Wong and Castiel said that, as public health leaders of cities with vulnerable populations contracting the virus at high rates, they should have access to vaccines as soon as possible.
“The people who are bearing the highest risk should get vaccinated first,” Wong said.
Jeannette Hinkle is a reporter for The Daily News. Reach her at [email protected]